Symptoms and Approaches to the Viral Coughs, Bronchitis, and Pneumonia
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Sep 16, 2024
- 12 min read
Updated: Jun 28
The Cough: Viral Coughs, Bronchitis and Pneumonia
So, why am I coughing?
There are MANY potential causes of coughs. Colds, bronchitis, pneumonia, asthma, gastric reflux, medication side effects, allergies, or thyroid problems may cause them.
The following explores symptoms and approaches to viral coughs, bronchitis, and pneumonia, explores typical symptoms of various cough problems, commonly recommended over-the-counter cough treatments, herbal remedies, and prescription medications to help you get to the point of relief and recovery.
There are several common causes and NUMEROUS approaches to controlling a cough. Some medications, such as antitussives, are explicitly used to treat a dry or "watery," irritating cough. Others, called expectorants, treat wet coughs with thick mucus. It is essential to decide what type of cough you have so you know what over-the-counter medicine to take.
Also, be aware that there are NO perfect cough medicines, prescriptions, remedies, or over-the-counter.
A cough begins as an important AND valuable reflex the body uses to help clear irritants, particles, and secretions from the throat and lungs, especially postnasal drainage, foreign particles, and other irritants.
At first, it is important to preserve your cough, to some degree, during the day as it is either clearing your lungs of infectious mucus or protecting them from a postnasal drip. Overall, it is best not to suppress your cough unless it is severe or if it is keeping you up at night. You need to rest and sleep to get better.
Sometimes, when it gets bad, the cough can become a vicious cycle: The more a
person coughs, the more their lungs become irritated and inflamed, which makes them cough even more, which, in turn causes even more irritation, and so on.
In addition to medical treatments and remedies, which will be discussed on other pages, there are a few common-sense things you need to do to help yourself through your illness. You want to shore up your immune system:
1. Get enough sleep
2. Manage stress. Stress is awful for your immune system. It can cause you to get sick and stay sick. Sit down, relax, and put your feet up for a change.
3. Stop smoking and vaping or reduce frequency if you think you can’t quit; avoid second- hand smoke, allergens, and particulates in the air.
4. Avoid contact with infected people (sneezing, coughing people – viruses are often airborne (of course, we can’t live in a bubble).
5. Eat a balanced diet and reputable multivitamins. Increase fruits and vegetables.
6. Stay well hydrated: That eight glasses of water/day you were told to drink is currently unsupported. Everyone has their own, different food and fluid requirements. Age, metabolism, body temperature, and activity levels all play a role in determining the optimal daily intake of fluids. Rather than counting ounces of water as we used to, you generally measure your hydration status by, looking at the color of your urine. Is it a darker yellow color? This is often a sign of dehydration: It likely means you are not getting enough fluid. Is it light yellow to straw color? This usually indicates a good level of hydration. (If your urine is brown it can indicate other health problems - you should see a healthcare provider if it persists).
You should drink more when sick (you often lose more fluids when ill, especially with a fever). The good news is that you can get hydration from drinking moderate amounts of coffee and tea —the idea that they are strong enough diuretics to offset the water intake has been disproven (1). But water is still optimal, and alcohol is a no-no. But do stay well hydrated.
What's Causing Your Cough?
"What is this nagging, horrible cough I have had for two weeks?"
An acute cough can last up to three weeks. A chronic cough lasts more than three weeks.
A cold almost always starts as a virus which is typically self-limiting and treatable with over-the-counter medicines. However, if it does not go away, it can turn into bacterial bronchitis. And, if the latter does not go away, it can turn into pneumonia. To complicate things, sometimes a person can have both. These ailments are discussed below.
What Might Your Cough be About?
If you are going to treat your cough, it is important to know the cause. How long has the cough been going on? Are you coughing up mucus? Thin? Thick? Are you getting winded when you are very active? Any Wheezing? It is important to remember what was going on when it started: Did your cough begin with a cold? Is it leftover from that cold you had a couple of weeks ago? Sometimes, after having a cold, instead of going away, it lasts three to four weeks - maybe even a bit longer.
