Management of patients with chest and lower respiratory tract Disorders

Respiratory tract infections (RTIs or pokenga atewharowharo) can affect any part of your body involved in breathing, from your nose and throat down to your airways and lungs. RTIs often occur after a bout of the common cold or flu. They are easily spread in the coughs and sneezes of someone with an infection.

1. RTIs are divided into 2 categories: upper and lower.
2. Lower RTIs, such as pneumonia, tend to be more serious than upper RTIs, such as colds or a sinus infection.
3. Most upper RTIs can be treated at home, but young children, older adults, pregnant women or people with long-term health conditions who get a lower RTI may need to see a doctor.
4. You can reduce the spread of RTIs by washing your hands and covering your coughs and sneezes.
5. You can reduce your risk of catching RTIs by having an annual flu vaccination, and healthy lifestyle habits such as regular exercise, quitting smoking, eating well and getting plenty of sleep.

Upper RTIs are very common and affect your nose, sinuses, throat (pharynx) and voice box (larynx). Symptoms of upper URIs include a cough, sore throat, runny nose, nasal congestion, headache, low-grade fever and facial pressure.

Common upper RTIs include:

What are lower respiratory tract infections?

Lower RTIs are also known as chest infections. They affect your larger airways (bronchial tubes and bronchioles) and your lungs.

Lower RTIs are generally more serious than upper RTIs. Symptoms of lower RTIs include shortness of breath, weakness, fever, coughing with green or brown phlegm, and fatigue.

Common lower RTIs include: 

• bronchitis
• bronchiolitis
• pneumonia. 

Do I need to see a doctor? 

Most upper RTIs get better in 1–2 weeks. You can usually treat your symptoms at home. However, a lower RTI can be serious. Those most at risk are young children, older adults, pregnant women or people with long-term health conditions.

See a doctor if you or someone you are caring for has a respiratory tract infection and:

• feels very unwell or symptoms get worse
• has had a cough for more than 3 weeks
• is pregnant
• is over 65
• is a child under 2 years
• had a weakened immune system
• had a long-term health condition, such as diabetes, heart disease, asthma, COPD.

See a doctor immediately if you or another adult has:

• a high fever that doesn’t come down (sweating, shivering, chills)
• fast or difficult breathing
• chest pain
• signs of dehydration.

See a doctor immediately if your baby or child:

• is breathing fast or noisily or if they are wheezing or grunting
• is very pale, drowsy, limp or difficult to wake
• is severely irritable, not wanting to be held
• has dry nappies or no tears when they are crying, which means they are dehydrated
• you are worried that something is not right.

Do I need antibiotics for a respiratory tract infection?

Most upper RTIs are caused by a virus, which cannot be treated with antibiotics (these only work on bacterial infections). Your immune system will be able to fight off most viral infections. Misusing antibiotics to treat viral infections contributes to the problem of antibiotic resistance.

Some lower RTIs are caused by bacteria. If your immune system is having difficulty fighting off the infection your doctor may prescribe a course of antibiotics. 

You should always take antibiotics according to your doctor’s instructions, making sure to complete the entire course even once you’re feeling better. This helps to minimise the risk of the development of bacteria resistant to that antibiotic. 

How can I treat respiratory tract infections at home?

To help you or the person you are caring for feel more comfortable and speed your recovery, take the following self-care steps:

• Get plenty of rest.
• Drink lots of water to stay hydrated and loosen mucous.
• Take paracetamol or ibuprofen for pain and fever.
• Drink warm lemon and honey for a sore throat and cough.
• Gargle warm salty water for a sore throat.
• Take a teaspoon of honey for a cough.
• Inhale steam (adults only).
• Rub mentholated ointment onto your chest.
• Try decongestants and nasal sprays for a blocked or runny nose.
• Use a saline nose rinse for sinus congestion.
• If you have been prescribed any medications, take these as directed.

Contact your doctor immediately or call Healthline free on 0800 611 116 if you or your child have trouble breathing, have a high fever or show other signs that the infection is getting worse.

How can I avoid passing a respiratory tract infection on to others?

• Wash your hands often.
• Cover your coughs and sneezes, eg, by using your elbow.
• Use disposable tissues and put them in a bin straight away.
• Clean surfaces around the house more often.
• Stay at home if you are unwell.

How can I reduce my chance of getting a respiratory tract infection?

Vaccination can protect against certain viruses. However, not all viruses can be vaccinated against. Get the annual flu vaccination – find out if you're eligible for the free flu vaccine.

If you keep getting RTIs or you're at a high risk of getting one (eg, because you're over the age of 65 or have a serious long-term health condition) ask your GP about the pneumococcal vaccine – this helps prevent pneumonia.

Taking the following steps also reduces your risk of getting an RTI:

• wash your hands often
• avoid close contact with people who have a cold or the flu
• eat a healthy diet, get plenty of sleep and exercise regularly
• stop smoking if you smoke.

Learn more

Chest infection NHS, UK
Respiratory tract infection NHS, UK
Chest infections Better Health, Australia
Common upper respiratory tract infections Patient Info, UK

Reviewed by

Dr Helen Kenealy is a geriatrician and general physician working at Counties Manukau DHB. She has a broad range of interests and has worked in a variety of settings including inpatient rehabilitation, orthgeriatrics and community geriatrics.