Bronchitis is a common diagnosis when a child or teen has a cough.
If they have a runny nose and cough, with a runny nose being their bigger symptom, then they would likely be told they have a cold or sinus infection instead. Those are considered upper airway infections.
But when a cough is the major symptom, then bronchitis is often diagnosed. In contrast to a cold, bronchitis is usually thought to be a lower airway type cough, although in reality, it is often hard to tell the difference.
One big question is whether it really matters though, since neither a cold or acute bronchitis are usually treated with antibiotics.
Bronchitis is usually a clinical diagnosis, based on the symptoms the patient has, and does not usually rely on doing any specific tests.
Like other respiratory infections, children with bronchitis will usually have a runny nose and cough, and they may have a fever and sore throat. The degree of the various symptoms is just a lot different than other infections.
Typical bronchitis symptoms usually start with a runny nose, sore throat (from postnasal drip), and low grade fever. Three or four days later, the child with bronchitis will develop a dry, hacking cough.
Other signs and symptoms of bronchitis can include that the cough is very frequent and:
- may be productive (the child coughs up clear, yellow, or green sputum)
- may be associated with vomiting (typically because of children swallowing drainage)
- may cause chest pain (because of frequent coughing)
- kids with bronchitis sometimes develop coarse breath sounds, and even wheezing, when your pediatrician listens to their chest
Most importantly, parents should understand that kids with bronchitis can typically have a cough that lasts for two to three weeks.
Is it Really Bronchitis?
It shouldn't be surprising that bronchitis is often confused with a lot of other conditions that can cause a lingering cough. And this may be surprising to many parents - many of these conditions don't require treatment with antibiotics.
Some common causes of cough that are sometimes misdiagnosed as bronchitis can include:
- the common cold - cold symptoms
- allergic rhinitis - can be seasonal and often includes a clear runny nose, itchy eyes, and congestion
- a post-viral cough - a cough that lingers for a few weeks after a child has a cold or other viral infection, even after the other cold symptoms had gone away
- cough variant asthma - this is basically asthma without the typical wheezing that other kids with asthma have, which makes it harder to recognize
- acute asthma exacerbation - but asthma should be suspected in the child with frequent episodes or previous asthma attacks
- habit cough - a dry cough that is often described as a "honking" sound. Another characteristic feature of a habit cough is that it doesn't occur when the child is asleep.
- GERD - gastroesophageal reflux disease is a surprisingly common cause of chronic coughs in children
- walking pneumonia - although many of the bacteria that cause walking pneumonia, like Mycoplasma pneumoniae, can also cause bronchitis, symptoms of walking pneumonia are usually a little more severe
- whooping cough - it is likely more common that unvaccinated teens and adults with whooping cough (pertussis) are misdiagnosed as having chronic bronchitis though. Keep in mind that B. pertussis, the bacteria that causes whooping cough, can also less commonly cause bronchitis though, especially during community outbreaks.
- pneumonia - in addition to a productive cough, children with pneumonia will often have fever, fast breathing rate and difficulty breathing, and chest examination findings suggestive of pneumonia. A chest xray can be done isn't sure if your child has pneumonia or bronchitis.
Although getting bronchitis symptoms mixed up with common cold symptoms or a post-viral cough won't do any harm, since all of those conditions go away without treatment, your child's symptoms might be overtreated if a simple case of bronchitis is thought to be allergies, asthma, or pneumonia.
Acute vs. Chronic Bronchitis
The definition of a chronic cough and chronic bronchitis in adults is a cough that lingers for more that 2 to 3 months. In addition, to have a formal diagnosis of chronic bronchitis, experts usually look for those symptoms in 2 consecutive years.
In addition to the longer duration of symptoms, another difference between acute and chronic bronchitis is that chronic bronchitis has a strong association with cigarette smoking. The vast majority of people with chronic have smoked, with the more they smoked, the more likely they were to develop chronic bronchitis.
When diagnosing chronic bronchitis in kids, many experts use a shorter duration of about 4 weeks.
What You Need to Know About Bronchitis
Bronchitis is probably one of the more over-diagnosed and over-treated conditions that can cause a cough. That is unfortunate, because that means a lot of unnecessary antibiotic prescriptions, which can lead to side-effects and antibiotic resistance.
Other things to know about bronchitis include that:
- Many people consider bronchitis to be a "chest cold."
- Like the common cold, bronchitis is a condition for which antibiotics are often overprescribed.
- Common causes of bronchitis include rhinovirus, influenza, parainfluenza, RSV, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.
- Although the age-appropriate use of cough suppressants are sometimes useful to relieve symptoms in some kids with bronchitis, expectorants are not usually thought to be helpful. Bronchodilator medications, like those used in kids with asthma, may be helpful for some patients with bronchitis who are wheezing, but should usually not be used routinely.
- A pediatric pulmonologist can be helpful to diagnose and treat your child who frequently gets bronchitis.
Most importantly, if you recognize that your child has typical bronchitis symptoms but is given a prescription for an antibiotic by your pediatrician, consider asking if it is really necessary.
Long: Principles and Practice of Pediatric Infectious Diseases Revised Reprint, 3rd ed.
Kliegman: Nelson Textbook of Pediatrics, 19th ed.
Sidney S. Braman. Chronic Cough Due to Acute Bronchitis: ACCP Evidence-Based Clinical Practice Guidelines. Chest. January 2006 129:1 suppl 95S-103S.