Lower respiratory tract infection
This is the name for infections of the airways and the lungs, the thing usually called a chest infection.
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Medicines commonly prescribed for Lower respiratory tract infection
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 500 mg paracetamolActive substance: paracetamolManufacturer: Haleon Spain S.A.Prescription not requiredDosage form: INJECTABLE, 100 mg/mlActive substance: acetylcysteineManufacturer: Kern Pharma S.L.Prescription requiredDosage form: TABLET, 650 mg paracetamolActive substance: paracetamolManufacturer: Viatris Pharmaceuticals S.L.U.Prescription required
This is the name for infections of the airways and the lungs, the thing usually called a chest infection. Behind it lie two rather different conditions: acute bronchitis, in which the inflammation goes no deeper than the bronchial tubes, and pneumonia, in which the tissue of the lung itself is involved. They begin alike, usually on the back of a cold, but they end very differently: bronchitis clears up on its own in the great majority of cases, while pneumonia needs treatment and sometimes admission to hospital. So when a cough with fever drags on, the question that matters is not which syrup to buy but whether this is still bronchitis or already pneumonia. What follows is how the two are told apart, what genuinely helps at home, and the point at which a doctor is needed.
How it usually runs
The first days look like a cold: a blocked nose, a sore throat, aching all over. Then it moves down:
- a cough, dry at first and later bringing up phlegm, worse at night and on waking;
- fever, chills, weakness, headache and muscle pain;
- tightness or rawness behind the breastbone that gets worse with coughing;
- wheezing and breathlessness on exertion.
All of this usually eases over a week to ten days, but the cough outlasts everything else: three weeks is a normal length and does not mean the treatment has failed. After the infection the lining of the airways stays irritable and answers cold air, smoke and even laughter with more coughing.
The colour of the phlegm deserves a paragraph of its own, because a great deal of nonsense surrounds it. Yellow or green does not mean antibiotics are needed: the colour comes from the cells that tackle any inflammation, viral included. How you feel and how you breathe matter far more.
What points towards pneumonia is different: fever that lasts more than three or four days or returns after a period of improvement, breathlessness at rest, faster breathing, a stabbing pain in the side on taking a deep breath, and a sense of being far more ill than with an ordinary cold. In older people the picture can be misleading — no high temperature, but confusion, unusual drowsiness or sudden weakness, which is often the only sign of pneumonia they show.
What helps at home
In ordinary bronchitis, home measures are the treatment.
- Rest, and do not carry on as though nothing has happened: the body needs that energy to recover.
- Drink enough warm fluid; it soothes the throat and makes phlegm easier to shift.
- A spoon of honey in warm water with lemon eases a cough as well as most syrups. Honey is not given to children under one year.
- Sleep propped up on extra pillows; there is less coughing that way.
- Air the room and keep it from becoming too dry, especially during the heating season.
- Ordinary fever medicines are fine for temperature and aches. Aspirin is not given to children or teenagers.
- Do not smoke and stay out of smoky rooms: this prolongs the cough directly.
What to avoid: leaning over a bowl of boiling water, since scalds from steam are a common and entirely avoidable injury, especially in children; and giving cough syrups to small children, which are not recommended under the age of six and do little at any age. Expectorants and chest rubs achieve less than a plain warm drink. If you are unsure about something bought over the counter, ask a pharmacist, particularly if you already take medicines for blood pressure or the heart.
Signs that cannot wait
Call the emergency services without hesitating if there is:
- severe breathlessness at rest, an inability to finish a sentence, fast shallow breathing;
- blue lips or skin, pallor with a mottled look;
- confusion, dullness, unusual sleepiness that is hard to rouse someone from;
- severe chest pain, particularly if it came on suddenly and without a cold beforehand;
- blood in the phlegm, beyond the odd streak after a hard bout of coughing;
- fever with cold hands and feet, no urine passed all day, a fit;
- in a child, the skin sucking in between the ribs and above the breastbone, flaring nostrils, grunting on breathing out, refusing to drink, floppiness, and in a baby pauses in breathing.
See a doctor within a day or two if you are over sixty-five, pregnant, living with chronic lung, heart, kidney or liver disease or diabetes, or have lowered immunity because of treatment; and also if the fever returns or things get worse again after several days of improvement.
Antibiotics: when they work and when they do not
The overwhelming majority of acute bronchitis is caused by viruses, and an antibiotic contributes nothing there: it does not shorten the cough by a single day, while it does cause diarrhoea, rashes and thrush and teaches bacteria to resist treatment. That is why a doctor often suggests waiting and watching. It is not a refusal of care but a considered decision.
Antibiotics are needed for pneumonia and other bacterial infections, and the choice depends on age, other conditions and what you have taken before. If they are prescribed, take them exactly as directed: do not stop at the first sign of improvement and do not stretch the course out on your own initiative. Leftover boxes from last time and the antibiotic that worked for a friend are no use, because similar symptoms come from different organisms.
To work out what is going on, the doctor listens to the chest, counts the breathing rate and measures the oxygen level in the blood. If pneumonia is suspected, a chest X-ray and blood tests may be needed, and occasionally a sample of phlegm.
When the cough will not go
A cough lasting more than three weeks is worth showing to a doctor even if you feel well otherwise. There are several causes, and not all of them are infections.
- The ordinary twitchiness of the airways left behind by the infection: it can last a couple of months and fades by itself.
- Asthma showing itself for the first time during the illness; the clue is coughing at night, in the early hours and on exercise.
- Whooping cough: bouts that end in vomiting, with a noisy gasp, going on for weeks; in vaccinated people the picture is much milder.
- A side effect of blood pressure medicines from the ACE inhibitor group, a dry nagging cough that only settles once the drug is changed.
- Acid travelling up from the stomach, and mucus dripping down the back of the throat.
- Tuberculosis: weeks of coughing, night sweats, weight loss, a low-grade fever and blood in the phlegm. It is uncommon, but it must not be missed.
- Lung cancer: the concern centres on a smoker over forty whose usual cough has changed, who has blood in the phlegm, a hoarse voice or unexplained weight loss.
What lowers the chance of it happening again
If chest infections come round every winter, the effort is better spent on prevention than on treating the latest episode.
- the yearly flu vaccination, the simplest measure with proven effect;
- pneumococcal vaccination if you are over sixty-five or live with a chronic illness; ask your doctor what applies to you;
- stopping smoking, which nothing else matches for reducing how often bronchitis strikes;
- keeping chronic conditions in order: poorly controlled asthma, chronic obstructive pulmonary disease, heart failure and diabetes each raise the risk of pneumonia on their own;
- moderation with alcohol, decent food and enough sleep;
- washing hands and staying away from other people in the first days of illness, which protects them rather more than it protects you.
Online consultation
A remote appointment answers the question of the first days well: is this still bronchitis that will settle by itself, or a picture that needs examination and an X-ray. The doctor will ask about the timeline, the fever, the breathlessness and what you can still manage, go through your long-term conditions and medicines, and explain what to watch for at home and when exactly to make contact again. It is also a convenient way to sort out a cough now in its fourth week after an infection and to decide whether tests are worth doing. The signs listed above are not for a screen: marked breathlessness, confusion or blue lips mean calling the emergency services.
This material is for information only and does not replace medical advice.
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