Upper Respiratory Infection: Prevention and Treatment

Covering the mouth and nose when coughing and sneezing, washing hands appropriately, and avoiding touching one’s eyes and nose are the most effective preventive strategies.

Moderation in exercise may help immunity. There is a high incidence of upper respiratory infection in endurance athletes, due to impairments in neutrophil function, reductions in serum and mucosal immunoglobulin production, and, possibly, natural killer cell cytotoxicity. In contrast, moderate physical activity either has a null or a stimulant effect on these parameters.^2,3

Individuals who have more frequent or long–lasting periods of psychological stress are at greater risk for upper–respiratory infection. In this population, studies have shown an increase in certain proinflammatory cytokines (eg, interleukin–6)⁴ or a reduction in mucosal production of secretory immunoglobulin A (sIgA).⁵ Although further research is required, some studies have found that stress management techniques (cognitive–behavioral therapy, progressive muscle relaxation, focused breathing, relaxation, guided imagery) increase the production of sIgA and reduce the number of sick days.^5,6

When cold symptoms occur, only symptomatic treatment is beneficial. There are no specific treatments for URIs, such as antibiotics. Heated and humidified air may improve symptoms.⁷ The following agents may also be helpful:

• Decongestants. A brief course of pseudoephedrine may be of benefit, as may topical nasal decongestant sprays. However, topical agents should only be used for 2 to 3 days, as they cause tachyphylaxis, and extended use of pseudoephedrine is unlikely to be helpful. In general, it is best to avoid nasal sprays, except perhaps for sleep. Pseudoephedrine taken with an antihistamine is more effective than when taken alone. Data are lacking on decongestant use in children.⁸
• Intranasa cromolyn sodium and ipratropium bromide may reduce the severity of cold symptoms. Cromolyn sodium can also be inhaled.
• Antihistamines. Clemastine fumarate improves sneezing and rhinorrhea,⁹ and diphenhydramine may also be effective. Both drugs cause sedation and anticholinergic effects and should be used with caution in elderly patients or in individuals taking other anticholinergic agents. Several other antihistamines are also available without a prescription.
• Analgesics. Acetaminophen, aspirin, and ibuprofen may improve sore throat symptoms and myalgias. Their use for mild fever is unnecessary. Aspirin should not be used in children with an acute viral illness, due to the risk of Reye’s syndrome.
• Evidence supporting mucolytics, such as guaifenesin, and anti–tussives, such as dextromethorphan and codeine, is varied and inconclusive.¹⁰ Their use may benefit certain patients, but more research is needed to make global recommendations. Caution: Codeine may be habit–forming.
• Antibiotics should be considered or used only for specific bacterial infections, such as sinusitis, streptococcal pharyngitis, otitis media, and bronchitis. In the case of bronchitis, they should not be used unless the cough is persistent or the patient has underlying lung disease. Not all cases of otitis media and sinusitis require antibiotics. Unnecessary prescribing increases the likelihood of antibiotic resistance.

Antibacterial cleaning products do not affect disease transmission, and may also cause bacterial resistance. Phenol/acetate sprays for household use do have virucidal qualities.

Complications of upper respiratory illness include sinusitis, asthma exacerbation, otitis media , and other respiratory illnesses. See the chapters on these conditions for more information.