Upper respiratory infection
Background
- Infection and inflammation of the upper respiratory tract, typically self-limiting
- May involve any portion of the upper airway, thus causing rhinitis, sinusitis, pharyngitis, or laryngitis, etc
- A variety of viruses and bacteria can cause an URI
- Rhinovirus is most common cause[1]
- Other causes include: coronavirus, adenovirus, influenza, Respiratory syncytial virus, adenovirus, enterovirus, parainfluenza
- Pathophys: Aerosolized (droplet and airborne) transmission, deposition in the nasopharyngeal mucosa, hours-days incubation period, host inflammatory response leading to symptoms
- Although aerosol transmission predominates, contact (ex. hand to eye) transmission is also common
Clinical Features
- Common cold[2]
- Sore throat
- Malaise
- Low-grade fever
- Fevers are more common in pediatrics than adults
- Cough (usually 24-48 hrs later)
- Postinfectious cough can last for weeks after other symptoms have resolved
- Rhinorrhea
- Nasal congestion
- Sneezing
- Myalgia
- Hoarse voice
- Depending on the organism, typically symptoms peak by day 3 or 4, resolve by day 7
Differential Diagnosis
Influenza-Like Illness
- Influenza
- Parainfluenza
- URI
- Pneumonia
- Sinusitis
- Toxic exposure
- Pyelonephritis
- Bronchitis
- Coronavirus
Cough
Acute (< 3 wks)
- URI (rhinitis, sinusitis, pertussis)
- LRI (bronchitis, pneumonia)
- Influenza
- Allergy
- Asthma
- Environmental irritants
- Transient airway hyperresponsiveness
- Foreign body
- SARS
Chronic (> 8 wks)
- Postinfectious; pertussis
- Smoking and/or chronic bronchitis
- Postnasal discharge
- Asthma
- GERD
- ACEI/ARB
- CHF
- Lung cancer or intrathoracic mass
- Emphysema
- Interstitial lung disease
- Psychiatric
Evaluation
- Clinical diagnosis
- Depending on provider preference, can send viral panels, but this often doesn't change management
- Exceptions: Tamiflu for flu, paxlovid for COVID, etc
- Rule out other serious causes of this presentation, such as pneumonia, bacterial sinusitis, epiglottitis, etc
Management
- Supportive care and symptomatic relief are the mainstays of management
- Analgesics, including ibuprofen and acetaminophen[3]
- Nasal decongestants[4]
- Oral decongestants such as pseudoephedrine may be used, but contraindicated in systemic hypertension
- Topical decongestants: Nasal saline spray and oxymetazoline spray can reduce nasal passageway resistance
- Avoid oxymetazoline use in children due to risk of unintended a2-agonism; limit number of days to <3 to prevent rhinitis medicamentosa
- Antitussives have equivocal evidence but may be trialed for symptomatic relief[5]
- Cough suppressants: Dextromethorphan or Benzonatate; avoid in young children
- Cough expectorant: Guaifenesin
- Topical anesthetics for sore throat: Benzocaine, menthol lozenges
- Avoid prescribing antibiotics[6]
- Mucolytics: little evidence to support usage
- Bronchodilators if wheezing present
Disposition
- Outpatient
See Also
External Links
References
- ↑ Tallman TA. Acute Bronchitis and Upper Respiratory Tract Infections. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011
- ↑ Tallman TA. Acute Bronchitis and Upper Respiratory Tract Infections. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011
- ↑ Kim SY, Chang YJ, Cho HM, Hwang YW, Moon YS. Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database Syst Rev. 2015 Sep 21;2015(9):CD006362. doi: 10.1002/14651858.CD006362.pub4. PMID: 26387658; PMCID: PMC10040208.
- ↑ Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD009612. doi: 10.1002/14651858.CD009612.pub2. PMID: 27748955; PMCID: PMC6461189.
- ↑ Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev. 2014 Nov 24;2014(11):CD001831. doi: 10.1002/14651858.CD001831.pub5. PMID: 25420096; PMCID: PMC7061814.
- ↑ Choosing Wisely. Infectious Diseases Society of America. http://www.choosingwisely.org/clinician-lists/infectious-diseases-society-antbiotics-for-upper-respiratory-infections/