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Health condition · Clinically reviewed

Bronchitis, when antibiotics help, when they do not, and when to worry.

Most acute bronchitis is viral and settles on its own. Chronic bronchitis is a different problem, sitting inside the COPD spectrum. This guide covers both.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BTS and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on antibiotic stewardship, COPD care and vaccination programmes.

Key facts

Bronchitis at a glance.

The essentials in plain English. What causes it, how long it lasts and why antibiotics are usually not the answer.

  • What it is

    Inflammation of the bronchi. Acute bronchitis lasts under three weeks and is almost always viral. Chronic bronchitis is a productive cough on most days for three months in two consecutive years.

  • Acute causes

    Over 90 per cent viral - rhinovirus, coronavirus, influenza, parainfluenza, RSV, adenovirus, human metapneumovirus and COVID. Bacteria account for only 5 to 10 per cent.

  • Chronic bronchitis

    Part of the COPD spectrum. Strongly linked to smoking, air pollution, occupational dusts and alpha-1 antitrypsin deficiency.

  • Post-viral cough

    A dry or productive cough can linger for up to eight weeks after acute bronchitis. Usually not a sign of anything sinister.

  • Antibiotics

    Not routinely indicated in uncomplicated acute bronchitis. NICE and Cochrane evidence is clear - antibiotics offer minimal benefit and drive resistance.

  • When to worry

    High fever, breathlessness, low oxygen saturations, chest pain, blood in the sputum, weight loss or a cough persisting beyond three weeks all warrant review.

Why this guide matters

Two conditions, one name.

Acute and chronic bronchitis are different problems that share a label. Getting the distinction right changes what happens next.

  • Acute is almost always viral

    Over 90 per cent of cases are viral. Antibiotics offer no meaningful benefit in otherwise healthy adults and drive resistance.

  • Chronic sits inside COPD

    Chronic bronchitis is defined by cough and sputum for three months in each of two consecutive years, part of the COPD spectrum.

  • Red flags change everything

    Fever, breathlessness, low saturations, blood in the sputum or cough beyond three weeks means a different plan and often a chest X-ray.

How the diagnosis is made

From first cough to a clear plan.

The NICE-aligned steps a UK GP will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Focused history

    Duration, sputum colour, red-flag symptoms, smoking history, occupational exposure, travel and immune status.

  2. 02

    Assessing

    Examination and vitals

    Temperature, respiratory rate, heart rate, blood pressure and oxygen saturation. Chest auscultation for wheeze and focal signs.

  3. 03

    Assessing

    Bedside tests

    SpO2, peak flow and where available a point-of-care CRP. CRP under 20 makes bacterial infection unlikely. Over 100 raises suspicion.

  4. 04

    Confirming

    Chest X-ray if concerned

    Not routine. Reserved for red flags, suspected pneumonia, haemoptysis, persistent symptoms or two-week wait criteria.

  5. 05

    Confirming

    Sputum culture selectively

    Not needed for uncomplicated acute bronchitis. Considered in COPD exacerbations or suspected antibiotic resistance.

  6. 06

    Escalating

    Spirometry for chronic disease

    Used to characterise COPD, assess reversibility and stage severity in anyone with a chronic productive cough.

  7. 07

    Escalating

    Two-week wait if red flags

    Age over 40 with unexplained persistent cough, haemoptysis, chest pain or weight loss triggers an urgent suspected lung cancer referral.

Typical timeline: a first visit to a settled plan within one appointment for straightforward cases.

Symptoms

What bronchitis actually feels like.

The typical pattern of acute viral illness, the daily-cough picture of chronic disease, and the features that mean you need to be seen.

  • Productive cough

    Starts dry then becomes productive with clear, yellow or green sputum. Colour alone does not indicate bacterial infection.

  • Retrosternal soreness

    A raw, burning sensation behind the breastbone from irritated airways, worse with coughing.

  • Wheeze and chest tightness

    Reversible bronchial narrowing can cause audible wheeze and a tight feeling in the chest.

  • Coryzal features

    Runny nose, sore throat and mild fever typical of a preceding upper respiratory viral infection.

  • Low-grade fever and malaise

    A mild temperature and fatigue lasting a few days. High fever or rigors suggests something more serious.

  • Daily morning cough (chronic)

    Chronic bronchitis usually presents as a daily productive cough worst on waking, often in a smoker.

  • Progressive breathlessness (chronic)

    Reduced exercise tolerance and breathlessness on exertion, with periodic exacerbations of sputum volume and purulence.

  • Red flag - haemoptysis

    Coughing up blood, weight loss, night sweats or a cough beyond three weeks needs same-week clinical review.

Treatment

How bronchitis is treated in the UK.

Self-care and reassurance for most acute cases. Bronchodilators, pulmonary rehab and vaccination for chronic disease. Antibiotics only when they earn their place.

  • Self-care and reassurance

    Rest, fluids, honey, warm drinks and humidified air. Simple analgesia and antipyretics for symptom relief. Most acute bronchitis resolves in one to three weeks.

  • Smoking cessation

    The single most important intervention in chronic bronchitis and a strong recommendation in acute illness. Referral to NHS Stop Smoking services is offered routinely.

  • No routine antibiotics

    NICE and Cochrane evidence is clear. Antibiotics are not indicated for uncomplicated acute bronchitis in otherwise healthy adults.

  • Delayed antibiotic prescription

    A back-pocket prescription with clear safety-net advice, used selectively when the clinician judges the risk of deterioration is low.

