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Respiratory Infection

The respiratory tract has two sections, which is determined by anatomy.

Upper Respiratory Tract: the nose, mouth, throat, larynx and trachea.

Upper respiratory infections are usually regarded as “colds”.

Lower Respiratory Tract: the airways (bronchial tubes) and the lungs.

Pneumonia and bronchitis are considered infections of the lower respiratory system.

A viral infection is the usual cause of the “common cold” and treatment is aimed at controlling symptoms while a person’s own immune system fights off the infection. Upper respiratory infection symptoms include: cough, post-nasal drip, runny nose and nasal congestion. A person may become hoarse or even lose their voice if they develop laryngitis (swelling of the larynx/voicebox).

Often, it’s troublesome to determine the difference between a severe upper respiratory infection and the flu. However, the flu (Influenza)routinely causes complaints and symptoms involving the entire body, including chills, fever, pain, muscle aches and just a general feeling of malaise (feeling poorly). Generally, colds do not cause such total body involvement.

If the doctor is concerned about the diagnosis of the flu, antiviral drugs will be prescribed. There is no antiviral treatment/medications for the common cold.

A person may “catch” a cold when they come into contact with viruses that are airborne (spread by sneezing or coughing). Spreading or transmission of viruses can also be spread secondary to poor hand washing practices. The virus can be transmitted just by shaking someone’s hand and then touching your own eyes, nose or mouth. Some viruses can even survive for up to two hours on surfaces such as doorknobs and handles, sink faucets, pens, tabletops, and computer keyboards.

People should remember that upper respiratory infections are very contagious and are transmittable (spreadable) from one person to person. Even before symptoms arise people are potentially contagious. This is why good hygienic habits are important. Always cover your coughs and sneezes and regularly wash your hands, even when you are not ill.

The two most common viruses that cause upper respiratory tract infections are the rhinovirus and coronavirus. Other viruses, such as adenovirus, respiratory syncytial virus and parainfluenza virus can cause colds and may also cause pneumonia in children and infants.

Risk Factors for Upper Respiratory Infections

Not everybody who is exposed the “common cold” virus will “catch” it. Those who have a weak immune system or a decrease in their immune system may be more susceptible, allowing the virus to spread and cause signs and symptoms in the body.

Upper Respiratory Infections Symptoms

Common cold symptoms may include:
• Runny nose, nasal congestion, post-nasal drip, low grade fever and cough;
• Cough is often dry (no mucus is produced from lungs);
• Post-nasal drip secretions/drainage may be coughed up from back of throat;
• Symptoms of sinusitis such as increased nasal secretion drainage, fever and occasional pain;
• In children and infants may have swelling in the small upper airways that will cause croup (laryngotracheobronchitis). This causes a barking cough.


When to Request Medical Care

Most people recover from the “common cold” with symptoms improving and resolving in 7-10 days. Depending upon symptoms progression and circumstances some people should seek medical evaluation and treatment.

• Chills, fever and shortness of breath are not common symptoms observed with upper respiratory infections and may tell of a potentially more serious infection such as pneumonia, acute bronchitis or influenza.

• Anyone under the age of 2 or anyone who is pregnant who has shortness of breath or who has contributing illnesses such as emphysema or asthma should obtain medical treatment.

• Diarrhea, nausea and vomiting are not commonly associated with acute upper respiratory infections; however, evaluation by a doctor may be required if these symptoms are present.

• It’s common for infants to catch colds but babies who are less than three months old who develop a fever should be evaluated by a doctor immediately because their immune system is under developed and other infections/complications may be present.

• People who have a compromised immune system due to illness or medications should contact their doctor if they develop a fever, even if it appears secondary to an upper respiratory infection.

• Most people recover from a cold within 7-10 days. If symptoms continue, seek medical treatment.

Tests and Exams

History and physical examination

The diagnosis of an upper respiratory infection or cold is typically made by physical examination and history. The doctor may ask questions in relation to the duration and onset of symptoms. The physical exam may focus on the lungs, neck and head.

