Bronchitis, Bronchiolitis, Pneumonia, & Mycoplasma Pneumonia – An Integrative Perspective

When lower respiratory tract infections occur, they often present with similar symptoms — such as coughing, fatigue, fever, and congestion — making it challenging to tell them apart. Conditions such as bronchitis, bronchiolitis, pneumonia, and mycoplasma pneumonia all impact the lungs and can be especially challenging to distinguish from one another. 

In this article, you’ll learn the differences between four common lower respiratory tract infections — bronchitis, bronchiolitis, pneumonia, and mycoplasma pneumonia — as well as some home care tips and when to call a doctor. 

What are Lower Respiratory Tract Infections?

Lower respiratory tract infections are illnesses caused by pathogens that affect the lungs and include bronchitis, bronchiolitis, pneumonia, and mycoplasma pneumonia. 

• Bronchitis affects the bronchi (the large airways that connect your trachea to your lungs)
• Bronchiolitis affects the bronchioles (the small airways of the lungs that connect to the alveoli – the small sacs in which air exchange takes place)
• Pneumonia & mycoplasma pneumonia affect the alveoli of the lungs

These infections can arise from different underlying causes, such as viruses (like RSV or influenza), bacteria, or fungi (1). Symptoms and severity can vary significantly. While some lower respiratory conditions can be relatively mild and resolve with rest and supportive care, others may become more severe and require medical attention, particularly in young children and infants. It is important to know what you’re dealing with, and what to look out for. 

You may also be interested in this article: Does My Child Get Sick Too Often? Understanding Sickness Frequency in Children

What is Bronchitis?

Bronchitis is the inflammation of the large airways (bronchial tubes) responsible for carrying air into and out of the lungs (2). When someone has a “chest cold,” they are typically experiencing acute bronchitis. This condition is often caused by viral infections, such as the common cold or flu, but bacteria can also be the culprit in some cases. According to the CDC, acute bronchitis usually resolves on its own, and antibiotics are not normally helpful (2).

Note: Acute bronchitis caused by respiratory infection is different from chronic bronchitis, which is a form of chronic obstructive pulmonary disease (COPD) that is commonly associated with smoking and exposure to pollutants. However, repeated episodes of acute bronchitis may be a sign that chronic bronchitis is present. 

Symptoms of Bronchitis

• Persistent cough, often with thick mucus (sputum)
• Chest discomfort or tightness
• Sore throat
• Mild fever and chills (a fever in infants under 3 months of age is a serious concern and requires immediate medical attention)
• Fatigue and shortness of breath
• Wheezing (especially in people with asthma or underlying lung conditions)

Bronchitis tends to last 10-14 days (2), though a lingering cough can persist for several weeks. 

Dealing with a cough that sounds like a bark? It may be croup. Read this article to learn more: Understanding Croup: Causes, Symptoms, Remedies, & When To Seek Medical Attention

What is Bronchiolitis?

Bronchiolitis primarily affects infants and young children under the age of two (3). Unlike bronchitis, which involves the larger airways, bronchiolitis affects the small airways (bronchioles).

It is most commonly caused by respiratory syncytial virus (RSV), though other viruses, such as rhinovirus, can trigger it, too (3). Children with bronchiolitis may initially present with symptoms similar to a cold, but as the illness progresses, it can lead to breathing difficulties (3).

Symptoms of Bronchiolitis

• Runny nose
• Cough (may be dry or productive with mucus) 

The below symptoms are common in bronchiolitis and require emergency care in infants and young children:

• Wheezing or stridor (a high-pitched whistling sound when breathing)
• Rapid, shallow breathing
• Difficulty breathing, with flaring of the nostrils and retractions (skin pulling in between the ribs)
• Grunting or groaning sounds while breathing

Since infants have narrower airways, even a small amount of swelling can significantly impact their ability to breathe, potentially making this condition very serious. While bronchiolitis can often be managed at home, it’s important to monitor young children closely for signs of distress. I usually recommend sleeping in the same room as a young child with bronchiolitis.

