UPPER RESPIRATORY TRACT INFECTION

WHAT IS AN UPPER RESPIRATORY TRACT INFECTION?

The respiratory system, also known as the respiratory tract, is made up of the organs we need to breathe such as the nose, throat, larynx, trachea, bronchi, and lungs.  The oxygen we breathe enters the lungs, passes into the bloodstream, and is then transported to the various cells in the body (1).

The respiratory system can be divided into upper and lower parts.  The upper respiratory tract specifically consists of the nose, nasal cavity, mouth, pharynx, and the voice box, also known as the larynx (2).

The upper respiratory tract plays an important role in immunity for the body.  When foreign matter is inhaled, the upper respiratory tract is the first place that this matter will encounter (3). The upper respiratory tract is lined with a mucous membrane that secretes mucous which functions to trap small foreign particles like smoke, pollen, and dust (2).

An upper respiratory infection (URTI) is a symptom complex typically caused by a range of different virus families including rhinovirus, coronavirus, parainfluenza, respiratory syncytial virus, adenovirus, human metapneumovirus, or influenza.  It can affect both adults and children (4).

RISK FACTORS OF UPPER RESPIRATORY TRACT INFECTION

Generally, anyone can be at risk of becoming infected with an URTI; however, certain persons are at a higher risk than others.  This includes children and older adults due to having weaker immune systems, and people with predisposed medical conditions such as heart disease, lung issues, or a weakened immune system.  Children are at a high risk especially because they are constantly interacting with other children who may be disease carriers, they don’t wash their hands frequently, and they may be more likely to rub their eyes and put their hands in their mouth (7).

SYMPTOMS OF UPPER RESPIRATORY TRACT INFECTION

• Pain, pressure, and tenderness over the affected sinus
• General discomfort
• Low-grade fever
• Sore throat
• Hoarseness
• Runny nose
• Cough (5)

UPPER RESPIRATORY TRACT INFECTION FACTS AND STATISTICS

• Upper respiratory tract infections are the most common infections among children in the United States of America (2009) (8).
• Adults have two to four URTIs annually (4).
• URTIs due to influenza have been noted to peak in winter globally (4).
• There are over 200 viruses responsible for human URTIs, but rhinoviruses are the most common cause (6).

MEDICAL TREATMENT OF UPPER RESPIRATORY TRACT INFECTION

Since viruses are what cause the majority of URTIs, the use of antimicrobial treatments is not necessary.  Instead, paracetamol and ibuprofen are the typical courses of treatment for pain relief (9).  For sinusitis, if symptoms in children are persistent and continue to get worse, bacteria may be the suspect.  Thus, a physician may prescribe amoxicillin alone or with clavulanate (9).

Other pharmacological treatments that may help relieve symptoms of URTIs include decongestants, intranasal ipratropium, cough suppressants, and vapor rubs (10).

NATURAL WAYS TO HELP SUPPORT A HEALTHY RESPIRATORY TRACT AND IMMUNE SYSTEMS

Practices to Support a Healthy Respiratory Tract and Immune System:

• Don’t smoke
• Stay hydrated (11)

Natural Supplements That Support a Healthy Respiratory Tract and Immune System:

There is limited evidence concerning the use of natural supplements for URTIs.  Some natural ingredients that may be potentially useful include:

• American Ginseng (12)
• Siberian Ginseng (13,14,15,16,17)
• Garlic (18,19)
• Andrographis (13,14,15,16,20,21)
• Umckaloabo (22,23,24)

Other ingredients may be helpful to support the immune system thus also helping to lower the risk of contracting a URTI.  These include:

• Arabinogalactans (Larch laricina) (25,26)
• Echinacea leaf (Echinacea purpurea) (27,28,29)
• Echinacea root extract (Echinacea angustifolia) (27,30)
• Olive leaf extract (Olea europaea) (31)

