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Family Health Magazine
FAMILY MEDICINE

Respiratory Tract Infections
Identifying and treating them

Respiratory tract infections (RTI’s) including common colds and ear, sinus or lung infections are usually caused by a virus. Over 200 different viruses can cause a cold, and some people are more prone to colds than others. A child attending pre-school may catch as many as eight colds in a year.

Sometimes viral cold symptoms may lead to more serious symptoms and bacterial infections. If you are unsure or if your symptoms worsen, please see your family doctor. The information in this article will help you to distinguish between viral infections, which don’t need antibiotics, and bacterial infections, which often need antibiotics.

Why aren’t antibiotics used for viral infections?

• Antibiotics do not kill viruses.
• Antibiotics encourage the growth of more resistant bacteria (superbugs).
• Subsequent infections with these resistant bacteria are more difficult to treat.

Health care professionals often suggest annual flu shots and a pneumonia shot every five to 10 years to prevent infections in people prone to infections as well as for those in close contact with people who have chronic illnesses.

Colds

Symptoms of a cold include:

• a scratchy, sore throat
• sneezing
• nasal discharge, which is watery at first, then thick
• extreme tiredness
• muscle aches
• low grade fever
• an overall sick feeling

A cold usually runs its course without any complications in one to two weeks. If you have cold symptoms lasting longer than two weeks, or if they are getting worse before one to two weeks are up, talk to your doctor.

Sinus Infections

How do I know if I have a sinus infection?

A cold that starts to get better and then gets worse may be a sign of a sinus infection. Pain that is only on one side of your face, or pain that starts when you lean forward, can also be a sign of acute sinusitis.

Other symptoms include a fever, thick green or yellow nasal mucus, and an ache in your upper teeth.

How can I treat my sinus infection?

• Get plenty of rest. When you go to sleep, try lying on the side that is least congested (where you can breathe the best).
• Sip hot liquids and drink plenty of fluids.
• Apply moist heat by holding a hot, wet towel against your face or breathe in steam. If you are inhaling steam, be sure to cover your entire face with a cloth or towel first, so you don’t burn yourself.
• Use over-the-counter (OTC) medications such as acetaminophen (e.g. Tylenol™) for pain. Do not take acetylsalicylic acid (e.g. Aspirin™) if you are allergic to it or are under age 20.
• Talk with your doctor before using cold remedies, as some can make a sinus infection worse by drying out the mucus membranes and blocking sinus openings. Other medicines might disturb your sleep, make you nervous, or raise your blood pressure or pulse.
• If you use a nose spray with a decongestant in it, don’t use it for more than three days. If you use it longer, your nasal swelling may get worse when you stop the medicine.

Do I need antibiotics?

Some sinus infections get better on their own while others need to be treated with an antibiotic. Your doctor will do a thorough assessment and examination to decide if a virus is causing the illness. Remember that viral illnesses are not treated with antibiotics. If your doctor decides that you have a sinus infection caused by bacteria (acute bacterial sinusitis), antibiotics might be given.

Ear Infection

How do I know if my child has an ear infection?

Ear infections usually affect small children and are often accompanied by a runny nose, cough, irritability and a slight fever.

What should I do?

Take your child’s temperature with a thermometer and record it. If it is above 38.5°C try to reduce the fever and see your family doctor. If the fever is less than 38.5°C try to reduce it on your own with home remedies.

Tips to reduce fever

• Undress your child.
• Give your child a lukewarm bath.
• Provide cool drinks and popsicles.
• Acetaminophen (e.g. Tylenol™, Tempra™) is usually all that is needed to help with pain and fever.
• If your child does not seem to be getting better after 24 to 72 hours, see your doctor.

Does my child need antibiotics?

Your doctor will do a thorough assessment and examination to decide if a virus is causing the illness. Viral illnesses are not treated with antibiotics and most children get better within two to three days. An antibiotic may be given if your child is not better within two to three days and your doctor decides that a bacterial ear infection is present. If your child is less than two years old, your doctor may choose to treat with antibiotics sooner.

Sore Throat

What causes sore throats (also known as pharyngitis)?

