Coughing sucks! Nothing attracts more attention than a cough. It comes in many flavors - wet, dry, green, yellow, hacking, tightness, wheezing, productive, barking, and so on.

man coughing


What exactly is bronchitis? Simply, inflammation of the bronchial airways. It can be caused by viruses, bacteria, allergies, asthma, environmental exposures, and more. Antibiotics are NOT always the best treatment for bronchitis. True, some folks swear by the trusty old "Z-pack" -- that 5-day course of antibiotics --- that seems, for some, to "knock it out".

In reality, antibiotics usually don't help bronchitis. Rather, your immune system generally does its job to rid your body of the virus and/or inflammation.

So how do you know if it's a bacteria, virus, or something else? Sometimes it is tough to tell the difference. A lot can be gleaned from the history of your cough, the character of your cough, what makes it worse/better, and your medical history. You can enter all of your symptoms into your favorite internet search engine and perhaps get an idea. However, diagnosing and treating bronchitis is something that should probably be left to a physician. Especially if you are wondering whether or not you need a prescription.

Try this first:

*Drink plenty of fluids. That mucus that drains down the back of your throat and builds up in your chest is more likely to move up and out of your chest and sinuses when you are hydrated. The less you drink, the more stubborn your phlegm gets. It becomes more like velcro stuck to your throat (thus the sore throat) and more likely to harbor nasty bacteria and worsen your condition. Water and/or a warm salty solution (i.e. soup or tea) can go a long way toward reducing your cough and helping you feel better.

* Sleep with a few pillows to prop your head up. This will keep the mucus from settling in the back of your throat and causing you to cough all night.

* Over-the-counter medications such as guaifenesin (e.g. Mucinex, Robitussin), plain or with the "DM" may be worth a try. These are essentially expectorants that work best when combined with plenty of water. Caution with diphenhydramine (Benadryl) or doxylamine (in Nyquil) products may dry things up a little too well and lead to excessively dry/sticky phlegm like that mentioned above. Decongestants can also be drying but are ok to try for a short period of time (a few days) to help with daytime congestion and sinus/ear pressure. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) will help with the fever, aches, and pains.

* Humidity. The warm steam and humidity from soups, teas, showers, and the like all lessen those sensitive airways with tend to be more reactive in cold and dry environments (i.e. wintertime)

Try this second if you happen to have the following around:

* Albuterol (e.g. ProAir, Ventolin). If you happen to have asthma, chronic bronchitis, or COPD, then you likely have some albuterol around either in the handheld inhaler form or as a solution for the nebulizer. This bronchodilator helps with bronchospasm which is what often causes the cough of bronchitis. If you wheeze when you cough or breathe out fast, you likely have bronchospasm and you would benefit from an inhaler. Your physician can prescribe an inhaler if needed.

* Prednisone. Ok, most doctors would say these should ONLY be taken as prescribed by your doctor. These steroids are pure anti-inflammatories, used for just about any inflammatory condition known to man. Usually, a "burst" dose of 20-40 mg/d for 5-7 days will do wonders for your cough. Of course, prednisone does come with several precautions: elevates blood sugar (careful if you are diabetic), makes one moody or "amped up", may increase weight temporarily due to water retention, and they are not to be abruptly stopped if taken for more than 10-14 days (thus the 5-7 day burst). Often used second line, steroids can get a person with persistent cough and bronchitis over the hump.

If you have the following "RED FLAGS", contact your physician:

* Fever for more than 24 hours (over 100.3); older folks may just have chills, sweats, or rigors.
* Bloody sputum/phlegm

Bloody Sputum

Bloody Streaked Sputum (photo credit:

* Shortness of breath
* Inability to keep fluids down or excessive nausea/vomiting/diarrhea


The following are common symptoms along with bronchitis:

* Chest wall/rib pain with the cough -- likely strained chest wall muscles from coughing; usually sharp in nature. Chest pain with pressure-like exertion may indicate a more serious condition and need to be evaluated.
* Clear or yellow sputum

What about GREEN or BROWN sputum?

The color of sputum doesn't necessarily correlate with bacterial,  viral, or other causes of bronchitis. However, if one has green or dark-colored sputum, usually after a few days of coughing, with general malaise, +/-fever, +/- aches and generally feeling worse than the previous few days, this might indicate a secondary bacterial infection that may respond to antibiotics. This is by no means a steadfast rule. Sputum or phlegm color and consistency is only one-factor doctors use to determine how best to treat cough and bronchitis.

What can your online physician do for you?

Not sure what to do? Maybe you are experiencing some of the "red flags" described above or you are basically at your wits end? Rather than rushing to urgent care, or leaving a message with your family doctor and hoping for a same-day appointment, why not message your online physician and/or set up an online consultation? Since your CirrusMED physician already knows your medical history, he or she can easily evaluate your case and if needed, prescribe the appropriate treatment.

Some things your personal Cirrus Medical Network (CirrusMED) physician can do include:

* evaluate your symptoms and determine what treatment would work best for you
* call in a prescription for antibiotics
* call in a prescription for cough syrup (non-narcotic)
* call in a prescription for prednisone
* call in a prescription for an albuterol inhaler
* follow-up with you to make sure you are improving
* document your care in a secure cloud-based medical record

All of this can be done from the convenience of your home. All you need is an internet connection. If you are on the road for the holidays or can't miss work, your CirrusMED physician will work with you so you can save time and money with "Your doctor. Online".

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