To learn more about RSV, read this article: RSV (Respiratory Syncytial Virus) – Treatment & Prevention

What is Pneumonia?

Pneumonia is a lung infection that occurs when the air sacs (alveoli) in one or both lungs become inflamed and filled with fluid or pus. This reduces the lungs’ ability to absorb oxygen, making breathing difficult. Pneumonia can result from bacteria, viruses, or fungi, with bacterial pneumonia often being more severe (4,5). The most common bacterial causes of community acquired pneumonia are mycoplasma pneumoniae infection and pneumococcal disease, and viral causes include covid, influenza, RSV, measles, rhinovirus, and more (5). Certain groups, including young children, the elderly, and individuals with weakened immune systems, are more vulnerable to complications (5).

Symptoms of Pneumonia

• A high fever, often above 102°F, with chills and sweating (a fever above 100.4°F in infants under 3 months of age is a serious concern and requires immediate medical attention)
• Sharp chest pain that worsens when coughing or breathing deeply
• Persistent cough, often producing thick phlegm (yellow, green, or even bloody)
• Rapid, shallow breathing – this is an emergency, especially in babies and young children
• Shortness of breath
• Fatigue and muscle aches

Pneumonia ranges in severity from mild to life-threatening. In more serious cases, people may experience confusion or low oxygen levels, requiring immediate medical attention (5). Pneumonia often requires antibiotics if bacterial in origin, and some individuals may need hospitalization.

What is Mycoplasma Pneumonia?

Mycoplasma pneumonia is a mild form of pneumonia caused by the bacterium Mycoplasma pneumoniae (6). It’s sometimes called “walking” pneumonia because individuals can carry on with daily activities, unaware they have a lung infection. Despite being less severe, mycoplasma pneumonia can still last for several weeks if untreated. This type of pneumonia is more common among older children, teens, and young adults. Antibiotics are sometimes used to treat walking pneumonia caused by Mycoplasma pneumoniae.

Symptoms of Mycoplasma Pneumonia

• Persistent dry cough that lingers for several weeks
• Low-grade fever below 100.4°F (be aware that a fever of 100.4°F in infants under 3 months of age is a serious concern and requires immediate medical attention)
• Mild fatigue and weakness
• Headaches and muscle aches
• Sore throat and hoarseness
• Young children under 5 sometimes experience diarrhea

Although walking pneumonia is generally not serious, it can spread easily, particularly in crowded spaces like schools and daycares. Early treatment helps reduce the risk of complications and shortens recovery time.

Other respiratory illnesses that families should be aware of include croup, whooping cough, strep throat and RSV. To learn more about them, see: Understanding Croup: Causes, Symptoms, Remedies, & When To Seek Medical Attention, Whooping Cough: An Integrative Approach, Managing Strep Throat, and RSV (Respiratory Syncytial Virus) – Treatment & Prevention

Chest Infection Cheat Sheet

Please note that this table is for informational purposes only and is not intended to serve as a diagnostic tool. While bronchitis, bronchiolitis, pneumonia, and walking pneumonia are common respiratory infections that can affect the lungs, they are not the only ones. This list is not exhaustive, and other respiratory conditions may also impact the airways and lungs. When in doubt, consult a healthcare provider for proper evaluation and treatment.

Condition	Area affected	Common Symptoms
Bronchitis	Large airways (bronchi)	Persistent cough with mucus, chest tightness
Bronchiolitis	Small airways (bronchioles)	Mostly affects babies and toddlers. Runny nose, wheezing, rapid breathing, nasal flaring, retractions
Pneumonia	Air sacs in the lungs (alveoli)	High fever, cough with phlegm, chest pain, shortness of breath, fatigue
Mycoplasma Pneumonia	Air sacs in the lungs (alveoli)	Dry cough, mild fever, fatigue, headaches, sore throat

Home Care Strategies for Respiratory Illnesses

Many respiratory illnesses can be managed at home with the right care. Below are some general home care tips that can help reduce symptoms and support a speedy recovery.