  • Immediate antibiotics

    Reserved for pertussis (clarithromycin), CRP over 100, systemic features, red flags, or high-risk adults with COPD, bronchiectasis, cystic fibrosis or immunosuppression.

  • Inhaled therapy for COPD

    Short and long-acting bronchodilators (SABA, LABA, LAMA) and inhaled corticosteroids for chronic bronchitis within the COPD spectrum.

  • Pulmonary rehabilitation

    A structured exercise and education programme that improves breathlessness, exercise capacity and quality of life in chronic disease.

  • Vaccinations

    Annual influenza, pneumococcal, seasonal COVID and RSV (aged 75 and over) vaccines reduce exacerbations and hospital admissions.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or respiratory specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Cough (acute): antimicrobial prescribing (NG120).

  • NICE. Chronic obstructive pulmonary disease in over 16s: diagnosis and management (NG115).

  • British Thoracic Society (BTS). Guidelines on the management of community-acquired pneumonia and chronic cough.

  • NICE. Suspected cancer: recognition and referral (NG12) - two-week wait criteria for lung cancer.

  • Cochrane Review. Antibiotics for acute bronchitis.

Red flags

When bronchitis needs urgent attention.

Most bronchitis is manageable at home. These are the situations that are not, and where a specialist opinion or urgent referral is needed.

  • High fever and rigors

    Sustained temperature above 38.5, shaking chills or drenching sweats point away from simple bronchitis toward pneumonia or sepsis.

  • Tachypnoea and low saturations

    Respiratory rate over 30, heart rate over 130 or oxygen saturation below 92 per cent needs urgent same-day assessment.

  • Focal chest signs

    Crackles, dullness or bronchial breathing in one area of the chest raises suspicion of pneumonia and warrants a chest X-ray.

  • Haemoptysis

    Coughing up blood in anyone over 40, especially with a smoking history, triggers an urgent two-week wait lung cancer referral.

  • Persistent cough beyond three weeks

    A cough that has not settled after three weeks needs a chest X-ray and consideration of other causes, including malignancy.

  • Severe pleuritic chest pain

    Sharp, one-sided chest pain worse with breathing suggests pneumonia, pleurisy or pulmonary embolism.

  • Weight loss and night sweats

    Unintentional weight loss or night sweats with a chronic cough needs investigation for lung cancer, tuberculosis or other systemic disease.

  • AECB in COPD

    Acute exacerbation of chronic bronchitis - increased sputum volume, purulence and breathlessness. Managed as a COPD exacerbation with bronchodilators, steroids and selective antibiotics.

  • High-risk adults

    Older adults, immunocompromise, COPD, bronchiectasis, cystic fibrosis or significant comorbidity lower the threshold for antibiotics and admission.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference. Rest, stopping smoking, keeping vaccinations current and knowing when to seek help.

A quiet reminder

Most bronchitis gets better on its own.

The best care for a viral chest is rest, fluids and time. Antibiotics rarely help and often harm through resistance and side effects.

  1. 01 Rest

    Give the airways time

    Most acute bronchitis settles within one to three weeks. Rest, fluids and simple analgesia usually do the job.

  2. 02 Quit

    Stop smoking for good

    The single biggest thing you can do for your lungs, whether the illness is acute or chronic. Free NHS support makes it easier.

  3. 03 Protect

    Keep vaccinations up to date

    Annual flu, pneumococcal, COVID and (if eligible) RSV vaccines meaningfully cut the risk of serious chest infections.

  4. 04 Escalate

    Know when to seek help

    Breathlessness, high fever, blood in the sputum or a cough beyond three weeks means it is time for review.

Frequently asked

Everything we get asked about bronchitis.

Quick answers on antibiotics, how long the cough lasts, and when it is time to see a doctor.

  • What is bronchitis?

    Bronchitis is inflammation of the bronchi, the airways that carry air into your lungs. Acute bronchitis is a short viral illness with a productive cough lasting under three weeks. Chronic bronchitis is a daily productive cough for three months in two consecutive years and sits within the COPD spectrum.

  • Do I need antibiotics for bronchitis?

    Usually no. Over 90 per cent of acute bronchitis is viral, and antibiotics offer little to no benefit in otherwise healthy adults. NICE and Cochrane evidence support avoiding antibiotics in uncomplicated cases. They are reserved for pertussis, systemic illness, high-risk patients or a raised CRP.

  • How long will my cough last?

    The acute illness usually settles in one to three weeks, but a post-viral cough can persist for up to eight weeks. If your cough is still there after three weeks or gets worse, you need a review and often a chest X-ray.

  • How is bronchitis different from pneumonia?

    Bronchitis is airway inflammation without lung tissue infection. Pneumonia involves the alveoli themselves, typically causes higher fever, focal chest signs, breathlessness and shows consolidation on a chest X-ray. If any red flags are present, pneumonia needs excluding.

  • What is chronic bronchitis?

    Chronic bronchitis is defined clinically as a productive cough on most days for at least three months in each of two consecutive years, after other causes are excluded. It is one of the two main phenotypes within COPD, alongside emphysema.

  • When should I see a doctor urgently?

    Seek same-day review for high fever, breathlessness, oxygen saturation below 92 per cent, chest pain, coughing up blood, confusion or a cough lasting more than three weeks. In anyone over 40 with persistent cough plus haemoptysis, weight loss or chest pain, a two-week wait lung cancer referral is warranted.

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