Bronchitis vs. pneumonia

A cold or the flu may be a common occurrence, especially during winter months, but these illnesses can lead to more serious illnesses, such as bronchitis and pneumonia.

Chronic bronchitis affects approximately 8.6 million people annually, and 75% of those people are over age 45. Pneumonia is the cause of approximately 1 million hospitalizations, with 50,000 people dying each year. Pneumonia is on the top 10 list for most expensive conditions treated in the hospital, costing about $9.5 billion for 960,000 hospital stays in 2013.

Certain chronic conditions can make you more susceptible to bronchitis or pneumonia, such as asthma, diabetes, cancer and heart disease. Pregnant women, children under age 2 years, adults over age 65 and people who smoke have a higher risk as well.

Bronchitis and pneumonia may cause similar symptoms, but they have different locations of inflammation or infection:

• Bronchitis is inflammation or irritation of the bronchial tubes or airways in the lungs. The condition can be acute or chronic. Acute bronchitis is usually caused by a viral infection from a cold or flu. It generally lasts only a few days or weeks and goes away without treatment. A sign of chronic bronchitis is a cough that lingers for months and recurs two or more years in a row. Airway linings are constantly inflamed and swollen, producing mucus that makes it difficult to breathe.
• Pneumonia is an infection of the air sacs or alveoli in one or both lungs. Fluid or pus fills the air sacs, causing a person to cough up phlegm or pus. Pneumonia can be caused by viruses, bacteria or fungi. It is most common to get pneumonia in the community, but you may get hospital-acquired pneumonia, especially if you have been on a ventilator to help you breathe.

Bronchitis and pneumonia can cause similar symptoms, but there are some notable differences:

Chronic bronchitis may also cause wheezing, shortness of breath, a low fever or chest pain. In adults over 65 years, pneumonia may also cause mental awareness changes or confusion. Infants might not show any sign of pneumonia, or they may have a fever, cough, trouble breathing, little energy or they may vomit.

If you have difficulty breathing, chest pain, a fever of 102°F (39°C) or greater or a persistent cough, especially with pus in mucus, see a healthcare provider. Pneumonia can be life-threatening for high-risk groups, such as adults older than age 65, children younger than 2 years of age and people with underlying health conditions, weakened immune systems, or who receive chemotherapy or take medication that suppresses the immune system. People at high risk for pneumonia should not delay getting medical treatment if they have any signs of pneumonia.

A healthcare provider will review your medical history, complete a physical exam and order tests. They may do a chest X-ray to assess if your lungs and bronchial tubes look normal, and diagnose or rule out pneumonia. They may also order a blood test to check for signs of infection. There are over 65 types of pneumonia, and this information helps your healthcare provider determine the type of pneumonia you may have.

There is no treatment for acute bronchitis, but medications can help manage symptoms. Over-the-counter (OTC) medicines can help loosen mucus, and a nonsteroidal anti-inflammatory drug can reduce fever or pain. Using a humidifier is a good home remedy for reducing symptoms. Your healthcare provider will only prescribe antibiotics if you have a bacterial infection, but usually bronchitis is a viral infection. Your healthcare provider may recommend a seasonal flu vaccine to keep bronchitis from recurring. If you smoke, your provider will recommend quitting. If you tend to be around secondhand smoke often, try to avoid it. You may need medications to clear airways or decrease symptoms. In some cases, certain people may need oxygen therapy or pulmonary rehabilitation.

Pneumonia treatments depend on the cause of infection, whether it's bacterial, viral or fungal. Recovery steps include getting extra rest and following your healthcare provider's treatment plan. Make sure to take all medication as prescribed to reduce the chance that pneumonia will come back.

• Bacterial pneumonia is treated with antibiotics. See your healthcare provider quickly if you're not responding to antibiotics, as you may need treatment in the hospital. Recovery from pneumonia may take several weeks.
• Viral pneumonia. Antibiotics don't work against viruses. Your healthcare provider may treat it with an antiviral medication, or you may not need any medication.
• Fungal pneumonia must be treated with prescription antifungal medications, such as trimethoprim/sulfamethoxazole or medication brands including Bactrim, Septra and Cotrim. Fungal infections are rare and are usually due to a weakened immune system from conditions such as human immunodeficiency syndrome (HIV)/acquired immunodeficiency syndrome (AIDS) or medications that decrease the body's ability to fight off germs.

If you require hospitalization due to severe symptoms or a combination of other health problems, you may receive oxygen therapy or intravenous antibiotics for bacterial pneumonia.

Prevention strategies include getting an annual flu shot, because the flu can lead to bronchitis or pneumonia, and good hand hygiene with frequent hand washing. Other strategies include quitting smoking if you smoke and boosting your immune system by eating healthy foods and exercising regularly. People at high risk for pneumonia should ask their healthcare provider about the pneumococcal vaccine.

Clinically reviewed and updated December 2021.