Respiratory tract infection (RTI) refers to a range of infections that can occur in the upper and lower respiratory tract. The upper respiratory tract covers the airway above the glottis (vocal chords) including the larynx, pharynx, sinuses and nose, while the lower respiratory tract (below the glotffftis) includes the trachea, bronchial tubes, bronchia and lungs. Infections are usually sub-classified by these areas (URTI and LRTI), although one of the most common RTIs, influenza, affects both the upper and lower respiratory tracts.([FOOTNOTE=Taubenberger JK, Morens DM. The pathology of influenza virus infections. Annu Revu Pathol. 1998;3:499-522.],[ANCHOR=],[LINK=])
Upper respiratory tract infections tend to be less severe than lower; for example tonsillitis, laryngitis and the common cold are URTIs, while bronchitis and pneumonia are LRTIs. Europe and in particular the UK see high mortality from diseases of the respiratory system, particularly in the elderly.([FOOTNOTE=Millett ERC, Quint JK, Smeeth L, et al. Incidence of Community-Acquired Lower Respiratory Tract Infections and Pneumonia among Older Adults in the United Kingdom: A Population-Based Study. Heimesaat MM, ed. PLoS ONE. 2013;8(9):e75131.],[ANCHOR=],[LINK=])
Most Upper Respiratory Tract Infection (URTIs) are viral, but they can also be bacterial([FOOTNOTE=Bosch A. T. M., Biesbroek G., Trzcinski K., Sanders E.A.M., Bogaert D.* Viral and Bacterial Interactions in the Upper Respiratory Tract. Plos Pathog. 2013;9(1): e1003057],[ANCHOR=],[LINK=]), fungal([FOOTNOTE=Chowdhary A, Agarwal K, Meis JF. Filamentous fungi in respiratory illness. What lies beyond Aspergillosis and Mucormycosis? Plos Pathog. 2016; 12(4):e1005491],[ANCHOR=],[LINK=]) or helminth([FOOTNOTE=Craig J.M., Scott, A.L. Helminths in the lungs. Parasite Immunology. 2014; 36:463–474],[ANCHOR=],[LINK=]) in origin. They are thought to be the most common infectious illness in the general population, and also the leading reason for individuals to miss work and school. The result of an upper respiratory tract infection can include:
Lower respiratory tract infections (LRTIs) is the fifth-leading cause of death, as well as the leading infectious cause of death worldwide.([FOOTNOTE=GBD 2015 LRI Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infectionsin 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 2017; 17: 1133–61.],[ANCHOR=],[LINK=]) The most common LRTI is pneumonia, which sees LTRI often used as a synonym, but in reality LRTI can refer to other types of infection, including lung abscess and acute bronchitis.
RTI illnesses share many symptoms and signs, most notably sneezing, sore throat, cough, nasal congestion and discharge, and some malaise, muscle fatigue and pain. Symptoms of itchy, watery eyes, fever and headache may point toward an allergy or influenza rather than a URTI.
Risk factors for URTIs can be the following:
The seriousness of LRTIs necessitates rapid and accurate diagnosis of the infection in order to minimise its effects.
Diagnosis of an RTI can be achieved through a physical examination, as outward signs and symptoms will generally be enough to indicate the presence of an infection. Diagnosing the specific type of infection is more difficult, however, and may necessitate swab, imaging, blood or pulmonary function tests([FOOTNOTE=Woodhead M, Blasi F, Ewig, S. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26: 1138–1180.],[ANCHOR=],[LINK=]), particularly in the case of serious lower respiratory tract infections.
Courses of treatment for respiratory tract infections vary as greatly as the conditions that the umbrella term covers. A mild URTI will not require any medical intervention, while a serious LRTI will often lead to hospitalisation.
URTI treatments target the underlying cause with first-line medications, supplemented with decongestants and cough medicines to reduce discomfort. Antibiotics have historically been used to treat common URTIs, but health authorities are now discouraging their use because they do not significantly reduce recovery time for these viral illnesses.([FOOTNOTE=Reveiz L, Cardona AF. Antibiotics for acute laryngitis in adults. The Cochrane Database of Systematic Reviews (5): CD004783.],[ANCHOR=],[LINK=]),([FOOTNOTE=World Health Organization. Global action plan on antimicrobial resistance 2015.],[ANCHOR=Available at],[LINK=http://apps.who.int/iris/bitstream/handle/10665/193736/9789241509763_eng.pdf?sequence=1 ])
LRTI treatments are specific to each condition. Pneumonia treatment is guided by the patient’s CURB-65 score([FOOTNOTE=Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 58 (5): 377–82.],[ANCHOR=],[LINK=]), lung abscess is treated primarily by broadspectrum antibiotics, pulmonary physiotherapy and postural drainage, and acute bronchitis is largely self-limiting.