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==Treatment==
==Treatment==
Treatment depends on the underlying cause. There are currently no medications or herbal remedies which have been conclusively demonstrated to shorten the duration of illness.<ref>{{cite journal | last1 = Smith | first1 = SM | last2 = Schroeder | first2 = K | last3 = Fahey | first3 = T | last4 = Smith | first4 = Susan M | title = Over-the-counter medications for acute cough in children and adults in ambulatory settings | journal = Cochrane database of systematic reviews (Online) | issue = 1 | pages = CD001831 | year = 2008 | pmid = 18253996 | doi = 10.1002/14651858.CD001831.pub3 | editor1-last = Smith | editor1-first = Susan M }}</ref> Treatment comprises symptomatic support usually via [[analgesics]] for headache, sore throat and muscle aches.<ref>^ "Common Cold: Treatments and Drugs". Mayo Clinic. http://www.mayoclinic.com/health/common-cold/DS00056/DSECTION=treatments-and-drugs. Retrieved 09 January 2010.</ref>
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.<ref>{{cite journal | last1 = Smith | first1 = SM | last2 = Schroeder | first2 = K | last3 = Fahey | first3 = T | last4 = Smith | first4 = Susan M | title = Over-the-counter medications for acute cough in children and adults in ambulatory settings | journal = Cochrane database of systematic reviews (Online) | issue = 1 | pages = CD001831 | year = 2008 | pmid = 18253996 | doi = 10.1002/14651858.CD001831.pub3 | editor1-last = Smith | editor1-first = Susan M }}</ref> Treatment comprises symptomatic support usually via [[analgesics]] for headache, sore throat and muscle aches.<ref>^ "Common Cold: Treatments and Drugs". Mayo Clinic. http://www.mayoclinic.com/health/common-cold/DS00056/DSECTION=treatments-and-drugs. Retrieved 09 January 2010.</ref>


There is no evidence to support the age-old advice to rest when you are sick with an upper respiratory illness. Moderate exercise in sedentary subjects with a URI has been shown to have no effect on the overall severity and duration of the illness. Based on these findings, it was concluded that previously sedentary people who have acquired a URI and who have initiated an exercise program may continue to exercise.<ref name="pmid12893713">{{cite journal |author=Weidner T, Schurr T |title=Effect of exercise on upper respiratory tract infection in sedentary subjects |journal=Br J Sports Med |volume=37 |issue=4 |pages=304–6 |year=2003 |month=August |pmid=12893713 |pmc=1724675 |doi= 10.1136/bjsm.37.4.304|url=}}</ref> Getting plenty of sleep; however, is advisable since even mild sleep deprivation has been shown to be associated with increased susceptibility to infection.<ref>"Effects of sleep on the production of cytokines in humansPsychosomatic Medicine", Vol 57, Issue 2 97-104</ref><ref>Behavioural Brain Research Volume 69, Issues 1-2, July–August 1995, Pages 43-54 The Function of Sleep</ref> Increasing fluid intake, or "drinking plenty of fluids" during a cold is not supported by medical evidence, according to a literature review published in the British Medical Journal.<ref>BMJ. 2004;328:499-500</ref>
There is no evidence to support the age-old advice to rest when you are sick with an upper respiratory illness. Moderate exercise in sedentary subjects with a URI has been shown to have no effect on the overall severity and duration of the illness. Based on these findings, it was concluded that previously sedentary people who have acquired a URI and who have initiated an exercise program may continue to exercise.<ref name="pmid12893713">{{cite journal |author=Weidner T, Schurr T |title=Effect of exercise on upper respiratory tract infection in sedentary subjects |journal=Br J Sports Med |volume=37 |issue=4 |pages=304–6 |year=2003 |month=August |pmid=12893713 |pmc=1724675 |doi= 10.1136/bjsm.37.4.304|url=}}</ref> Getting plenty of sleep; however, is advisable since even mild sleep deprivation has been shown to be associated with increased susceptibility to infection.<ref>"Effects of sleep on the production of cytokines in humansPsychosomatic Medicine", Vol 57, Issue 2 97-104</ref><ref>Behavioural Brain Research Volume 69, Issues 1-2, July–August 1995, Pages 43-54 The Function of Sleep</ref> Increasing fluid intake, or "drinking plenty of fluids" during a cold is not supported by medical evidence, according to a literature review published in the British Medical Journal.<ref>BMJ. 2004;328:499-500</ref>

Revision as of 23:22, 24 November 2011

Upper respiratory tract infection
SpecialtyPulmonology Edit this on Wikidata

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.[1]

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.

Pain and pressure of the ear caused by a middle ear infection (Otitis media) and the reddening of the eye caused by viral Conjunctivitis are often associated with upper respiratory infections.

