Upper respiratory tract infection
|Upper respiratory tract infection|
|Classification and external resources|
Upper respiratory tract infections (URI or URTI) are the illnesses caused by an acute infection which involves the upper respiratory tract: nose, sinuses, pharynx or larynx. This commonly includes: tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and the common cold.
Common URI terms are defined as follows:
- Rhinitis - Inflammation of the nasal mucosa
- Rhinosinusitis or sinusitis - Inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid
- Nasopharyngitis (rhinopharyngitis or the common cold) - Inflammation of the nares, pharynx,hypopharynx, uvula, and tonsils
- Pharyngitis - Inflammation of the pharynx, hypopharynx, uvula, and tonsils
- Epiglottitis (supraglottitis) - Inflammation of the superior portion of the larynx and supraglottic area
- Laryngitis - Inflammation of the larynx
- Laryngotracheitis - Inflammation of the larynx, trachea, and subglottic area
- Tracheitis - Inflammation of the trachea and subglottic area
Signs and symptoms 
Acute upper respiratory tract infections include rhinitis, pharyngitis/tonsillitis and laryngitis often referred to as a common cold, and their complications: sinusitis, ear infection and sometimes bronchitis (though bronchi are generally classified as part of the lower respiratory tract.) Symptoms of URI's commonly include cough, sore throat, runny nose, nasal congestion, headache, low grade fever, facial pressure and sneezing. Onset of symptoms usually begins 1–3 days after exposure. The illness usually lasts 7–10 days.
Group A beta hemolytic streptococcal pharyngitis/tonsillitis(strep throat) typically presents with a sudden onset of sore throat, pain with swallowing and fever. Strep throat does not usually cause runny nose, voice changes or cough.
|Itchy, watery eyes||Common||Rare (conjunctivitis may occur with adenovirus)||Soreness behind eyes, sometimes conjunctivitis|
|Sneezing||Very common||Very common||Sometimes|
|Sore throat||Sometimes (postnasal drip)||Very common||Sometimes|
|Cough||Sometimes||Common (mild to moderate, hacking)||Common (dry cough, can be severe)|
|Headache||Uncommon||Sometimes (sinus pressure headache)||Common|
|Fever||Never||Rare in adults, possible in children||Very common (100-102°F (or higher in young children), lasting 3–4 days; may have chills)|
|Fatigue, weakness||Sometimes||Sometimes||Very common, can last for weeks, extreme exhaustion early in course|
|Muscle pain||Never||Slight||Very common, often severe|
Over 200 different viruses have been isolated in patients with URIs. The most common virus is called the rhinovirus. Other viruses include the coronavirus, parainfluenza virus, adenovirus, enterovirus, and respiratory syncytial virus.
Treatment depends on the underlying cause. There are currently no medications or herbal remedies which have been conclusively demonstrated to shorten the duration of the illness. Treatment comprises symptomatic support usually via analgesics for headache, sore throat and muscle aches.
Moderate exercise in sedentary subjects with naturally acquired URTI probably does not alter the overall severity and duration of the illness. Getting plenty of sleep; however, is advisable since even mild sleep deprivation has been shown to be associated with increased susceptibility to infection. No randomized trials have been conducted to ascertain benefits of increasing fluid intake. 
Judicious use of antibiotics can decrease unnecessary adverse effects of antibiotics as well as out-of-pocket costs to the patient. But more importantly, decreased antibiotic usage will prevent the rise of drug resistant bacteria, which is now a growing problem in the world. Health authorities have been strongly encouraging physicians to decrease the prescribing of antibiotics to treat common upper respiratory tract infections because antibiotic usage does not significantly reduce recovery time for these viral illnesses. Some have advocated a delayed antibiotic approach to treating URIs which seeks to reduce the consumption of antibiotics while attempting to maintain patient satisfaction. Most studies show no difference in improvement of symptoms between those treated with antibiotics right away and those with delayed prescriptions. Most studies also show no difference in patient satisfaction, patient complications, symptoms between delayed and no antibiotics. A strategy of "no antibiotics" results in even less antibiotic use than a strategy of "delayed antibiotics". However, in certain higher risk patients with underlying lung disease, such as chronic obstructive pulmonary disease (COPD), evidence does exist to support the treatment of bronchitis with antibiotics to shorten the course of the illness and decrease treatment failure.
According to a Cochrane review single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults; however, "there is insufficient data on the use of decongestants in children." Therefore decongestants are not recommended for use in children under 12 years of age with the common cold. Oral decongestants are also contraindicated in patients with hypertension, coronary artery disease, and history of bleeding strokes.
Alternative medicine 
The use of Vitamin C in the inhibition and treatment of upper respiratory infections has been suggested since the initial isolation of vitamin C in the 1930s. Some evidence exists to indicate that it could be justified in persons exposed to brief periods of severe physical exercise and/or cold environments.