Cough from Cold and Flu
You have ruled out some other causes of a cough and figured out that your cough must be caused by a cold or flu. Please read on.
A virus usually causes a cough due to a cold. Because it is most likely a virus and not a bacteria, it will not respond to an antibiotic. With a cold, phlegm is usually produced in the upper airways above the chest - the nose, sinuses, larynx, and pharynx. Often, mucus that starts in the nose and sinus becomes a postnasal drip that drains into the lungs. Mucus can also be produced in the lower airways. The result may be an ongoing nagging cough.
When a cough is prolonged and troublesome, people worry that it is bronchitis or pneumonia, which it sometimes is, but more often than not, it is just a post-cold cough. These coughs tend to linger, and linger, sometimes for weeks. Patients sometimes feel that their ongoing cough must be pneumonia and warrants a chest X-ray. Food for thought: Most of the time chest X-rays are not warranted as long as the cough is not worsening, as long as you do not have chest pain or tightness, shortness of breath or wheezing; and as long as you do not have serious underlying medical problems (i.e. heart problems, lung problems or diabetes). Remember, while rare, there are also potential consequences to the radiation from too many X-rays. If problems persist, however, you should discuss it with a healthcare provider.
The course of this type of cough is predictable. A person develops sinus and postnasal drainage that travels down the throat into the lower airways and lungs. Irritated bronchi and lungs start to produce mucus, too, and the lungs become congested. The mucus and cough both cause more inflammation. The inflammation causes more coughing and irritation, which causes even more coughing. It is a vicious cycle. While the mucus usually dissipates, sometimes it gets thick and stubborn, and the cough can go on and on and on. Before you know it, you have bronchitis.
Bronchitis
Bronchitis is an irritation and inflammatory condition of the bronchi (airways leading to the lungs), that can manifest as a number of symptoms, the most common being cough.
There are two types of bronchitis: acute and chronic. The big difference is that acute bronchitis usually lasts two or three weeks. Chronic bronchitis (COPD), while it has its ups and downs, lasts forever and gets progressively worse over time.
Most colds will go away after seven to ten days. But, as mentioned above, if the cold lingers too long, it can lead to bronchitis. The infection moves into the chest and lower airways, causing irritation and inflammation of the bronchi (airway passages) leading to the lungs.
The diagnosis of "bronchitis" may sound like a death sentence, but it is often far from it: It can range in severity from mild to severe. It is often manifested by a broad range of symptoms: The cough of bronchitis usually starts as a wet, "watery" cough (except in the morning when mucus has accumulated overnight and may be thick and discolored). The cough may become severe and accompanied by wheezing, shortness of breath (especially on exertion like going up and down stairs), fatigue, headache, fever, chest tightness, chest "burning," sometimes there is chest pain, or rib pain (often from coughing so much), upper back discomfort—or stomach problems. Mucus may be purulent (thick, discolored), but again, studies say that the nature of mucus, its color, and its consistency are not determinants of a bacterial infection. Contrary to what many patients and some clinicians believe, green mucus can be viral, too! You have to look at the whole picture.
Because the symptoms are similar, it is difficult to tell the difference between viral and bacterial bronchitis. Practitioners often use the length of time of an illness as a significant determining factor. A respiratory specimen can be sent to the lab for testing, but they are not very accurate, and they are expensive, so they are not routinely done. In an ideal world, it would be amazing if we could do this instead of "guessing" whether someone has a viral or bacterial infection and if they need an antibiotic.
Acute Viral Bronchitis
Common viruses that often cause a viral cough and bronchitis include:
rhinovirus (the cold virus)
A note about RSV: In the past, RSV was primarily a childhood illness. But it has begun to spread to more adults over the last 10-20 years. Adults who are most affected by this are those at high risk and those over 60 with a poorer immune system than those who are young and vital. While this virus does not mutate as often as some of the other viruses, it has still undergone mutations that tend to make it more transmissible than it was in the past. Because it has become more of a threat, an RSV vaccine has been created to help protect those with risk factors.
