What’s the difference between asthma and bronchitis?

You’re coughing, wheezing, and feeling short of breath, but are your symptoms caused by asthma or bronchitis? It can be hard to tell the difference. Both conditions are relatively common. Asthma affects more than 27 million Americans and is the leading cause of chronic disease in children. Acute bronchitis is most often caused by colds and other viruses and sends about 5% of adults to their healthcare provider each year, most often during winter months. Chronic bronchitis, a form of chronic obstructive pulmonary disease (COPD), is when a cough lasts more than three months and affects roughly 10 million people in the U.S.

Because there is so much overlap between asthma, acute bronchitis, and chronic bronchitis, it may not always be obvious which condition you’re dealing with. Asthma is a chronic lung condition caused by inflamed airways that make it hard for people to breathe. Bronchitis is also an inflammatory lung condition that can cause breathing difficulty.

So, how can you tell them apart? Well, asthma is a chronic condition, but bronchitis is usually temporary and will go away on its own. However, there’s much more to know about the similarities and differences between these two conditions. Read on to learn how the symptoms, causes, treatments, and prevention of asthma and bronchitis compare.

Symptoms

Symptoms of asthma include coughing, wheezing, chest pain or tightness, and shortness of breath. Those symptoms also occur in bronchitis, but bronchitis can also consist of mucus production, and asthma doesn’t, says Vikas Sayal, MD, FCCP, the founder of Pulmonology Group in Nevada and Arizona. In other words, a productive cough (i.e., one that brings up sputum or phlegm) is one of the main ways to tell the difference between asthma and bronchitis.

Asthma symptoms

• Chronic or recurring cough (usually dry and/or unproductive)
• Vulnerability to viral respiratory infections and worsening symptoms when sick
• Cough with wheezing or chest tightness (usually at night)

Bronchitis symptoms

• Productive cough with mucus or phlegm
• Fatigue
• Low fever

Can you have asthma and bronchitis at the same time?

Yes, you can have asthma and bronchitis at the same time. Since bronchitis is usually a viral illness and people with asthma are more susceptible to viral respiratory illnesses, it’s not uncommon for people with asthma to end up with bronchitis.

Causes

Experts still aren’t sure exactly what causes asthma, but they do know some things that are risk factors for developing asthma. Two of these risk factors—viral illnesses and exposure to cigarette smoke or other irritants and allergens—are also common causes of acute and chronic bronchitis.

Causes of asthma

Asthma is your body’s immune system reacting in a way that causes the bronchial tubes in your lungs to become inflamed and swollen, says Amber Robins, MD, MBA, a family and lifestyle medicine physician at Rochester Regional Health. What triggers your immune system to have this response is unknown, though genetics or a family history of asthma is a common cause. It is believed that asthma often starts in childhood when the immune system is maturing, in addition to viral illness, exposure to cigarette smoke or environmental irritants, and allergies.

Causes of bronchitis

Acute bronchitis is a short-term condition caused by a viral infection, according to Dr. Robins. In contrast, chronic bronchitis (i.e., bronchitis lasting more than three months) may be caused by exposure to cigarette smoke or irritants as well as by other respiratory conditions like asthma, cystic fibrosis, and chronic obstructive pulmonary disease (COPD).

Diagnosis

The diagnostic steps for asthma and bronchitis are mostly the same, but one exception is a pulmonary function test. This test, performed with a device called a spirometer, measures how much air your lungs can hold and how quickly you can exhale it. It may be done when diagnosing either asthma or bronchitis.

Asthma diagnosis

According to Dr. Sayal, asthma is diagnosed with a physical exam and a combination of different tests. These tests include the pulmonary function test, a bronchoprovocation or methacholine challenge test to measure lung reactivity or responsiveness, and a peak expiratory flow (PEF) test to assess how much and how quickly you can expel air out of your lungs when exerting maximum force. In some cases, allergy or blood tests may also be performed.

Bronchitis diagnosis

Acute bronchitis is also diagnosed with a physical exam and review of symptoms, says Dr. Sayal. However, chronic bronchitis may require additional tests, like a chest X-ray or sputum culture. A pulmonary function test may also be performed, but it’s used to rule out other causes of your symptoms (like asthma) rather than to diagnose bronchitis.

Treatments

Even though asthma and bronchitis are two different conditions, some of their treatments overlap. Treatment options include a bronchodilator and a corticosteroid. An inhaled bronchodilator increases airflow to the lungs to help relax the muscles in the airway. Corticosteroids help decrease inflammation in the lungs caused by both asthma and bronchitis.

