Acute Upper Respiratory Infection

URI is a prevalent acute illness in the general population and outpatient setting that results in missed school or work days. The incidence of URI has been increasing globally. The WHO Statistics indicate 650,000 deaths related to URI and 18.8 billion incidences of URI globally with an estimated cost exceeding $22billion annually in the United States. The WHO report indicates the prevalence of deaths related to URI is high among the elderly and low-income economies which nearly all URI related deaths among under five years’ old children occurring in developing countries (World Health Organization, 2017).

Common cold medically referred to an upper respiratory infection (URI) is a viral infection of the upper respiratory tract. URI entails an infection of any of the parts of the upper respiratory tract that includes the throat, bronchi, nose, larynx, and pharynx. URI implies that air circulation along the trachea and around the lungs is constrained which limits the respiration process. Meneghetti (2018) highlights that URI range from common colds, sinusitis, epiglottis, rhinitis, pharyngitis, tracheobronchitis to critical conditions such as epiglottitis. The type of URI is classified based on the area where the inflammation occurred. The inflammation of the nasal cavity is referred as rhinitis, infection of the sinuses referred as rhinosinusitis or sinusitis, inflammation of the sinuses positioned around the nasal referred as common colds, inflammation of the pharynx referred as pharyngitis and the inflammation of trachea referred as tracheobronchitis.

Symptoms

Given the viral nature of URI, it’s almost impossible not to contract URI. The possibility of contracting the URI is high but people with lower immune system like children, elderly, smokers, heart disease patients and lung disease patients are more prone to developing acute URI. People with chronic conditions such as hematologic disease, chronic cardiac, HIV/AIDs are at a higher risk of contracting URI. In addition, the increased exposure health care workers to patients are at a higher risk of contracting URI and transmitting it to other people (Wald, Guerra, & Byers, 2006).

Symptoms for URI include sneezing, sore throat, coughing, nasal discharge, fever, nasal congestion, and nasal breathing. Typically infants and underage children may experience a fever of high of 102°F as a result of URI, while adults with URI may or may not experience fever. URI may be indicated by thick nasal secretions and subsequently a cough related to nasal secretions. Fatigue and headache are as well a common symptom of URI. Children experience abdominal pain and rash as while they are developing URI. Patients with severe URI resulting in life-threatening epiglottis condition may exhibit symptoms such as muffled dysphonia, drooling, respiratory distress, and tender larynx. (Meneghetti, 2018).

URI is a consequence of antigenicity of several serotypes that are viral agents for URI. The antigenicity yield pathogens that compromise the immune system. Incubation period before the symptoms appear is varied depending on the nature of the pathogens with lows of 1-5 days for influenza, and even 21 days for pertussis. URI may persist to up to two weeks with the average symptoms being 7-11 days (Wald, Guerra, & Byers, 2006)

Causes

URI is a common illness that results from virus and bacterial infection that causes inflammation of mucous membranes along the throats and nose. A vast of the URI is as a result of self-limited viral infections. URI is caused by more than 200 strands of viruses including rhinovirus, respiratory syncytial virus coronavirus, adenovirus, enterovirus, parainfluenza virus among others. URI is as well associated with bacterial infection resulting from bacterial overgrowth. Bacterial infections are indicated by consistent persistent nasal discharge coupled with sores of crusts. Meneghetti (2018) notes URI causing viruses are easily transmitted across people by inhaling respiratory droplets from sneezing or coughing. The infection is also contracted from touching the mouth or nose with hands exposed to the virus. Respiratory tract obstruction and inflammation due to asthma and allergic rhinitis as well increased the risk of URI.

Highly crowded places such as schools, hospitals, train systems, child care settings, among other places increase the risk of contracting URI. Moreover, seasonal weather conditions such as winter that necessitate indoor heating favors viruses’ survival which coupled with the likelihood that people are mostly indoors increasing the risk of acute URI. The declining outdoor air quality due to increasing industrialization has increased the risk factor for acute URI.

The incidence of URI is higher in children below the age of 5 attending daycare since they easily contract the infections amongst themselves and the caregivers. According to Wald, Guerra, & Byers (2006), on average, children contract URI 3-8 times while the adults contract URI an average of 2-4 times annually (Meneghetti, 2018). Mr. Smith son, is at the age highly prone to URI, hence taking a trip with the son not only increases the probability of severe URI but also puts the family at the risk of contracting the URI.