For current levels in the US, see the RSV wastewater map (wastewater checks for levels of various viruses going through a community).
RSV is very contagious and spreads via droplets from a cough, sneeze, or contact with the virus on a surface. Spread is mainly seen in the winter. Like many respiratory viruses, symptoms of RSV in an adult include a wet cough, low-grade fever, congestion (nasal and possibly lung), runny nose, and sometimes wheezing. Again, this can also "evolve" into viral or bacterial pneumonia, particularly in immune-compromised individuals. This can be extremely dangerous in infants younger than six months and older people because of excessive airway inflammation.
RSV testing is available at many clinics, and treatment for an average case of RSV is mainly supportive (e.g., Ibuprofen/Tylenol, and other over-the-counter cough, cold and flu medications, rest, and fluids). If the illness is severe or threatening, hospitalization may be necessary.
Croup
This is a severe, bark-like viral cough that typically comes on suddenly at night. It most commonly occurs in children, but can occur in adults. A croupy cough is due to swelling in the airways and sounds scary if you have never heard it before. The “bark” may be accompanied by hoarseness as well. It is caused by a virus.
This should NOT be treated with cough medicine. You can try a steamy bathroom or bundle up and go out to breathe the cold air for 10 minutes, or breathe in cold air from the freezer: It may help.
Caution! Recommend ER if:
If the cough is not responding to treatment
The person is becoming lethargic
The person is using chest or neck muscles to help breathe
You notice rapid breathing
There is a loud, throaty, or chest wheeze
The person is turning blue
Because of the harsh sound of this cough, parents tend to panic. It is best not to panic because kids often sense your distress and it can make them worse (this is true in many sickness situations with kids but easier said than done).
If a person improves with treatment, keep a watchful eye out and give their healthcare provider a call in to morning if problems continue. They may want to give a medication to keep it from coming back (no, not an antibiotic).
Acute Bacterial Bronchitis
Bacterial lung infections are more fatal than viral. This does not mean you should get an antibiotic immediately. If it is early on in the illness, there is a cough and the phlegm is still pretty watery and clear it is most likely viral. Treatment is symptomatic, and providers do not use antibiotics for prophylaxis (to prevent a viral infection from becoming bacterial) unless a patient has significant underlying risk factors; they use them for an active bacterial infection.
However, when you have tried to treat yourself with over-the-counter measures, but your cough is lingering, you are fatigued or have an intermittent fever; if your mucus has become thick, and you are becoming short of breath, you are wheezing, or there is rumbling in your chest, things are becoming worse. Your heart rate might go a bit faster, your chest might hurt, and you may have upper back pain. If this begins to happen, it is time to move on from over-the-counter medicines to a healthcare provider.
You can try to treat your early symptoms using the various treatments and remedies, but if the symptoms are worsening (as those above), you should see a healthcare provider. Keep track of your temperature and heart rate. A convenient device to use when you have a cough or lung congestion is a fairly inexpensive device you place on your finger called an oxygen saturation monitor, or "pulse ox," which conveniently measures your heart rate and oxygen levels in your blood. You can get these at most drug stores, and they are simple to use.
Ask a pharmacist if you are not sure.
Pneumonia
So you have been coughing and coughing and think you might have pneumonia...
There is often a fine line between bronchitis and pneumonia. Pneumonia is typically more severe and more uncomfortable than bronchitis. It involves inflammation of the lungs caused by viruses, bacteria, or fungi. When a person gets pneumonia, they get a lot of inflammation in their lungs, and the air sacs often fill with fluid. Those most likely to catch pneumonia are the immunocompromised, children younger than two, and adults over 65 (the latter two groups naturally have more immunocompromise than other age groups).
