When a “Chest Cold” Is Something More
Real stories by real family physicians
When I see patients with chest colds, they usually don’t need antibiotics. Instead, I tell them about some simple treatments they can do at home.
You probably know the feeling of having cold symptoms that move from your head into your chest. Many people call this a chest cold. The medical term for it is “acute bronchitis.” Bronchitis is an inflammation (or irritation) of the airways. Airways are the tubes in your lungs that air passes through. They are also called “bronchial tubes.” When these tubes get infected, they swell. Mucus (thick fluid) forms inside them. This narrows the airways, making it harder for you to breathe.
Acute bronchitis is usually caused by the same viruses that cause the common cold or the flu. In these cases, the virus may affect your nose, sinuses, and throat first. Then, the infection travels to your bronchial tubes. A bacterial infection or an irritant in the air (for example, fumes or cigarette smoke) can also cause acute bronchitis.
The early signs of acute bronchitis often seem like the symptoms of a cold. That was the experience my patient Susan had. Susan (not her real name) is a 35-year-old woman. About two weeks before she came in for an office visit, she had started using over-the-counter (OTC) cold medicine and saline nasal spray to treat a stuffy nose, a sore throat, and sinus pressure. Her sinuses had started to feel better, but then she developed the following symptoms:
- Persistent cough that brought up yellowish-green mucus
- Chest tightness
- Difficulty taking deep breaths
- Wheezing (especially at night when she was lying down)
- Occasional low-grade fever (under 102°F)
When these symptoms had not gone away after a week, Susan decided to make an appointment to see me.
Looking at Susan’s medical record, I was glad to see that she had come in previously for her yearly flu shot. I could also see that she does not have any lung conditions (for example, asthma) or chronic (ongoing) problems with her immune system. She doesn’t smoke or live with anyone who smokes.
After asking Susan about her symptoms, I gave her a physical examination. I listened closely to her lungs with a stethoscope. I didn’t hear any breathing sounds that might be a sign of pneumonia. Because Susan is otherwise healthy and doesn’t smoke, I didn’t need to order a chest X-ray to look at her lungs.
Most cases of acute bronchitis are caused by a virus, so antibiotics will not help. Antibiotics can only treat bacterial infections. I told Susan that mild cases of acute bronchitis will almost always go away on their own in 7 to 10 days. But I also let her know that she might continue to have a cough for several weeks after the other symptoms went away.
I recommended that Susan try the following simple home treatments to help her feel better in the meantime:
- Get plenty of rest
- Use a humidifier or try breathing steam from a hot shower to loosen mucus
- Drink lots of water to stay hydrated and thin mucus
- Use extra pillows to prop herself up in bed. This can help ease coughing and chest congestion.
- Use an over-the-counter (OTC) expectorant called guaifenesin to help break up chest congestion
- Avoid exposure to secondhand smoke
Even when acute bronchitis is caused by a virus, it’s possible for bacteria to grow in the infected airways. This is called a “secondary bacterial infection.” Your family doctor may treat it with an antibiotic. Signs of a secondary bacterial infection in a person who has acute bronchitis include the following:
- Continuing to get sicker instead of getting better
- Coughing up blood
- Having a high fever (103°F or higher)
- Having trouble breathing
I told Susan to call me if she had any of these symptoms. If she had contacted me, I would have asked her to come back into the office for a follow-up examination and additional tests, such as a chest x-ray. Fortunately, Susan got better without any complications.
When I diagnose acute bronchitis in patients who smoke, I talk to them about the importance of quitting. Smoking damages your bronchial tubes and puts you at risk for infection. Smoking also slows down the healing process when you’re sick.