Upper Respiratory Infections
Edward D. McCoul, MD, MPH
Upper respiratory infections (URIs) are among the most common reasons people seek medical attention and are the leading reason why people miss school or work. URIs are most commonly caused by viruses and can occur year-round, although most frequently in the cold or rainy months.
The respiratory tract refers to the pathway that carries air to the lungs, and can be divided into upper and lower parts. The lower respiratory tract consists of the lungs and windpipe, while the upper respiratory tract includes the nose, sinuses, throat (pharynx) and voice box (larynx). Although sinusitis, laryngitis and "strep throat" are all infections of the upper respiratory tract, the term URI usually refers to acute viral rhinitis. Another name for this condition is the “common cold.”
The symptoms of a viral URI typically include nasal congestion, sneezing, and a runny nose with clear mucus. A sore or scratchy throat, hoarse voice, ear fullness, headache and low-grade fever may also be present. Similar symptoms may be caused by influenza virus infection (also called “the flu”), but this usually causes more severe symptoms such as high fever, malaise, and aching muscles.
The typical viral URI lasts approximately 7 to 10 days. Often, the first 2 to 3 days are marked by nasal congestion and stuffiness, followed by several days of sniffling and a runny nose. If a URI lasts longer than 10 days without improving it is important to seek medical attention to rule out a more serious condition. Prolonged or worsening symptoms may indicate the presence of bacterial sinusitis, acute otitis media or bacterial pharyngitis, among other conditions.
Figure: Time course of symptoms during an upper respiratory (viral) illness.
Treatment of a viral URI typically involves reducing the burden of symptoms while allowing the infection to run it natural course. Antibiotics are not usually effective for treating a viral URI. Increased fluid intake of water or drinks rich in electrolytes can help to prevent dehydration and may loosen secretions. Regular use of zinc lozenges may reduce the duration of a viral URI by several days. Supplemental vitamin C (up to 1 gram per day) may reduce the duration of the illness as well.
Certain over-the-counter medications may be useful for symptom relief, although each has potential disadvantages. Oral decongestants such as pseudoephedrine (Sudafed) give relief during the early congestion phase, but may raise the blood pressure and can be dangerous for people with a heart condition. Decongestant nasal sprays such as phenylephrine (Neo-Synephrine) or oxymetaxoline (Afrin) have less effect on other body systems; however, these sprays should not be used longer than 3 days, because they can cause rebound congestion. Analgesics such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) may be useful for fever or moderate pain. Cough suppressants such as dextromethorphan or codeine may help to relieve sleeplessness, but can cause constipation in some people. Expectorants such as guaifenesin (Robitussin, Mucinex) have not been proven to have any benefit for viral URI. Antihistamines (e.g. Claritin, Allegra) are generally not advised for viral URI because they dry the nasal lining and prevent adequate drainage. You should contact your physician whenever there is doubt about whether to take a particular medication.
Upper respiratory infections are common and occur year round. Although common colds bring with them often times troublesome symptoms, URIs are generally benign and resolve with time and over the counter treatments.
©American Rhinologic Society