2024 - Acute respiratory tract infections in adults

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What is it about ?

The airways are divided into upper respiratory tract (RSV) and lower respiratory tract (VRI).

RSVs are made up of the nose and throat (above the vocal cords).
IRVs are made up of the trachea, bronchi, and lung tissue (the alveoli).

This patient guide deals with IRV infections in healthy people, over the age of 16, who do not have a chronic lung condition such as asthma or COPD (chronic obstructive pulmonary disease with lung damage) and who do not have a disease that reduces their natural defenses such as AIDS.

A lower respiratory tract infection is an acute illness that lasts up to 21 days and the main symptom of which is cough. A bronchitis (bronchial infection) is usually caused by a virus and will heal on its own. In the case of a pneumonia, bacterial infection is more likely and antibiotics should be taken.

How is the diagnosis made?

The doctor diagnoses an LRTI based on a careful discussion and physical examination. He tries to determine if it is bronchitis or pneumonia. It is important for the doctor to make the correct diagnosis to avoid prescribing unnecessary antibiotics. You should know that these unnecessary prescriptions are responsible for a growing problem of resistance, which means that the bacteria become unresponsive to antibiotics.

The doctor will ask you questions about the following:

onset and duration of symptoms;
the cough ;
mucus production and appearance;
fever ;
the respiratory distress ;
chest pain;
other general symptoms such as feeling sick, muscle and joint pain, runny nose, sore throat;
other conditions such as heart, liver or kidney disease;
recent hospitalization;
the use of drugs and the possible recent use of antibiotics;
smoking;
vaccination status: vaccination against pneumococci and / or influenza.

The doctor may also ask you if:

you have recently stayed abroad;
you often come into contact with birds or livestock;
you have been exposed to water treatment systems;
you have had contact with patients with tuberculosis.

Then the doctor will examine:

your blood pressure and pulse;
your temperature;
your heart and lungs;
how often you breathe (normal or rapid);
your nose, throat and ears;
your mental state: are you absent or confused?

Based on this information, the doctor will assess the likelihood of a lower respiratory infection.

The likelihood of pneumonia is minimal when:

your pulse is normal;
your breathing is normal;
you do not have a fever;
your lung auscultation is normal;
you are alert and wide awake.

The likelihood of pneumonia is high when:

your heart rate is fast;
your breathing is rapid;
auscultation of your lungs suggests an abnormality;
you have a high fever;
you are absent or confused;
you have other concomitant conditions.

The doctor will decide on a case-by-case basis whether to start treatment immediately or whether to first order a blood test and / or an x-ray of the lungs to confirm the diagnosis.

If you have recently been hospitalized, you may have contracted a nosocomial infection (infection contracted in a health facility). If so, the doctor will always order an x-ray of the lungs to rule out this risk.

Characteristic symptoms may be absent in older patients. A deterioration in general condition or an alteration in mental status, such as confusion, can often be the only sign of the disease. An x-ray of the lungs can confirm the diagnosis.

What can you do ?

In most cases, respiratory tract infections go away on their own. Try to get plenty of rest, drink enough, and eat a healthy diet. Stop smoking. You may not be able to work. In the elderly, (temporary) household help may be useful. Not only will household chores be performed, but supervision will also be provided for part of the day.

If you have severe symptoms or have a persistent cough, see a doctor. Never take antibiotics on your own. It is very important that you take the right antibiotic at the right dose. Inadequate treatment can mask symptoms without curing the disease and promote the development of resistance to antibiotics.

Vaccination against flu is recommended for groups at risk, such as people over 65 years of age and patients with chronic heart or lung disease. It is recommended for people who have had their spleen removed and for seniors aged 65 to 85 years of age. get vaccinated against pneumococci.

What can your doctor do?

If the diagnosis of pneumonia is established, antibiotic therapy will be started.
If pneumonia is unlikely, antibiotics are not indicated.

There is not much scientific evidence to support the usefulness of cough medications in reducing symptoms or shortening the duration of the cough, but some patients feel that they are relieving their symptoms. There are different types of drugs, the effects of which are different. Dextromethorphan cough medicines may decrease the urge to cough and are therefore more suitable for dry coughs. Guaifenesin can liquefy the mucus, making it a little easier to expectorate. The usefulness of all other drugs is not convincingly proven.

There is also insufficient evidence regarding the usefulness of inhalers (puffs) in people who do not have asthma or COPD.

In severe cases, hospitalization may be required.

Is a follow-up examination necessary?

A follow-up chest x-ray is usually not necessary. The patient will be invited to come for a check-up in the following cases:

general condition deteriorates;
symptoms do not improve or new symptoms appear;
fever lasts more than a week;
there is still no improvement after 1 week;
cough is still present after 30 days and mucus production persists for more than 14 days;
it is a nosocomial infection.

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