Transmission is via respiratory droplets or by virus-contaminated hands. Upper respiratory tract (nose, throat, sinuses) mucosa inflammation causes increased secretions, rhinorrhea and results in sneezing, and coughing facilitating the spread.
In United States URIs are the most common infectious illness in the general population. URIs are the leading reasons for people missing work and school. URI is the leading diagnosis in the office setting.
See also 
- Eccles MP, Grimshaw JM, Johnston M, et al. (2007). "Applying psychological theories to evidence-based clinical practice: Identifying factors predictive of managing upper respiratory tract infections without antibiotics". Implement Sci 2: 26. doi:10.1186/1748-5908-2-26. PMC 2042498. PMID 17683558.
- Viruses and Bacteria in the Etiology of the Common Cold Mika J. Mäkelä, Tuomo Puhakka, Olli Ruuskanen, Maija Leinonen, Pekka Saikku, Marko Kimpimäki, Soile Blomqvist, Timo Hyypiä, and Pertti Arstila J Clin Microbiol. 1998 February; 36(2): 539–542.
- Bisno, AL. Acute pharyngitis. N Engl J Med 2001; 344:205.
- Hao, Q; Lu, Z, Dong, BR, Huang, CQ, Wu, T (2011 Sep 7). "Probiotics for preventing acute upper respiratory tract infections". In Dong, Bi Rong. Cochrane database of systematic reviews (Online) 9 (9): CD006895. doi:10.1002/14651858.CD006895.pub2. PMID 21901706.
- Smith, SM; Schroeder, K; Fahey, T; Smith, Susan M (2008). "Over-the-counter medications for acute cough in children and adults in ambulatory settings". In Smith, Susan M. Cochrane database of systematic reviews (Online) (1): CD001831. doi:10.1002/14651858.CD001831.pub3. PMID 18253996.
- ^ "Common Cold: Treatments and Drugs". Mayo Clinic. http://www.mayoclinic.com/health/common-cold/DS00056/DSECTION=treatments-and-drugs. Retrieved 09 January 2010.
- Weidner T, Schurr T (August 2003). "Effect of exercise on upper respiratory tract infection in sedentary subjects". Br J Sports Med 37 (4): 304–6. doi:10.1136/bjsm.37.4.304. PMC 1724675. PMID 12893713.
- "Effects of sleep on the production of cytokines in humansPsychosomatic Medicine", Vol 57, Issue 2 97-104
- Behavioural Brain Research Volume 69, Issues 1-2, July–August 1995, Pages 43-54 The Function of Sleep
- BMJ. 2004;328:499-500
- Reveiz L, Cardona AF, Ospina EG (2007). "Antibiotics for acute laryngitis in adults". In Reveiz, Ludovic. Cochrane Database Syst Rev (2): CD004783. doi:10.1002/14651858.CD004783.pub3. PMID 17443555.
- Spurling GK, Del Mar CB, Dooley L, Foxlee R (2007). "Delayed antibiotics for respiratory infections". In Spurling, Geoffrey KP. Cochrane Database Syst Rev (3): CD004417. doi:10.1002/14651858.CD004417.pub3. PMID 17636757.
- Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, Garcia-Aymerich J, Barnes NC (2006). "Antibiotics for exacerbations of chronic obstructive pulmonary disease". In Ram, Felix SF. Cochrane Database Syst Rev (2): CD004403. doi:10.1002/14651858.CD004403.pub2. PMID 16625602.
- Spurling GKP, Del Mar C, Dooley L, Foxlee R. Delayed antibiotics for respiratory infections. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004417. doi:10.1002/14651858.CD004417.pub3.
- Tietze KJ. Disorders related to cold and allergy. In: Berardi RR, ed. Handbook of Nonprescription Drugs. 14th ed. Washington, DC: American Pharmacists Association; 2004:239-269.
- Common cold. In: Covington TR, ed. Nonprescription Drug Therapy. St Louis, Mo: Facts & Comparisons; 2002:743-769.
- Douglas RM, Hemilä H, Chalker E, Treacy B (2007). "Vitamin C for preventing and treating the common cold". In Hemilä, Harri. Cochrane Database Syst Rev (3): CD000980. doi:10.1002/14651858.CD000980.pub3. PMID 17636648.
- Kassel, JC; King, D, Spurling, GK (2010-03-17). "Saline nasal irrigation for acute upper respiratory tract infections". In King, David. Cochrane database of systematic reviews (Online) (3): CD006821. doi:10.1002/14651858.CD006821.pub2. PMID 20238351.
- "Mortality and Burden of Disease Estimates for WHO Member States in 2002" (xls). World Health Organization. 2002.
- 1.Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2006 Summary. Hyattsville, MD: National Center for Health Statistics; 2008. National health statistics reports.
- The Flu and Cold: Tips on Prevention and Feeling Better
- Upper Respiratory Tract Infection from Cleveland Clinic Online Medical Reference