Asthma treatment

The goal of treating asthma is to decrease the frequency and severity of symptoms. To do so, Dr. Robins says, most people with asthma benefit from having some type of inhaler to treat their symptoms. He notes that a quick-acting rescue inhaler, such as albuterol—and a daily inhaler like Symbicort (budesonide/formoterol) for ongoing management may be needed. Some other medications used to treat asthma include corticosteroids, biologics, leukotriene modifiers, and inhaled mast cell stabilizers. Staying up to date on immunizations, avoiding irritants, or even receiving regular allergy shots may also improve symptoms for certain people with asthma.

For severe asthma, a procedure called bronchial thermoplasty may be used to shrink specific muscles in the lungs, which, when irritated, makes it hard to breathe during an asthma attack. 

Bronchitis treatment

Acute bronchitis is usually viral and goes away without prescription medications. Treatment should focus on alleviating symptoms and include over-the-counter cough suppressants, expectorants, pain relievers, and warm liquids. Your provider might prescribe an inhaler to reduce inflammation while your lungs heal. Dr. Sayal notes that some cases of bronchitis may be caused by bacteria, and antibiotics should be prescribed in those cases. Depending on the severity of your symptoms, your provider may want to do a chest X-ray to rule out pneumonia.

Chronic bronchitis has a different set of treatments than acute bronchitis. In addition to using an inhaler, people with chronic bronchitis can improve their symptoms with some lifestyle changes, like quitting smoking. They may need to take corticosteroids and stay up-to-date on vaccines to avoid illness. Chronic bronchitis may also respond to treatments like oxygen therapy and pulmonary rehabilitation, a multifaceted program that helps people with chronic breathing problems receive counseling to improve their diet, exercise, and mental health.

Prevention

Since experts aren’t sure what causes asthma, says Dr. Robins, it’s not a preventable disease. However, to decrease the risk factors for asthma, it is vital to stay up-to-date on vaccinations for seasonal illnesses. 

This is also a good way to prevent acute infectious bronchitis (which is usually a bacterial infection following a viral illness like the flu or COVID-19) and a potential way to limit complications of chronic bronchitis.

Asthma prevention

Asthma usually can’t be prevented because its exact causes are unknown, and some of its risk factors (like genetics and allergies) are unavoidable. However, you can decrease the complications of asthma by being proactive in several ways, says Dr. Robins:

• Get tested for asthma if you suspect you have it so you can be appropriately treated
• Receive regular immunizations for seasonal illnesses like respiratory syncytial virus (RSV), COVID-19, pneumonia, and influenza; this reduces your risk of serious medical issues due to illness
• Know your asthma triggers and avoid them (or take allergy medications, if possible)
• Take your prescribed asthma medications to prevent allergy attacks

Additionally, you should ensure you have an asthma action plan: This written treatment plan should include your medications, information about recognizing changes in your symptoms and treating them accordingly, and guidance on when to call your provider or seek emergency medical care.

Bronchitis prevention

Bronchitis can be prevented by getting seasonal vaccinations against the flu, pneumonia, and COVID-19. You can also eat a healthy diet, exercise regularly, and practice good hygiene, including frequent handwashing. If you’re sick, get plenty of rest and drink fluids to help avoid a secondary infection caused by bacteria.

If you smoke, quit smoking and avoid secondhand smoke, as cigarette smoke is the most common cause of chronic bronchitis. Additionally, if you’re frequently exposed to airborne irritants like dust or fumes, you should also reduce or eliminate your exposure to them.

Bottom line: Asthma is chronic, but bronchitis should resolve

Asthma is always a chronic disease, but bronchitis can be either acute or chronic. Most cases of acute bronchitis will go away on their own, though in some cases, your provider might prescribe an antibiotic if they suspect a bacterial infection. Like asthma, chronic bronchitis has no cure, but it can be managed with lifestyle changes, medications, and pulmonary therapy.

Whether you’re dealing with asthma or bronchitis, there are a few symptoms that should prompt you to contact your provider, says Dr. Sayal, because they may mean your condition isn’t being appropriately managed or treated. These include:

• Worsening of shortness of breath
• Extreme wheezing
• Use of bronchodilators more than twice per day
• Phlegm with blood or pus
• Phlegm with a foul smell
• Worsening green or yellow phlegm
• Increase in your need for oxygen therapy

It’s also important to know the signs of respiratory distress, which might mean you are not getting enough oxygen and need urgent medical attention. These include:

• Fast and/or labored breathing
• No relief after use of usual medications (i.e., inhalers)
• Wide, flared nostrils
• Inability to talk
• Chest retractions, or a “sucking in” of the ribs during breaths
• Bluish lips or fingernails

If you’re experiencing any of the above symptoms or see someone experiencing these symptoms, call 911.