An exam of the ears may show fluid behind the ear drums suggesting Eustachian tube swelling secondary to a cold/upper respiratory infection. Examination of the nose/nares and nasal area may reveal a clear discharge and a throat exam may show redness and some post-nasal drip.

If the doctor suspects sinusitis, he/she will tap with their fingers over the areas of the face of the large area of the sinuses.

The doctor may palpate the neck area exploring to see if the lymph nodes are swollen which can be associated with an upper respiratory infection.

The doctor will listen to lung sounds. If wheezing or crackles are heard, it may be indicative of infection or inflammation.
Only a few tests are necessary for the diagnosis of an upper respiratory infection.


Testing and Imaging (X-Rays)

If it is though that strep throat is suspected then a rapid strep test or throat will be ordered.

If sinusitis is thought to be present, X-Rays of the sinuses will be performed to examine clouding or air fluid levels evaluated to determine if it’s consistent with infection. Also, a CT-Scan of the sinuses may be performed to evaluate for infection.

Treatment of Upper Respiratory Infection

At-home self-care

Most often, the treatment of an upper respiratory infection is focused at symptom control while the body fights off the virus responsible for the infection. Antibiotics are not effective in fighting viruses and are not typically prescribed unless the doctor determines that a bacterial infection is responsible for the cold.

OTC Medication and Home Remedies

Drinking plenty of fluids will prevent dehydration and also moisten the sinuses.

A humidifier will keep the air moist and the nose hydrated. Cool mist humidifiers are the most effective and safe.

Aspirin should be avoided secondary to the risk of Reye’s Syndrome in children and teenagers.

The American Academy of Pediatrics warns that over-the-counter (OTC) medications should not
Used in children and infants due to their lack of effectiveness in managing symptoms and the
probability of potential side effects.

Saline nose drops given via a bulb syringe may be given to infants for a stuffy nose.

OTC cold medications for adults should be used with caution as well. These medications may
contain active ingredients that may increase blood pressure, promote sleepiness and cause heart palpitations. One of the many active ingredients in these cold medications is alcohol.
Before taking any medications, read the labels and address any questions with your pharmacist or doctor about possible side effects.

Alternative care, such as Echinacea, vitamin C and zinc, has proven effective in some people; however scientific proof has not proven their effectiveness.

Medical Care

Medication

Medications/drugs are typically not prescribed for treatment of upper respiratory infections. Antibiotics are ineffective in treatment of viral infections. However, antibiotics are indicated if the doctor determines that a bacterial infection is present, for instance in cases of bacterial sinusitis, otitis media (ear infections) and strep throat.

In some circumstances, where there is pronounced inflammation of the upper airways (bronchial tubes), for example croup in children and infants, corticosteroid drugs such as dexamethasone or prednisone may be ordered to decrease the inflammation.


Complications of Respiratory Infections

For most people, colds improve on their own with no complications. Occasionally, the inflammation brought on by the upper respiratory infection may create drainage issues within the sinuses or the middle ear, which can cause the possibility of secondary bacterial infections such as otitis media or sinusitis.

Dehydration is often a possible complication of infection if enough fluid is not taken in.

Medical Follow-Up

Almost all upper respiratory infections improve on their own within a few days and no follow-up is indicated.

Prevention of Upper and Lower Respiratory Infections

We are social being and come in contact with one another every day.

Prevention of upper respiratory infection includes:

• Avoid people who are ill;
• If you are ill, stay at home until you are symptom –free, feeling better and no longer contagious;
• Avoid touching your mouth, nose and eyes;
• Cover your sneeze and cough with your inner elbow, not your hand;
• Wash your hands throughout the day, for 20 seconds or more with soap and warm water
• Modify your lifestyle with stress management and smoking cessation to diminish your susceptibility to acquiring the “common cold”.

Respiratory Infections Outlook

Upper respiratory infections are common and most people “catch” two to four common colds each year. Continuing research tries to find treatments and vaccines that can ease the symptoms of a cold and someday decrease the number of respiratory infections a person will catch per year.