URI, seasonal allergies, influenza: symptom comparison
Symptoms Allergy URI Influenza
Itchy, watery eyes Common Rare (conjunctivitis may occur with adenovirus) Soreness behind eyes, sometimes conjunctivitis
Nasal discharge Common Common Common
Nasal congestion Common Common Sometimes
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 Rare 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)
Malaise Sometimes Sometimes Very common
Fatigue, weakness Sometimes Sometimes Very common, can last for weeks, extreme exhaustion early in course
Muscle pain Never Slight Very common, often severe

Cause

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.[2]

Up to 15% of acute pharyngitis cases may be caused by bacteria, commonly Group A streptococcus in Streptococcal pharyngitis ("Strep Throat").[3]

Influenza (the flu) is a more severe systemic illness which typically involves the upper respiratory tract. Influenza is a relatively uncommon cause of influenza-like illness.

Prevention

Probiotics may be useful in preventing URTIs.[4]

Treatment

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.[5] Treatment comprises symptomatic support usually via analgesics for headache, sore throat and muscle aches.[6]

There is no evidence to support the age-old advice to rest when you are sick with an upper respiratory illness. Moderate exercise in sedentary subjects with a URI has been shown to have no effect on the overall severity and duration of the illness. Based on these findings, it was concluded that previously sedentary people who have acquired a URI and who have initiated an exercise program may continue to exercise.[7] Getting plenty of sleep; however, is advisable since even mild sleep deprivation has been shown to be associated with increased susceptibility to infection.[8][9] Increasing fluid intake, or "drinking plenty of fluids" during a cold is not supported by medical evidence, according to a literature review published in the British Medical Journal.[10]

Antibiotics

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.[11] 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.[12] 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.[13]

Decongestants

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.[14] Oral decongestants are, also, contraindicated in patients with hypertension, coronary artery disease, and history of bleeding strokes.[15][16]

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.[17]

The benefits versus risk of nasal irrigation are currently unclear and therefore is not recommended.[18]

Epidemiology

Disability-adjusted life year for upper respiratory infections per 100,000 inhabitants in 2002.[19]
  no data
  less than 10
  10-30
  30-60
  60-90
  90-120
  120-150
  150-180
  180-210
  210-240
  240-270
  270-300
  more than 300

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.[20]

See also

References

  1. ^ 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. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  2. ^ 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.
  3. ^ Bisno, AL. Acute pharyngitis. N Engl J Med 2001; 344:205.
  4. ^ Hao, Q (2011 Sep 7). Dong, Bi Rong (ed.). "Probiotics for preventing acute upper respiratory tract infections". Cochrane database of systematic reviews (Online). 9: CD006895. doi:10.1002/14651858.CD006895.pub2. PMID 21901706. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  5. ^ Smith, SM; Schroeder, K; Fahey, T; Smith, Susan M (2008). Smith, Susan M (ed.). "Over-the-counter medications for acute cough in children and adults in ambulatory settings". Cochrane database of systematic reviews (Online) (1): CD001831. doi:10.1002/14651858.CD001831.pub3. PMID 18253996.
  6. ^ ^ "Common Cold: Treatments and Drugs". Mayo Clinic. http://www.mayoclinic.com/health/common-cold/DS00056/DSECTION=treatments-and-drugs. Retrieved 09 January 2010.
  7. ^ Weidner T, Schurr T (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. {{cite journal}}: Unknown parameter |month= ignored (help)
  8. ^ "Effects of sleep on the production of cytokines in humansPsychosomatic Medicine", Vol 57, Issue 2 97-104
  9. ^ Behavioural Brain Research Volume 69, Issues 1-2, July–August 1995, Pages 43-54 The Function of Sleep
  10. ^ BMJ. 2004;328:499-500
  11. ^ Reveiz L, Cardona AF, Ospina EG (2007). Reveiz, Ludovic (ed.). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (2): CD004783. doi:10.1002/14651858.CD004783.pub3. PMID 17443555.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ Spurling GK, Del Mar CB, Dooley L, Foxlee R (2007). Spurling, Geoffrey KP (ed.). "Delayed antibiotics for respiratory infections". Cochrane Database Syst Rev (3): CD004417. doi:10.1002/14651858.CD004417.pub3. PMID 17636757.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ^ Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, Garcia-Aymerich J, Barnes NC (2006). Ram, Felix SF (ed.). "Antibiotics for exacerbations of chronic obstructive pulmonary disease". Cochrane Database Syst Rev (2): CD004403. doi:10.1002/14651858.CD004403.pub2. PMID 16625602.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ 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.
  15. ^ 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.
  16. ^ Common cold. In: Covington TR, ed. Nonprescription Drug Therapy. St Louis, Mo: Facts & Comparisons; 2002:743-769.
  17. ^ Douglas RM, Hemilä H, Chalker E, Treacy B (2007). Hemilä, Harri (ed.). "Vitamin C for preventing and treating the common cold". Cochrane Database Syst Rev (3): CD000980. doi:10.1002/14651858.CD000980.pub3. PMID 17636648.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ^ Kassel, JC (2010-03-17). King, David (ed.). "Saline nasal irrigation for acute upper respiratory tract infections". Cochrane database of systematic reviews (Online) (3): CD006821. doi:10.1002/14651858.CD006821.pub2. PMID 20238351. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  19. ^ "Mortality and Burden of Disease Estimates for WHO Member States in 2002" (xls). World Health Organization. 2002.
  20. ^ 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.

External links

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