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.
Treatment of a viral URI typically involves reducing the burden of symptoms while allowing the infection to run its natural course. Certain treatments are backed by evidence from medical research, while other treatments are still being evaluated. You should contact your physician whenever there is doubt about whether to take a particular medication.
Oral antihistamine-decongestant combination pills have some general benefit in adults and older children. Adding an analgesic (such as acetaminophen) also has benefit. These are available over-the-counter as generic or brand-name products, including Sudafed and Benadryl. Decongestants may raise the blood pressure and can be dangerous for people with a heart condition.
Guaifenesin is an over-the-counter medication that helps to break up thick mucus. This may be useful for treating cough during a URI. It is available as a single medication or as a component of certain brand-name products such as Robitussin or Mucinex. Other cough suppressants such as dextromethorphan or codeine may help to relieve sleeplessness due to cough, but carry some side effects that may limit use.
Decongestant nasal sprays such as phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin) are available over-the-counter. These typically have less effect on other body systems than pills taken by mouth. However, these sprays should not be used longer than 3 days, because they can cause rebound congestion and can cause dependence (addiction).
Ipratropium bromide (Atrovent) is a prescription nasal spray that is effective in treating a runny nose. It does not have an effect on nasal congestion, and carries some side effects.
Nasal steroid sprays, such as Flonase and Nasacort, have not been shown to help a common cold.
Nasal saline irrigation may help to clear the nasal passages and remove mucus and debris. This is available as a “neti pot” or as a reusable squeeze bottle.
Common over-the-counter pain relievers such as aspirin, ibuprofen, and naproxyn are somewhat effective in relieving pain and discomfort. There is no clear evidence that they help cough or runny nose. Acetaminophen (Tylenol) is useful for treating fever as well as pain.
Antibiotics are not effective for treating a viral URI. Unnecessary use of antibiotics may reduce their effectiveness when they are truly needed. In addition, antibiotics can produce unpleasant side effects and potentially serious allergic reactions. (KENEALY)
Echinacea, which is an herbal medication, has some possible benefit in easing the symptoms of a common cold when taken at the first sign of symptoms.
Garlic, when taken daily as a tablet, may be useful in preventing the development of the common cold.
Vitamin C, when taken as a preventive measure, may slightly reduce the duration and severity of a cold in both adults and children. However, taking vitamin C once a URI has begun is not likely to have a benefit. Taking vitamin C as a preventive measure does not typically reduce the frequency of developing a cold.
Zinc, when taken within 24 hours of the start of symptoms, is likely to reduce the duration and severity of symptoms. Taking zinc as a preventive measure may lower the rates of developing a cold as well as the severity, but carries the risk of side effects such as bad taste and nausea.
Increasing fluid intake during a URI is a commonly-advised practice. However, there is no strong evidence to show any particular benefit.
Exposure to heated, humidified air is commonly advised to soothe the membranes of the nose and throat. However, studies have shown no consistent benefit for this practice.
Chinese medicinal herbs are widely used in some parts of the world to treat a wide variety of illnesses including the common cold. Certain formulations appear to have some benefit based on a limited number of studies.
- AlBalawi ZH, Othman SS, AlFaleh K. Intranasal ipratropium bromide for the common cold. Cochrane Database of Systematic Reviews 2013, Issue 6.
- De Sutter AIM, van Driel ML, Kumar AA, Lesslar O, Skrt A. Oral antihistamine-decongestant-analgesic combinations for the common cold. Cochrane Database of Systematic Reviews 2012, Issue 2.
- Guppy MPB, Mickan SM, Del Mar CB, Thorning S, Rack A. Advising patients to increase fluid intake for treating acute respiratory infections. Cochrane Database of Systematic Reviews 2011, Issue 2.
- Hayward G, Thompson MJ, Perera R, Del Mar CB, Glasziou PP, Heneghan CJ. Corticosteroids for the common cold. Cochrane Database of Systematic Reviews 2012, Issue 8.
- Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2013, Issue 1.
- Karsch-Völk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2014, Issue 2.
- Kassel JC, King D, Spurling GKP. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database of Systematic Reviews 2010, Issue 3.
- Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews 2013, Issue 6.
- Kim S, Chang Y, Cho H, Hwang Y, Moon Y. Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database of Systematic Reviews 2013, Issue 6.
- Lissiman E, Bhasale AL, Cohen M. Garlic for the common cold. Cochrane Database of Systematic Reviews 2014, Issue 11.
- Singh M, Das RR. Zinc for the common cold. Cochrane Database of Systematic Reviews 2013, Issue 6.
- Singh M, Singh M. Heated, humidified air for the common cold. Cochrane Database of Systematic Reviews 2013, Issue 6
- Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database of Systematic Reviews 2012, Issue 8.
- Wu T, Zhang J, Qiu Y, Xie L, Liu GJ. Chinese medicinal herbs for the common cold. Cochrane Database of Systematic Reviews 2007, Issue 1.
©American Rhinologic Society