Respiratory tract infection, upper (URI or URTI)

• Rhinitis
• Rhinosinusitis
• Sinusitis
• Nasopharyngitis
• Pharyngitis
• Epiglottitis
• Laryngitis
• Laryngotracheitis
• Tracheitis

• 465.9 Acute upper respiratory infections of unspecified site
• PT diagnoses/treatment diagnoses that may be associated with respiratory disorders
  • 780.7 Malaise and fatigue
  • 786.0 Dyspnea and respiratory abnormalities
  • 786.05 Shortness of breath

• J06.9 Acute upper respiratory infection, unspecified

• 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated With Airway Clearance Dysfunction
• 6F: Impaired Ventilation and Respiration/Gas Exchange Associated With Respiratory Failure

Description

• Non-specific term for acute infections in the nose, paranasal, sinuses, pharynx, larynx, trachea, and bronchi
• Viruses are the main cause

Essentials of Diagnosis

• Diagnosis is based upon clinical manifestation2
• Sinusitis and acute bronchitis usually occur after a common cold

General Considerations

• Influenza is a systemic illness involving the respiratory tract that is separate from URI
• Spread by aerosol, droplet, hand-to-hand contact
• Antibiotics have no to limited role in the treatment of the common cold or URI2

Demographics

• Across the lifespan

Signs and Symptoms1

• Edema
• Nasal congestion
• Sneezing
• Headache
• Local swelling
• Fever
• Sore throat
• Chest tightness
• Wheezing
• Cough
• Shoulder raised to allow increased lung air flow
• Shortness of breath
• Tensed muscles from dyspnea

Functional Implications

• Disabling dyspnea when performing simple tasks such as
  • Arm elevation to reach into cabinet
  • Decreased exercise tolerance
• Patients with mononucleosis should avoid contact sports for 6 weeks as fear of splenic rupture

Possible Contributing Causes

• Smoking
• Cocaine use
• Air pollution
• Long-term exposure to lung irritants
• Environmental irritants
• Periodontal disease
• Deviated septum
• Immunodeficiency disorders

Differential Diagnosis

• Influenza
• Measles
• Asthma
• Chickenpox
• Gastroesophageal reflux disease
• Ludwig’s angina
• Bronchiectasis
• Adult cystic fibrosis
• Kawasaki disease
• Pneumonia
• Goiter
• Bronchitis
• Asthma (reversible)
• Central airway obstruction
• Lung tumor
• Tuberculosis

Laboratory Tests

• Viral culture
• Nasopharyngeal swab for influenza

Imaging

• Chest radiograph
• CT for sinuses

• Acute sinusitis on CT will show complete opacification and air-fluid level1

• For imaging, x-ray
• Medication: anti-inflammatory agents, bronchodilators, expectorants, antihistamines, or vaccines
• Surgical consult, deviated septum
• Ear, nose, and throat (ENT) physician
• Pulmonologist

• Exercise limitation
• Shortness of breath
• Limited endurance capacity

• Increased fluid intake
• Smoking cessation
• Manual sinus drainage
• Coughing techniques
• Pulmonary rehabilitation (PR)
  • Enhances the patient’s sense of well-being
  • Improves exercise capacity
• Inspiratory muscle training (IMT)

• Improve oxygenation
  • Achieved by
    • Reducing airway edema secondary to inflammation and bronchospasm
    • Facilitating elimination of bronchial secretions
    • Preventing/treating respiratory infection
    • Increase exercise tolerance
    • Avoid irritants/allergens
    • Relieve anxiety/treat depression
    • Improve muscle oxidative capacity
• Patient will be able to
  • Ambulate more than 600 m in a ...