REFERENCES

1. Respiratory System – National Library of Medicine – PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022181/. Accessed July 20, 2018.
2. Upper respiratory tract: MedlinePlus Medical Encyclopedia Image. https://medlineplus.gov/ency/imagepages/19378.htm. Accessed July 21, 2018.
3. Parker D, Prince A. Innate immunity in the respiratory epithelium. Am J Respir Cell Mol Biol. 2011;45(2):189-201. doi:10.1165/rcmb.2011-0011RT
4. Cotton M, Innes S, Jaspan H, Madide A, Rabie H. Management of upper respiratory tract infections in children. S Afr Fam Pract. 2008;50(2):6-12.
5. Dasaraju P V., Liu C. Infections of the Respiratory System. 4th ed. University of Texas Medical Branch at Galveston; 1996. http://www.ncbi.nlm.nih.gov/pubmed/21413304. Accessed July 21, 2018.
6. Eccles R. Understanding the symptoms of the common cold and influenza. Lancet Infect Dis. 2005;5(11):718-725. doi:10.1016/S1473-3099(05)70270-X
7. Acute Respiratory Infection: Causes, Symptoms, and Diagnosis. https://www.healthline.com/health/acute-respiratory-disease#risk-factors. Accessed July 25, 2018.
8. Loo M, Loo M. Upper Respiratory Tract Infection. Integr Med Child. January 2009:450-455. doi:10.1016/B978-141602299-2.10060-X
9. Ferrara P, Cutrona C, Sbordone A. Which treatment for upper respiratory tract infections? Ital J Pediatr. 2015;41(Suppl 2):A31. doi:10.1186/1824-7288-41-S2-A31
10. Allan GM, Arroll B. Prevention and treatment of the common cold: making sense of the evidence. CMAJ. 2014;186(3):190-199. doi:10.1503/cmaj.121442
11. SATOMURA K, KITAMURA T, KAWAMURA T, et al. Prevention of Upper Respiratory Tract Infections by Gargling A Randomized Trial. Am J Prev Med. 2005;29(4):302-307. doi:10.1016/j.amepre.2005.06.013
12. McElhaney JE, Simor AE, McNeil S, Predy GN. Efficacy and Safety of CVT-E002, a Proprietary Extract of Panax quinquefolius in the Prevention of Respiratory Infections in Influenza-Vaccinated Community-Dwelling Adults: A Multicenter, Randomized, Double-Blind, and Placebo-Controlled Trial. Influenza Res Treat. 2011;2011:759051. doi:10.1155/2011/759051
13. Melchior J, Spasov AA, Ostrovskij OV, Bulanov AE, Wikman G. Double-blind, placebo-controlled pilot and Phase III study of activity of standardized Andrographis paniculata Herba Nees extract fixed combination (Kan Jang) in the treatment of uncomplicated upper respiratory tract infection. Phytomedicine. 2000;7(5):341-350. doi:10.1016/S0944-7113(00)80053-7
14. Gabrielian ES, Shukarian AK, Goukasova GI, et al. A double-blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis. Phytomedicine. 2002;9(7):589-597. doi:10.1078/094471102321616391
15. Poolsup N, Suthisisang C, Prathanturarug S, Asawamekin A, Chanchareon U. Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials. J Clin Pharm Ther. 2004;29(1):37-45.
16. Spasov AA, Ostrovskij O V., Chernikov M V., Wikman G. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang® and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phyther Res. 2004;18(1):47-53. doi:10.1002/ptr.1359
17. Narimanian M, Badalyan M, Panosyan V, et al. Randomized trial of a fixed combination (KanJang®) of herbal extracts containing Adhatoda vasica, Echinacea purpurea and Eleutherococcus senticosus in patients with upper respiratory tract infections. Phytomedicine. 2005;12(8):539-547. doi:10.1016/j.phymed.2004.10.001
18. Lissiman E, Bhasale AL, Cohen M. Garlic for the common cold. In: Lissiman E, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2012:CD006206. doi:10.1002/14651858.CD006206.pub3
19. Josling P. Preventing the common cold with a garlic supplement: a double-blind, placebo-controlled survey. Adv Ther. 18(4):189-193.
20. Bertoglio JC, Baumgartner M, Palma R, et al. Andrographis paniculata decreases fatigue in patients with relapsing-remitting multiple sclerosis: a 12-month double-blind placebo-controlled pilot study. BMC Neurol. 2016;16:77. doi:10.1186/s12883-016-0595-2
21. Saxena RC, Singh R, Kumar P, et al. A randomized double-blind placebo-controlled clinical evaluation of extract of Andrographis paniculata (KalmColdTM) in patients with uncomplicated upper respiratory tract infection. Phytomedicine. 2010;17(3-4):178-185. doi:10.1016/j.phymed.2009.12.001
22. Lizogub VG, Riley DS, Heger M. Efficacy of a Pelargonium Sidoides Preparation in Patients With the Common Cold: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Explor J Sci Heal. 2007;3(6):573-584. doi:10.1016/j.explore.2007.09.004
23. Timmer A, Günther J, Motschall E, Rücker G, Antes G, Kern W V. Pelargonium sidoides extract for treating acute respiratory tract infections. Cochrane Database Syst Rev. 2013;(10):CD006323. doi:10.1002/14651858.CD006323.pub3
24. Tahan F, Yaman M. Can the Pelargonium sidoides root extract EPs® 7630 prevent asthma attacks during viral infections of the upper respiratory tract in children? Phytomedicine. 2013;20(2):148-150. doi:10.1016/j.phymed.2012.09.022
25. Dion C, Chappuis E, Ripoll C. Does larch arabinogalactan enhance immune function? A review of mechanistic and clinical trials. Nutr Metab (Lond). 2016;13:28. doi:10.1186/s12986-016-0086-x
26. Udani JK. Immunomodulatory effects of ResistAidTM: A randomized, double-blind, placebo-controlled, multidose study. J Am Coll Nutr. 2013;32(5):331-338. doi:10.1080/07315724.2013.839907
27. Zhai Z, Liu Y, Wu L, et al. Enhancement of innate and adaptive immune functions by multiple Echinacea species. J Med Food. 2007;10(3):423-434. doi:10.1089/jmf.2006.257
28. Kim LS, Waters RF, Burkholder PM. Immunological activity of larch arabinogalactan and Echinacea: a preliminary, randomized, double-blind, placebo-controlled trial. Altern Med Rev. 2002;7(2):138-149.
29. Melchart D, Linde K, Worku F, et al. Results of Five Randomized Studies on the Immunomodulatory Activity of Preparations of Echinacea. J Altern Complement Med. 1995;1(2):145-160. doi:10.1089/acm.1995.1.145
30. Echinacea angustifolia – an overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/medicine-and-dentistry/echinacea-angustifolia. Accessed April 9, 2018.
31. Omar SH. Oleuropein in olive and its pharmacological effects. Sci Pharm. 2010;78(2):133-154. doi:10.3797/scipharm.0912-18