Upper respiratory infection

Disease Description (Causes and Symptoms)

• Definition: Upper respiratory infections are a collective term for acute infectious inflammation involving the nose (nasal cavity), paranasal sinuses, pharynx, larynx, and upper respiratory tract structures (including acute rhinitis, acute sinusitis, acute pharyngitis, acute otitis media, and acute bronchitis).
• Causes and pathophysiology: Most are viral infections (e.g., rhinoviruses, coronaviruses, adenoviruses, influenza viruses, etc.), while bacterial causes are relatively uncommon at 5–10%. Viruses penetrate the mucous membranes and trigger an inflammatory response, leading to increased mucus secretion, mucosal swelling, and narrowing of passages, which result in symptoms.
• Main symptoms: Fever, cough, runny nose (clear or yellowish nasal discharge), nasal congestion, sneezing, sore throat, fatigue, and headache. Children may develop high fever, ear pain, and decreased feeding due to otitis media or complications.
• Course: Most improve within 7–10 days, although coughing may last longer. Some people may develop bacterial complications (such as sinusitis, otitis media, or pneumonia) or worsening of underlying conditions (such as asthma).

Treatment Methods

• General principles: Symptomatic treatment is the foundation. Antibiotics are generally not necessary (used only when bacterial complications are suspected).
• Medication treatment
  • Antipyretics and analgesics: Acetaminophen (Tylenol), ibuprofen (follow pediatric dosing instructions).
  • Decongestants (for relieving nasal congestion): Use oral medication or nasal sprays for a short period (up to 3 days is recommended). Children should follow age restrictions.
  • Saline nasal irrigation: Helps remove nasal secretions and relieve symptoms.
  • Cough medicine: Use expectorants or antitussives depending on the type of cough; caution is needed with OTC cough and cold medicines in children (especially contraindicated in children under 2 years of age).
  • Antibiotics: Consider only in the following cases — symptoms lasting more than 10 days or worsening after improvement (secondary bacterial infection), severe high fever with purulent discharge (suspected bacterial sinusitis), confirmed bacterial pharyngitis (e.g., acute streptococcal infection), otitis media, pneumonia, etc.
• Procedures/Surgery
  • Consider tonsillectomy for recurrent tonsillitis (or when it affects breathing or sleep) after consultation with a specialist.
  • If recurrent otitis media causes complications such as hearing loss, consider insertion of tympanostomy tubes, etc.
• Lifestyle management and precautions
  • Get sufficient rest and fluids, and maintain an appropriate indoor temperature and humidity.
  • Practice thorough hand hygiene and follow cough etiquette (use a tissue or your sleeve).
  • Children: Do not use aspirin (risk of Reye syndrome). Some OTC medications are restricted for children under 2 years of age.
• Prevention
  • Handwashing, cough etiquette, and minimizing contact with infected people.
  • Vaccination with the influenza vaccine (depending on age and eligibility), and COVID-19 vaccination when recommended.

Cases requiring urgent medical evaluation: Difficulty breathing, wheezing, difficulty swallowing, persistent high fever, cyanosis, severe dehydration, changes in consciousness, etc.

Outpatient Visit Checklist (Items to Prepare and Things to Check Before Visiting the Hospital)

• Items to prepare
  • List of currently taken medications (including dosage and frequency)
  • Allergy history (medications and food)
  • Bring previous test results (recent chest X-rays, blood tests, ear or throat photographs, etc.) or a medical certificate if available
  • Date symptoms and fever began and their course (important: how many days it has been since symptom onset)
• Information to record
  • Body temperature (highest recorded fever), type of cough (dry cough or accompanied by phlegm), changes in nasal discharge color, presence or absence of difficulty breathing, ear pain or hearing changes, and whether difficulty swallowing is present
  • When symptoms worsened or improved and previous treatment (whether pain relievers or antibiotics were used)
  • Underlying conditions (asthma, COPD, heart disease, diabetes, immunocompromised status), whether pregnant, and vaccination status for children
• Tests that may be performed at the hospital (prepare in advance)
  • Rapid antigen testing (for streptococcus, influenza, etc.) or PCR (if necessary)
  • Throat culture (if necessary), blood tests (for high-risk groups)
  • Auscultation, ear examination, and chest X-ray if necessary

Example questions (items to check for yourself before seeing the doctor):

• When did the symptoms begin?
• Fever pattern (intermittent/continuous) and highest temperature
• Presence or absence of difficulty breathing, wheezing, ear pain, or difficulty swallowing

Examples of General Questions to Ask the Doctor

• How can we distinguish whether these symptoms are viral or bacterial? Are antibiotics necessary?
• What are the effects and possible side effects of the prescribed medication?
• How long is it normal for the symptoms to last? How many days is it okay to wait?
• What are the warning signs of complications (such as otitis media, sinusitis, or pneumonia)?
• Are there any special lifestyle precautions or isolation recommendations for my child (or me)?

Examples of Disease-Specific Questions

• Regarding children/infants: "What signs indicate that my child is likely to develop otitis media, and when should we seek medical attention immediately?"
• Regarding recurrent pharyngitis/tonsillitis: "My tonsillitis keeps recurring. What are the criteria for considering tonsillectomy?"

(If symptoms worsen or emergency symptoms occur, an immediate visit to the emergency room is recommended: severe difficulty breathing, persistent chest pain, decreased consciousness, dehydration, inability to eat or drink, etc.)