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Bronchitis vs. Pneumonia: How to Tell Symptoms Apart

Bad cough? It could be one of these common wintertime illnesses


spinner image a set of lungs showing red inflamed passages the left lung is on a purple background and the right lung is on a red background
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If it seems like everybody has a cough these days, you’re not wrong. Respiratory illnesses that can cause you to whoop and hack — your colds, flu, COVID, respiratory syncytial virus (RSV) and more — are running rampant in the U.S.

Activity spiked just before the holidays and remains high, according to the Centers for Disease Control and Prevention (CDC), especially among a cluster of states in the South and West. If you’ve had a cough that you just can’t shake, you may be wondering if it’s bronchitis or even pneumonia. Both share some similar symptoms, but they can require different treatments.

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Here’s how to tell if you have bronchitis vs. pneumonia, plus the questions you should — and shouldn’t — be asking your doctor.

What is bronchitis?

Bronchitis — or what’s officially called acute bronchitis — often starts out as a cold or flu-like illness. You might experience congestion or feel run-down and achy, says Neil Kalsi, M.D., an assistant professor in the University of Nebraska Medical Center Department of Family Medicine.  

But with bronchitis, the infection — which is almost always caused by a virus — evolves and the airways leading to the lungs get inflamed and filled with mucus. The result is a nagging cough that can persist for several weeks.

“It’s that cough that doesn’t go away. It’s the cough that comes up when you’re trying to laugh or talk to someone on the phone,” says Kalsi, who adds that the cough can either be dry or come with some mucus and possibly even wheezing. “But it’s a really, really annoying cough that makes it hard for people to go to work because they just can’t talk to people.”

Other symptoms of bronchitis can include:  

  • Soreness in the chest
  • Fatigue
  • Body aches
  • Sore throat

How is it treated?

Because bronchitis is usually caused by a virus — typically the same viruses that cause colds and the flu — antibiotics rarely help and, in fact, could cause more health issues. Instead, the common prescription for recovery is plenty of rest, fluids — and even some honey.

Multiple clinical trials have found that honey can help to improve the symptoms of a cough and does a better job than over-the-counter cough medicines. A summary of the research was published in 2020 in the journal BMJ Evidence-Based Medicine. “If you’re going to spend the 10 bucks on a cough medicine, might as well buy some local honey instead,” Kalsi says.

Just know that with bronchitis, recovery can take time, especially when it comes to getting rid of the cough. “It’s not going to be a day-by-day improvement; it’s going to be a week-by-week improvement,” Kalsi says.

Acute vs. chronic bronchitis

Acute bronchitis is what’s commonly called a chest cold. According to Mayo Clinic, symptoms usually improve within a week to 10 days, though the cough can persist for weeks. Chronic bronchitis is long-term inflammation of the airways and is one of the more common lung diseases that contribute to COPD (chronic obstructive pulmonary disease). 

What is pneumonia?

While bronchitis affects the upper airways, pneumonia develops lower down in the lungs. Like bronchitis, it also causes inflammation and fluid buildup. 

Viruses, bacteria and fungi can all cause pneumonia. In the U.S., some of the more common causes of viral pneumonia include influenza, RSV, COVID-19 and rhinovirus (the predominant cause of the common cold), according to the CDC. When it comes to bacteria, pneumococcus, which causes pneumococcal disease, is often to blame.

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Like bronchitis, pneumonia can trigger a bad cough that may come with mucus. But other symptoms of pneumonia tend to be more serious and can include:

  • Fever, shaking and chills
  • Shortness of breath
  • Rapid, shallow breathing
  • Chest pain
  • Loss of appetite
  • Fatigue
  • Confusion, especially in older adults

With pneumonia, “you can feel much more run-down, fatigued, short of breath,” says Kalsi, who says that a chest X-ray is typically used to diagnose pneumonia. “It can be much more intense.” According to the American Lung Association, pneumonia causes more than 1 million hospitalizations and more than 50,000 deaths each year in the U.S.

How is it treated?

That depends on what’s causing the infection. If it’s bacterial pneumonia — a blood test or sputum test can help identify the cause — your doctor may prescribe an antibiotic. And antifungals can help treat pneumonia caused by a fungal infection.

Viral pneumonia usually isn’t treated with prescription medication. However, your doctor may recommend over-the-counter cold medicines or fever reducers to help with symptoms.

Don’t ignore severe signs

A fever that’s higher than 101 degrees F. is concerning and is a sign you need to see a doctor, says Anthony Szema, M.D., a physician who specializes in pulmonary diseases at Northwell Health in Long Island, New York. The same goes if you are short of breath, or if your breathing worsens, or if you are extremely fatigued or feel dehydrated.

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“If you are wheezing and waking up at night with chest tightness, those are all reasons to seek medical care,” Kalsi says.  

It may be the case that your illness is severe enough to require extra care in the hospital.

Preventing bronchitis and pneumonia

The good news: You can do a few things to reduce your risk of coming down with bronchitis or pneumonia. The pneumococcal vaccine, which is recommended for adults 65 and older, can help reduce the risk of pneumonia caused by pneumococcus bacteria.

Similarly, the vaccines for COVID-19, RSV and influenza can lower the likelihood of those infections and the complications they can cause. And don’t forget about frequent handwashing and face masks, which can help block the spread of many germs, including those that can cause bronchitis and pneumonia. “The pandemic taught us how effective just wearing a mask can be,” says Kalsi, who adds that people with lung issues like asthma and emphysema will want to take extra precautions.

Szema also recommends air purifiers using high-efficiency particulate air (HEPA) filters in bedrooms and common rooms. These portable machines can help to remove germs from the air.

Questions to ask — and to avoid

If your doctor suspects your illness is caused by a virus, it’s important to not push for antibiotics if they aren’t recommended. Remember, antibiotics only help to treat bacterial infections. Still, “a lot of people request antibiotics for their bronchitis,” Kalsi says. Research suggests viruses cause 85 to 95 percent of acute bronchitis cases in healthy adults.

Here are some questions you should be asking your doctor if you have a bad cough:

  • Should I be concerned if I develop a fever?
  • Do I need a chest X-ray or other medical tests?
  • What’s the best course of treatment?
  • Can I take over-the-counter medications with my routine prescription drugs?
  • What should I do if symptoms linger?
  • Are there any severe signs I need to be on the lookout for?

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