Cardiology · Beaumont and St. Joseph Mercy
What is Upper respiratory infection? - Dr. James Heinsimer

Upper respiratory infections

What is Upper respiratory infection?

Upper respiratory infections, colds, bronchitis and flu

One of the most common problems to bring people to the doctor is an upper respiratory infection. This may include a cough, fever, sore throat, runny nose, headache, sputum (phlegm) production, fatigue, muscle aches, etc. It may include just some of these or any combination.

Many people do not realize that most upper respiratory infections are due to viruses and common cold viruses do not respond to antibiotics (antibiotics are drugs used to treat bacterial-not viral infections). Viruses such as HIV-AIDS,hepatitis and flu may be suppressed by anti-viral drugs but the viruses causing the common cold are not touched by these anti-viral medications. Unfortunately, although we have made many advances in medicine, the common cold is still treated symptomatically - which is to say with medicine designed to make you feel better -- aimed at your symptoms. Most colds are caused by rhinoviruses which do not respond to antibiotics or anti-viral drugs. Rhinoviruses infect and cause inflammation of the airways from the nose through the mouth and into the trachea (the big windpipe) and bronchioles (the smaller pipes) leading to the lungs. It is this irritation, swelling, and pus that leads to the stuffy or runny nose, sore throat and irritated, red and raw windpipe causing cough.

The overuse of antibiotics is a bad thing with serious consequences . Some doctors hand out antibiotics at the drop of a hat. This irresponsible behavior has led to many bacteria becoming more resistant to antibiotics. So whereas antibiotics have only been around since 1940, more and more bacteria are becoming tougher to treat because of the overuse of antibiotics. Many doctors hand out antibiotics because the patient wants, insists, or expects to be given a prescription when they come to a doctor with a cold - but it is grossly irresponsible medicine.

If you have a cold - typically manifest by cough, low grade fever, sore throat or runny nose or any combination of the above -- I recommend that patients take DayQuil during the day and NyQuil at night. These are over-the-counter medications that do not require a prescription and are used to help the cold sufferer relieve his/her symptoms. Many drugstores or grocery stores have generic equivalents to NyQuil and DayQuil. You should take the medication as directed on the box.

You should look for the best medicines for you based on your symptoms:

For pain or fever
: acetaminophen (Tylenol)
250-500 mg mg as a pain reliever or fever reducer every 4-8 hours but no more than 2000 mg total daily (no fever or pain - do not take this )

For cough
: dextromethorphan
as a 1st line cough suppressant. If this does not work I will prescribe Tessalon Perles (a non sedating cough suppressant) 100-200 mg every 6 hours or codeine 30 mg every 6 hours (watching for constipation, confusion, stomach upset).

To loosen secretions : Guaifenesin is an expectorant used to loosen cough (It is in many cough and cold formulas)

Stuffy or runny nose: phenylephrine
30 mg is a nasal decongestant (use it for runny nose, sinuses, plugged ears). If phenylephrine does not dry up a runny nose or help with sinuses or plugged ears then pseudoephedrine can be obtained from the pharmacy. It is a stimulant used to dry up to nasal secretions and decrease the congestion and headache. Because of warnings on the box, people are sometimes worried about whether these drugs will worsen their blood pressure or cause heart problems but when used in the doses recommended on the box, it is okay. Just monitor the blood pressure to make sure it does not go up over 160 systolic.

is similar to DayQuil but has doxylamine 6.25 mg which is an antihistamine which can help with sleep. During the day people can takeAllegra-D or Zyrtec-D which are not sedating and which have decongestant and antihistamine combined to decrease congestion. Claritin is another antihistamine that does not produce daytime drowsiness. However, since the common cold is not an allergic manifestation in most people, antihistamines are slightly less helpful than in allergic situations.

If sore throat is a major problem, I recommend Cepastat lozenges which are throat lozenges that also contain a mild anesthetic which numbs the sore throat. Any throat lozenge that has a local anesthetic such as benzocaine is fine.

When trying to sort out whether someone has strep throat (due to a bacteria called Streptococcus) or is simply part of the cold, I use several clinical clues. Strep throat is usually manifest by a severe red throat with white patches, swollen glands (lymph nodes), high fever, and recent exposure to someone who has a throat culture documenting strep throat. If these manifestations are present, I will usually do a throat culture before prescribing antibiotics. The antibiotic of choice for Streptococcus is penicillin and is important to use antibiotics in this situation to prevent kidney problems or a heart problem called rheumatic fever. In contrast, if someone has a sore throat -- even with white patches -- but has a runny nose, cough and other symptoms of a cold -- many viruses can cause this picture. In this case, antibiotics are not warranted.

Both a cold and the flu (influenza) are viral infections that cause similar symptoms such as coughing and sore throat. A cold is a viral infection of the nose and throat, mostly causing a runny nose with prominent nasal congestion, sore throat, headache and cough. The flu, on the other hand, is usually more severe, with symptoms that include the sudden onset of high fever, dry cough and severe aches and pains. The difference is important only in that there is a medication that can decrease flu symptoms if started within 2 days of the flu. The drug Tamiflu can help to shorten the course of influenza but does not help the common cold.

One of the most common concerns that patients come in with who have a cold is whether they have pneumonia. Pneumonia is usually manifest by a very prominent cough with a high fever and shaking chills. Patients usually have lots of greenish sputum as opposed to the whitish or yellowish sputum of the common cold. If necessary, a chest x-ray can sort things out as can the physical examination. If someone has pneumonia as opposed to the common cold, we will often use antibiotics although many pneumonias are, in fact, viral and not helped by antibiotics.

Most people hope that their symptoms will go away a day or two and call if a cough or fatigue lasts longer than a week. Often, colds or flu symptoms will last up to 2, 3 or even 4 weeks. About this time, the patient is usually wondering whether they really should have been on antibiotics and whether something was missed. Unfortunately, sometimes it simply takes this long for the viral infection to run its course. Of course you can help yourself by getting plenty of rest, keeping up your nutritional or at least fluid intake so that you do not become run down. Coughing by itself leads to irritation of the airways - so called tracheobronchitis. Medicines to stop coughing and cough drops can help heal the irritated airways.

Staying away from smoke , dust, pollution etc can hasten the resolution of symptoms. Exposure to tobacco smoke will definitely prolong the illness – if you smoke—stop!!! If you are exposed to “secondhand smoke” from others – try to avoid it. Smoke will lead to additional damage to airways as will any preexisting allergies. Clearly, covering your mouth if you cough and washing your hands so you don’t spread your cold is a considerate and reasonable idea. If you are coughing – stay home so you don’t spread your cold.

If your symptoms get worse, please call !!! Even though most of these are viral and have to run their course, we don't want to miss a case of severe pneumonia or a cold turning into a pneumonia or something else.