Viruses are responsible for most sore throats but bacteria also cause some. The most common of the bacteria that cause a sore throat is called Group A Strep. A sore throat caused by this bug is often called 'Strep throat.'

When should I see my doctor about my sore throat?

If you have a sore throat with a runny nose or cough, then you probably just have a cold. If you have a sore throat for two or more days, without a runny nose or cough, then you may have Strep throat and you should see your doctor. Your doctor must do a throat swab to diagnose Strep throat. The results of the throat swab will be available within 48 to 72 hours. Most sore throats get better on their own, but if the throat swab shows Strep throat, your doctor will give you a prescription for antibiotics.

Bronchitis

How do I know if I have acute bronchitis?

Acute bronchitis is an infection of the tubes that carry air from the mouth and nose to the lungs (bronchial tree). When these tubes get infected, they swell and mucus forms (mucus is the material that comes up when you cough). The swelling of the tubes makes it more difficult for you to breathe and may make you wheeze.

When should I see my doctor about my acute bronchitis?

If your cough lasts more than one month or you continue to have a fever, you should see your doctor. You should also see your doctor if you cough up blood, if you have trouble breathing only when you lie down, or if your feet swell.

Viruses cause acute bronchitis, so antibiotics are not helpful. Even when the mucus you cough up is coloured or thick, antibiotics probably won’t help you get better faster. If you smoke, you should cut down on your number of cigarettes or stop smoking altogether.

How do I know if I have chronic bronchitis?

With chronic bronchitis, mucus cannot be cleared from the airways in your lungs. Instead of helping to clean the lungs, the mucus blocks the airway. Bacteria can then settle in the airways and cause infection. The signs of chronic bronchitis are a continual cough and mucus production that lasts for at least three months each year, for two years in a row. Children do not get chronic bronchitis.

How will my doctor treat my chronic bronchitis?

The treatment of chronic bronchitis is aimed at reducing irritation in the airways. Inhalers (like Ventolin™) may be prescribed to help relax and open up air passages in the lungs. Some of these drugs can be inhaled and others taken as pills. Your doctor may also prescribe antibiotics if it is suspected that you have a bacterial infection. Most people with chronic bronchitis do not need to take antibiotics continually.

Viral Pneumonia

Pneumonia is a serious infection or inflammation of the lungs. It is not a single disease and can have over 30 different causes, but half of all pneumonias are believed to be caused by viruses.

Early symptoms

• flu-like symptoms
• fever
• dry cough
• headache
• muscle pain
• weakness

Within 12 to 36 hours

• increasing breathlessness
• cough becomes worse
• small amounts of mucus produced
• high fever
• sometimes blueness of the lips

Bacterial Pneumonia

Sometimes, bacteria cause pneumonia. Streptococcus pneumonia is the most common of these bacteria, but it is the one form of pneumonia for which a vaccine is available. The vaccine (Pneumovax) is recommended for anyone aged 65 and older, or people with diabetes or heart failure, or those whose immune (defence) system is not working well (immunocompromised). The symptoms of bacterial pneumonia can come on gradually or suddenly and include:

• shaking, chills
• severe chest pain
• cough that produces rust-coloured or greenish mucus
• fever (about 38.5°C or higher)
• sweating
• rapid breathing

If you have symptoms of pneumonia, call your doctor immediately.

How will my doctor treat my pneumonia?

In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia and speed recovery. There is not yet a general treatment for viral pneumonia. Most people can be treated at home. Besides antibiotics, treatment includes proper diet and oxygen (when needed). In some people, medication
to provide relief from coughing may be given.

Tips to prevent pneumonia

• Get a flu shot every fall.
• If you are at high risk for getting pneumonia (over the age of 65, have diabetes or heart failure, or are immunocompromised) talk to your doctor about the vaccine against pneumococcal pneumonia (Pneumovax).

Where can I get more information about respiratory tract infections?

• See your doctor.
• Ask your doctor for the patient brochures developed by the Alberta Clinical Practice Guidelines Program on sinusitis, sore throats, ear infections, bronchitis and pneumonia.