According to the Cleveland Clinic, bacteria are the most common cause of pneumonia. Bacteria, Streptococcus pneumoniae, often cause community-acquired pneumonia (caught outside the hospital) in adults. The flu and the COVID-19 virus are the most common causes of viral pneumonia. Fungal cases of pneumonia have been increasing due to the increase in immunocompromised people and environmental changes. The primary fungi involved with lung disease are Cryptococcus, Pneumocystis, and Aspergillus. Recently, the media has turned our attention to regional outbreaks of Candida auris as well. These fungal infections are typically caught through airborne transmission. Most people, except those with weakened immune systems, can fight fungal infections.
Two other types of pneumonia worth mentioning are aspiration pneumonia and chemical pneumonia. The first, aspiration pneumonia, is caused by food or fluid going down the throat into the trachea ("windpipe") and into the lungs instead of into the stomach. Older people are at most risk of aspiration pneumonia because of a decrease in their ability to swallow. The second, chemical pneumonitis, is caused by inhaling chemical substances or particulate matter. When inhaled, these substances can lead to lung inflammation or chemical pneumonitis (inflammation of lung tissue). Pneumonia or reactive airway disease (an asthma-like condition) can subsequently develop. Those at risk for chemical pneumonitis are people exposed to some cleaning and disinfectant agents (especially those containing chlorine, like bleach), chlorine gas (from pools), smoke, and pesticides.
Some More Common Symptoms of Pneumonia
You can try to treat your symptoms of pneumonia; however, they are usually more severe than those of bronchitis. The severity is often how you can tell the difference. Symptoms frequently include the following:
High and ongoing fever
Shaking chills
Shortness of breath (especially with activity)
A cough is productive of thick, often discolored mucus.
Chest discomfort (usually sharp) - especially when you cough or take a deep breath; sometimes upper back pain
Sweating,
Loss of appetite
Extreme fatigue
Rapid breathing
Fast heart rate
Discoloration of lips or nailbeds,
Sometimes, confusion (especially in older people)
A "rattle" in the chest (mucus)
Wheezing
Pneumonia usually has a slow onset (several days) and is often a complication of the flu or a cold. Sometimes, symptoms get a little better and then worse again.
Note: A cough alone is not usually pneumonia!
HOW IS PNEUMONIA DIAGNOSED?
Pneumonia is diagnosed in several ways: an oxygen level (oxygen saturation level less than around 90-92), a chest X-ray, blood work (a white count), and occasionally a sputum sample (culture) is sent to the lab for analysis. Chest X-rays are often one of the better diagnostic tools; however, they are not easily ordered due to the cancer risks involved with radiation exposure.
Treatment will depend on the degree of illness. Most cases are treated outside the hospital, but those at high risk and severe cases will be hospitalized. A person needs an accurate diagnosis and appropriate treatment.
What is Walking Pneumonia?
Walking pneumonia is milder than regular pneumonia. With both, there is still mucus in the lungs. It is typically much better tolerated than full-blown pneumonia. There may be a low-grade recurrent fever and some of those symptoms above, but they are milder. It is called "walking pneumonia" because people are often not laid up in bed or hospitalized when they have it.
Walking pneumonia can be caused by viruses, foreign particles, fungi, and chemicals, although the most common causative agent is the bacteria Mycoplasma pneumonia.
If you cannot solve the problem or if you have any of the following, I would recommend you see your healthcare provider or go to urgent care:
Shortness of breath
Chest pain
Cough beyond 6-8 weeks a chronic, ongoing; does not respond to any treatment (above)
If you have been producing large amounts of mucus
Unintended weight loss
Drenching nighttime sweats
History or symptoms of underlying chronic disease (e.g., asthma, COPD, or GERD)
Aspirating a foreign object
Cough that comes and goes and keeps coming back
Cough accompanied by “whooping.”
A severe bark-like cough that does not go away
Still not sure? There are plenty of OTHER CAUSES OF A COUGH