• Hydration: Drink plenty of fluids to prevent dehydration and help thin mucus, making it easier to expel. Warm fluids such as herbal teas or broth-based soups can soothe the throat and provide extra hydration. For babies under one, breast milk and formula are the best for hydration.
• Vitamin A Megadose: Vitamin A megadoses are sometimes given at the onset of certain viral illnesses, especially measles, RSV, and Covid-19. It is important to be careful with dosing. Please read this article for details and consult with your doctor.
• Steam or Humidifier: Breathing in moist air can ease congestion, reduce coughing, and soothe irritated airways. Consider using a humidifier, or practicing at home steam inhalation. Humidifiers are a potential source of additional contamination so ensure that they are carefully cleaned. 
• Herbs for Coughs: Herbs such as lovage (7), mullein (8), and wild cherry bark (9) may help soothe coughs and irritated airways. Herbs can be consumed in teas, glycerites, or in herbal syrups, or they can be used to make an herbal steam treatment.
• Herbs for Immune Strength: When my family is sick, I like to increase our intake of immune-boosting herbs to support the body’s natural defenses. Herbs such as elderberry (10), echinacea (11), and goldenseal (12) can help strengthen immune function and promote recovery. 
• Onion Poultice for Chest Congestion: A warm onion poultice applied to the chest can help loosen congestion. 
• Nebulizer: Using a nebulizer with hypertonic saline can help loosen mucus and clear the lungs (13), providing relief from congestion. This treatment can be done at home but should be used under the guidance of a healthcare provider, especially for young children.
• Supportive Remedies: Use supportive remedies to manage fevers and body aches as needed.
• Sleeping at an Incline: Sleeping at an incline can sometimes help with congestion. For older kids and adults using extra pillows can help. However, sleeping at an incline is dangerous for young infants and is not recommended by the American Academy of Pediatrics. Young infants should always sleep on a flat surface, even when congested (14). For older infants and toddlers who are not ready to sleep with pillows, but who may benefit from having their head slightly raised, the head of their bed may be lifted a couple of inches with books, blocks, or something similar. Speak with your doctor about what is best for your child, and when in doubt, keep the crib flat on the ground. 

To learn more about home care for respiratory infections, read: Natural Treatment for Coughs, Botanical Steam Inhalation to Reduce Congestion & Soothe Coughs, How to Make An Onion Poultice: A Natural Cough Remedy For Chest Congestion, and What To Eat After An Illness To Rebuild Strength & Immunity.

When to See a Doctor

Some respiratory illnesses improve with rest and home care, but certain symptoms indicate that you may need to call your doctor or seek immediate medical attention.

When to Call Your Doctor

• Persistent Fever: If fever* lasts more than three days or returns after initially improving.
• Lingering Cough: If a cough persists for more than two weeks, especially with phlegm or wheezing.
• Minor Shortness of Breath: Mild difficulty breathing or wheezing that doesn’t improve fully and quickly with home remedies.
• Chronic Conditions: If you or your child has asthma, COPD, or another chronic respiratory condition that is worsening.
• Fatigue or Appetite Loss: If symptoms prevent eating, drinking, or sleeping well for several days.
• Infant specific considerations: If a baby under 3 months has a fever, or an infant of any age is feeding poorly, seems lethargic, or has fewer wet diapers than usual.
• Walking Pneumonia Symptoms: If a lingering cough and fatigue persist beyond two weeks or worsen suddenly.

