Bronchitis or Pneumonia: How to Tell Them Apart

By Michael Lasalandra
BIDMC Correspondent
You’ve got a nasty cough and are bringing up gobs of mucus. Is it bronchitis or pneumonia? How do you know and what’s the difference?
Both are serious illnesses affecting the lower respiratory tract and, if left untreated, can lead to other problems. Pneumonia is potentially the more serious condition, however, since it can affect the ability to breathe, lead to more serious lung injury, or even death if left untreated or if symptoms are ignored for several days.
Both illnesses are caused by infections. But bronchial infections are most often viral in nature, while pneumonia infections can be viral or bacterial. Either can start with a cold or flu.
Both bronchitis and pneumonia can involve a cough and mucus. Both may involve a fever, though the fever associated with bronchitis is usually mild, while the fever associated with pneumonia is often higher than 101°F. The big difference is that pneumonia is associated with a shortness of breath and potentially chest pain or discomfort when breathing.
“Bronchitis is an inflammation of the airways,” says Dr. Michael Wong, an infectious disease specialist at Beth Israel Deaconess Medical Center. “The infection has settled past the larynx or vocal chords into the breathing tubes, or bronchi, but not into the actual lung tissues where oxygen is transferred. It generally doesn’t affect the breathing.”
Typically, the course of action is to treat the symptoms of bronchitis and not to give antibiotics since they don’t work against viral infections and can cause problems of their own, he adds.
“We want to be very careful about prescribing antibiotics these days,” says Wong. “We know there can be serious downsides when prescribed too often or when not needed.”
Most often, over-the-counter medications that are designed to break up mucus and treat aches and pains are all that are needed, although in some cases steroidal inhalants or a short course of the steroid prednisone may be prescribed. Patients are also advised to stay hydrated.
Usually, acute bronchitis lasts three to seven days. However, even if the infection is gone, symptoms may last for several weeks due to inflammation of the airways caused by the body’s own immune response, he says.
In some cases, a secondary infection may occur, resulting from bacteria that live in the upper airways or what is present in the mouth or throat taking advantage of the body’s weakened condition and gaining a foothold in the injured tissues. This can be evidenced by a change in color or quantity of the mucus or new fevers after it appears the patient has started to improve. In such cases, an antibiotic may need to be prescribed.
Pneumonia occurs when the infection involves the actual lung tissue and must be treated with strong antibiotics or an antiviral medication for on average up to 10 days. For patients who develop pneumonia outside of a hospital or nursing home setting, it is referred to as community acquired pneumonia, or CAP, which is usually caused by bacteria. Several days of hospitalization may be required, but often it can be treated as an outpatient.
Some people used to call this “walking pneumonia.” It simply means the patient was not sick enough to require hospitalization, Dr. Wong says.
Serious cases can result in lung damage or even death. “We recommend anyone who is feeling un-well, with a fever greater than 101.5°F, and experiencing sputum production, to be seen by a healthcare provider,” he says.
A medical history, exam, blood test, and chest X-ray can tell the doctor if the patient needs to be admitted for IV antibiotic treatment and or if he or she can be treated as an outpatient.
Another common occurrence involves complications following the flu.
“When the Centers for Disease Control refers to deaths from the flu, they are talking about people who are usually dying of lung complications, typically bacterial pneumonia,” says Dr. Wong.
Those most at risk for pneumonia are those over age 65, children under 5, people with chronic medical conditions, smokers and those with asthma. Pneumonia may also be contracted as a result of a hospital stay, known as hospital acquired pneumonia.
In many cases, the most common form of bacterial pneumonia may be prevented by being immunized with the pneumonia vaccine. The flu vaccine also helps prevent pneumonia.
Above content provided by Beth Israel Deaconess Medical Center
For advice about your medical care, consult your doctor.