Complications

Although independently URI hardly causes death, Wald, Guerra, & Byers (2006) cautions URI could be a gateway to susceptibility to other serious complications such as bronchitis, meningitis and pneumonia that contribute to substantial morbidity. Infection in deep tissues of the respiratory tract may extend the infection to other organs such as the middle ear, the orbit, the cranium leading to further health complexities (Meneghetti, 2018). While URI is easily treated and resolves easily, failure to manage an acute URI puts a patient in risks of extremely serious complications such as respiratory arrest, respiratory failure, and congestive heart failure. A respiratory arrest occurs when the lungs seize to function, which causes accumulation of carbon dioxide in the blood resulting in respiratory failure. Consequently failure to manage acute URI results to build up of fluids in the lungs air sacs limiting the circulation of oxygen and carbon dioxide and constraining vital body organs.

Prevention and Treatment

Simple hygiene habits can reduce the chances of acute URI. Simple habits such as hand washing, putting on mouth mask and using napkins to cover your face while sneezing and coughing are simple practices that minimize contracting and spreading of URI. While self-diagnosis of URI is simple, a physical exam is often encouraged to ascertain the severity of URI. Test such as chest x-ray, throat swab, CT scan, and lateral neck X-rays are some of the physical exams that a doctor can use to diagnose the severity of acute URI.

Non- Prescriptive Therapies

Development of vaccines to prevent URI has not realized major breakthrough yet globally. Evidence from randomized controls demonstrates an insignificant difference incidence of URI among people taking the URI vaccines and those not on vaccines (Wald, Guerra, & Byers 2006). However. The non-conventional approach of probiotics which entails consumption of microorganisms such as bifidobacteria and lactic acid bacteria is exponentially gaining momentum as a mechanism to prevent the occurrence of URI. To reduce the incidence of URI, people are frequently consuming soy yogurt, yogurt and dietary supplement rich on probiotics. Clinical trials are indicating that the priorities approach of preventing URI would be a noble way to counter the increasing resistance to antibiotics and reducing the prevalence of URI.

Wald, Guerra, & Byers (2006) recommends that people with URI take sufficient rest, stay at home and intake plenty of fluids. Mr. Smith would need to ensure the son is persistently hydrated, warmly dressed and engages in less strenuous activities. Additionally, Mr. Smith family has to observe high hygiene habits such as frequently washing their hands, and ensuring the son wears a mouth mask to prevent spreading the URI to the rest of the family members.

Prescriptive Therapies

Prescriptive URI treatment varies on the severity of the URI. The mostly low-risk group without other chronic illness are prescribed symptomatic treatment. URI treatment is mostly meant to relieve the symptom such as fever and aches, with monitoring being done by the patients themselves among adult patients and by guardians among children. On the other hand, a patient with chronic conditions or another clinical syndrome such as sepsis or pneumonia is treated with monitored antiviral drugs. Treatments span from the use of expectorants, cough suppressants, Zinc and vitamin C which reduce the duration of the symptom and often procured over the counter. Other treatments may include nasal decongestants that aids in breathing, steam inhalation, and analgesics such as NSAIDs and Acetaminophen which aid in reducing aches, fever, and pain. The Smith would need to pack, decongestants, saline nose drops and antihistamines and analgesics to relieve the URI symptoms. Further, the Smith would refer from informative medical websites such as the Kids Health (Solo- Josephson, 2017) and Medscape (Meneghetti, 2018) for an in-depth understanding of acute URI management.

Meneghetti (2018) cautions the use of aspirin to treat URI when a child has fever since the use of aspirin for a viral illness treatment has been identified to cause a deadly disorder: Reye syndrome. Pediatricians recommend preventive measures for underage children as opposed to prescription measures. Such measures include a child not being attended by a person with URI, frequent washing of hands and frequent cleaning of toys and surfaces that children are constantly touching. Although antibiotics are a common prescription for URI, the use of antibiotics is frequently discouraged to treat URI since the use of antibiotics may reduce the recovery period from some viral infections. Moreover, frequent use of antibiotics may increase bacteria resistance which reduces the effectiveness of antibiotics (Meneghetti, 2018).

References

References

Meneghetti, A. (2018, 12 21). Upper Respiratory Tract Infection. Retrieved from Medscape: https://emedicine.medscape.com/article/302460-overview#a5

Solo- Josephson, P. (2017, 06). Colds. Retrieved from Kids Health from Nemours: https://kidshealth.org/en/parents/cold.html

Wald, E., Guerra, N., & Byers, C. (2006). Upper respiratory tract infections in young children: duration of and frequency of complications. Medline, 129 – 133.

World Health Organization. (2017, 12 14). Up to 650 000 people die of respiratory diseases linked to seasonal flu each year. Retrieved from World Health Organization: https://www.who.int/news-room/detail/14-12-2017-up-to-650-000-people-die-of-respiratory-diseases-linked-to-seasonal-flu-each-year