*A note about fevers: Fevers can be scary but are not necessarily a cause for concern. Read this article to learn more: Fevers 101: Benefits, Home Care Strategies, & When to Medicate

When to Seek Emergency Care

Call 911 or go to the emergency room if you notice any of the following:

• Chest Retractions: The skin between the ribs, around the collarbone, or under the ribs visibly pulls in with each breath. This indicates severe difficulty breathing and requires immediate medical care. This video shows how to recognize chest retractions.
• Nasal Flaring: This is a sign of labored breathing, particularly in young children and infants.
• Breathing Difficulty: Rapid, shallow, or labored breathing, accompanied by gasping or grunting sounds.
• Bluish Skin, Lips, or Nails: A sign of low oxygen levels (cyanosis). Immediate medical attention is required.
• Extreme Lethargy or Unresponsiveness: Particularly in infants, if a baby becomes floppy, unresponsive, or unusually difficult to wake up, seek emergency care.
• Severe Dehydration: If your infant has gone more than 6-8 hours without a wet diaper, or if they show signs of dehydration such as sunken eyes, dry mouth, or crying without tears. 
• Fever in Infants: For babies under 3 months old, any fever (above 100.4°F) should be treated as an emergency.
• Uncontrolled Fever: In older children and adults, if fever exceeds 105°F, or won’t respond to antipyretics or is accompanied by seizures, confusion, or severe discomfort.
• Severe Chest Pain: Sharp, stabbing chest pain that worsens with deep breathing or coughing.

Can Respiratory Infections Be Prevented?

It’s not always possible to prevent respiratory infections, even with the healthiest lifestyle. If you or your child comes down with a respiratory infection, it is sometimes simply back luck. 

Tips for Reducing the Risk of Infection

There are several steps you can take to reduce the risk of respiratory infection for yourself and your family.

1. Practice Good Hygiene

Teach your children to regularly wash their hands with gentle soap and water, especially after spending time in public places or touching shared surfaces. 

2. Strengthen the Immune System

Strengthening the immune system starts with a nutrient-dense diet and consistently getting enough restorative sleep. Additional supplementation with immune-supporting herbs and nutrients can be helpful, especially during cold and flu season.

Nutrients that Support the Immune System

Micronutrients — including the B vitamins; vitamins A, D and C; and minerals like zinc, iron, copper, and selenium — work together to support the immune system and optimize immune responses (15). Daily intake requirements of these micronutrients may increase during times of stress or illness (15). As such, supplementing with key nutrients like vitamin C, vitamin D, and zinc may enhance immunity and potentially reduce the risk of infection.

Herbs that Support the Immune System

In addition to increasing micronutrient intake, certain herbs – supported by both research (16,17) and traditional knowledge – can further boost immune function and strengthen our defenses. 

Studies show that echinacea may reduce the frequency and severity of respiratory tract infections (16). A meta-analysis of 30 clinical trials found that echinacea lowered the risk of recurrent infections by 40% and antibiotic usage by 70% (16).

Black cumin seed oil has a long history of use for immune support – a benefit which is now backed by modern research (17). Along with regulating immune function (17), it promotes a healthy inflammatory response in the airways (17), which may help reduce the risk of complications during respiratory illnesses.

To learn more about how to keep a strong immune system year round, read this article: Winter Immune Support For All Ages.

3. Consider Vaccination

According to the CDC, the annual flu vaccine, COVID-19 vaccines, as well as RSV and pneumococcal vaccines can help prevent complications, like pneumonia, from occurring (16), but it is important to know that they are not 100% effective. To learn more about these vaccines and their potential benefits and risks, I recommend reading these articles and my Vaccine Strategy Guide.

Summary

Bronchitis, bronchiolitis, pneumonia, and walking pneumonia are common respiratory illnesses that affect different parts of the airways and lungs, often presenting with similar symptoms, such as coughing, fatigue, fever, and congestion. While some cases can be mild and resolve with home care, others – particularly in vulnerable groups like infants – can escalate and require medical attention. Understanding the differences between these conditions, knowing how to care for them at home, and recognizing when to seek medical help is essential to ensure the best possible outcome.

