What is an Upper Respiratory Infection?

Ahhh, the upper respiratory infection (URI). It’s one of the most common reasons for visiting the doctor every year. It’s also the most common illness resulting in missed days of work and school.^[1]

Most frequently occurring in the fall and winter, the upper respiratory infection is a contagious infection of the upper respiratory tract, which refers to the nose, paranasal sinuses, pharynx, larynx, trachea, and bronchi. While most cases are mild and go away on their own without treatment beyond rest, extra fluids, and chicken soup, some are severe enough to be life-threatening and require hospitalization.¹

Causes

The vast majority of URIs are caused by viruses, although bacteria are responsible for a small percentage of cases.^[2] There are over 200 different viruses that can cause the symptoms of a URI, the most common being the rhinoviruses which are responsible for the common cold. Other common viruses include the coronavirus, parainfluenza virus, adenovirus, enterovirus, and respiratory syncytial virus.^[3]

Types of URIs

The common cold is the most widespread type of URI. Other types refer to the area of the upper respiratory tract that is most involved in the infection and include:

• Sinusitis – inflammation of the sinuses
• Laryngitis – inflammation of the larynx (voice box)
• Pharyngitis – inflammation of the pharynx (back of throat)
• Epiglottis – inflammation of the epiglottis, the upper part of the trachea.
• Bronchitis – inflammation of the bronchi (air tubes in the lungs)

Symptoms

The most common symptoms of a URI include:^[4]

• Nasal congestion
• Runny nose
• Increased mucus
• Sore, scratchy throat
• Cough
• Sneezing

Other possible symptoms include fever, general malaise, headache and body aches. Most symptoms go away on their own within 7 to 10 days. If symptoms persist beyond that or worsen, it’s important to seek medical attention as soon as possible.^[5]

How Upper Respiratory Infections Spread

URIs can spread in several different ways. For example, when you cough or sneeze, tiny droplets of fluid containing the virus are propelled into the air. If someone nearby inhales them, they too may become infected.^[6]

Upper respiratory infections can also be spread through indirect contact. For example, if you have a URI and touch your nose, eyes or mouth and then you touch an object like a doorknob, the virus may be transmitted to someone else who touches that same doorknob and then touches their own nose, mouth or eyes.⁵

Diagnosis

Most URIs are self-diagnosed and managed at home. If a patient goes to the doctor with an uncomplicated URI, a diagnosis can be made by reviewing a patients’ medical history, assessing their symptoms and performing a physical exam. Tests that are used to address more complicated cases of upper respiratory infection include:

• • Throat swab – used for diagnosing group A beta-hemolytic strep, the most common cause of strep throat
  • Lateral neck X-rays – used to rule out epiglottis in patients who are having difficulty breathing
  • Chest X-ray – used if a doctor suspects pneumonia
  • CT – used to diagnose sinusitis

Treatment

Because most URIs are caused by viruses, are self-limiting, and managed at home by the patient themselves, treatment for uncomplicated cases in an otherwise healthy patient is based on relief of symptoms and may include the following:^[7]

• Acetaminophen – may provide relief of fever, sore throat, body aches and facial pain.
• Decongestants – may provide symptom relief for stuffy nose and sneezing.
• Antihistamines – may reduce stuffy nose, sneezing, and nasal secretions.
• Saline nasal drops – may provide relief from congestion and thick secretions.
• Guaifenesin – a mucolytic; may help thin thick secretions making them easier to expel (cough up).

Additional home-care measures that help relieve symptoms include:⁷

• Drinking at least 8, eight-ounce glasses of water, juice, or non-caffeinated beverages (unless your doctor tells you otherwise) to help thin mucus and replace fluid loss.
• Breathing warm, moist air by turning on the shower, closing the bathroom door, sitting down, and inhaling the steam to help moisten mucus membranes and loosen secretions.
• Reducing airway irritants (smoking, secondhand smoke, indoor and outdoor air pollution, cold, dry air) that provoke coughing.
• Sleeping with head and shoulder slightly elevated to help promote sinus and nasal drainage.
• Using warm facial packs (warm, folded washcloth or warm water bottle) applied directly to the face and cheeks may provide comfort, relieve congestion, and promote drainage (in cases of rhinosinusitis).

It’s important to note that antibiotics are ineffective against viral infections of the upper respiratory tract and are reserved for URIs that are bacterial in nature including:⁷

• Group A streptococcal pharyngitis
• Bacterial sinusitis
• Epiglottis
• Pertussis
• Diptheria

Lowering Your Risk

People with COPD or other chronic (ongoing) health conditions are at risk for respiratory infections that may further impair their lungs. The following tips may help you prevent a URI before it happens:⁷

• Ask potential visitors with cold or flu symptoms to visit when they’re feeling better.
• Wash hands frequently with soap and warm water whenever possible. If a sink is unavailable, use a hand sanitizer instead.
• Don’t smoke (and avoid secondhand smoke) as this may exacerbate (worsen) symptoms.
• Get plenty of sleep and rest to promote healing.
• Sneeze or cough into a tissue, then discard promptly and wash your hands.
• Avoid touching your eyes, nose and mouth as these are the most common places that viruses and bacteria can enter your body.
• Talk to your doctor about getting an annual flu shot and pneumonia vaccine if you haven’t had one.

Upper respiratory infections are common and many people get several each year. Although treatment is directed toward managing symptoms while the body’s own immune system fights the infection, the best way to manage URIs is through prevention. For more information about preventing URIs, talk to your primary health care provider.

_{[1] Roger Zoorob, MD, MPH, et. al. “Antibiotic Use in Acute Upper Respiratory Infections.” Am Fam Physician. 2012 Nov 1;86(9):817-822.}

_{[2] Sherif B. Mossad. Upper Respiratory Infections. Cleveland Clinic. Accessed 3/23/2017.}

_{[3] Johns Hopkins Medicine. Upper Respiratory Infection (URI or Common Cold). Accessed 3/23/2017.}

_{[4] Mary T. Caserta, MD. Overview of Viral Respiratory Tract Infections in Children. Merck Manual. Accessed 3/23/2017.}

_{[5] American Rhinologic Society. Upper Respiratory Infections. Revised 2/17/2015.}

_{[6] National Health Services UK. Respiratory Tract Infections. Last reviewed 4/14/2015.}

_{[7] Anne Meneghetti, MD. Respiratory Tract Infections. Medscape. Updated 2/17/2017.}