References:

1. CDC. (2024, July 22). About Respiratory Illnesses. Respiratory Illnesses. https://www.cdc.gov/respiratory-viruses/about/index.html
2. CDC. (2024, April 23). Chest Cold (Acute Bronchitis) Basics. Acute Bronchitis. https://www.cdc.gov/acute-bronchitis/about/index.html
3. Justice, N.A., & Le, J.K. (2023). Bronchiolitis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK441959/
4. National Heart, Lung and Blood Institute. (2022). Pneumonia. Www.nhlbi.nih.gov; NIH. https://www.nhlbi.nih.gov/health/pneumonia
5. CDC. (2024, April 11). About Pneumonia. Pneumonia. https://www.cdc.gov/pneumonia/about/index.html
6. CDC. (2024, January 19). Clinical Features of Mycoplasma pneumoniae Infection. Mycoplasma Pneumoniae Infection. https://www.cdc.gov/mycoplasma/hcp/clinical-signs/index.html
7. Mirjalili, M.H. & Javanmardi, J. (2006). Lovage. Elsevier EBooks, 438–452. https://doi.org/10.1533/9781845691717.3.438
8. Cleveland Clinic. (n.d.). 4 Ways Mullein Benefits Your Lungs. https://health.clevelandclinic.org/mullein-benefits
9. Pizzorno, J.E., Murray, M.T., & Joiner-Bey, H. (2016). Bronchitis and pneumonia. The Clinician’s Handbook of Natural Medicine. 2016:147–57. doi: 10.1016/B978-0-7020-5514-0.00022-1. Epub 2015 Dec 3. PMCID: PMC7149724.
10. Wieland, L.S., Piechotta, V/, Feinberg, T., Ludeman, E., Hutton, B., Kanji, S., Seely, D., & Garritty, C. (2021). Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complement Med Ther. 2021 Apr 7;21(1):112. doi: 10.1186/s12906-021-03283-5. PMID: 33827515; PMCID: PMC8026097.
11. Mount Sinai Health System. (n.d.). Echinacea Information. Mount Sinai – New York. https://www.mountsinai.org/health-library/herb/echinacea
12. Mount Sinai Health System. (n.d.). Goldenseal Information. Mount Sinai – New York. https://www.mountsinai.org/health-library/herb/goldenseal
13. Zhang, L., Mendoza-Sassi, R.A., Wainwright, C., & Klassen, T,P. (2023). Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2017 Dec 21;12(12):CD006458. doi: 10.1002/14651858.CD006458.pub4. Update in: Cochrane Database Syst Rev. 2023 Apr 4;4:CD006458. doi: 10.1002/14651858.CD006458.pub5. PMID: 29265171; PMCID: PMC6485976.
14. Moon, R.Y. (2023, December 22) My baby has a stuffy nose. How can I help them sleep safely? HealthyChildren.org. https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/my-baby-has-a-stuffy-nose-how-can-i-help-them-sleep-safely.aspx
15. Gombart, A.F., Pierre, A., & Maggini, S. (2020). A Review of Micronutrients and the Immune System-Working in Harmony to Reduce the Risk of Infection. Nutrients. 2020 Jan 16;12(1):236. doi: 10.3390/nu12010236. PMID: 31963293; PMCID: PMC7019735.
16. Gancitano, G., Mucci, N., Stange, R., Ogal, M., Vimalanathan, S., Sreya, M., Booker, A., Hadj-Cherif, B., Albrich, W.C., Woelkart-Ardjomand, K., Kreft, S., Vanden Berghe, W., Hoexter, G., Schapowal, A., & Johnston, S.L. (2024). Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA). Antibiotics (Basel). 2024 Apr 16;13(4):364. doi: 10.3390/antibiotics13040364. PMID: 38667040; PMCID: PMC11047471.
17. CDC. (2024, April 11). Pneumonia Prevention and Control. Pneumonia. https://www.cdc.gov/pneumonia/prevention/index.html