Chest and throat infections - diagnosis and treatment
Depending on the site of the infection, there are different names used.
- Pharyngitis: inflammation in the mouth - the back of the mouth and throat is sore, red and inflamed.
- Tonsillitis: again the tonsils can be easily seen in some people, especially children, as cherry red lumps at the back of the mouth (so long as the mouth can be opened wide enough). With acute tonsillitis (and/or glandular fever) they may have white spots of pus on them. If the tonsillitis does not settle within a week, then blood test for glandular fever. Recurrent tonsillitis is often a symptom of allergy to dairy products.
- Epiglottitis: a nasty and dangerous throat infection which may cause severe difficulty breathing, noisy breathing (stridor), hoarseness, drooling and difficulty swallowing. Don't try to look in the throat: just movement of the jaw can precipitate a serious relapse. Professional help needed urgently.
- Laryngitis causes a hoarse voice in adults and often croup in children. Again croup is a nasty thing, once the cough is heard it is instantly recognisable. Treatment is with inhaled steroids (or oral steroids, say 20-40 mgs, but takes 2-6 hours to work) to reduce the laryngeal oedema. Sometimes just steam will relieve the cough (hot steamy bathroom or basin of hot water and towel over the head!).
- Otitis media: ear infections. Sometimes I think all mums should be issued with auroscopes so they can check ears! An ear infection is a common cause of illness in children, often secondary to chronic catarrh. Again I usually treat with antibiotics. Try to avoid using pain killers because they have the undesirable effect of bringing the temperature down: running a temperature is the body's way of killing infection. Warm olive oil poured into the ear often relieves pain.
If any of these problems are recurrent think of allergy! The commonest cause is dairy products. Indeed a colleague of mine who is a paediatrician considers it medical negligence to perform a tonsilectomy in a child without first doing a dairy free diet.
- Bronchiolitis: children only. Causes fast breathing rate and fever and other respiratory symptoms. May need hospital admission. Contact a doctor if there is respiratory distress.
- Bronchitis: often follows a cold "which goes onto the chest". Presents with productive cough, illness, fever and sometimes shortness of breath.
- Bronchiectasis: usually an acute flare on a chronic condition. Patients with bronchiectesis I give an emergency supply of antibiotics so they can take them at the first sign of a flare.
- Pneumonia: may present with fever, cough, shortness of breath, feeling very ill, pleuritic chest pain and signs of collapse or shock. Pneumonia can be fatal: get a doctor to see.
- Pleurisy: characterised by pain in the chest when a deep breath is taken. Pleuritic type chest pain can also be caused by pulmonary embolus or pneumonia, so professional help should be sought!
- Tuberculosis: can present with any of the above symptoms.
For all cases: In the early stages, treat all respiratory infections as per Viral infections - avoid them and treat them aggressively with high dose vitamin C, vitamin A, zinc and echinacea and/or propolis, along with good nursing care and rest. Allow, indeed encourage, the patient to run a fever since this kills bugs. Do not use paracetomol or aspirin unless the temperature is above 40�c or there is a history of febrile convulsions.
When to ask for professional help?:
- If there is pleuritic chest pain, or severe chest pain.
- If there is stridor: noisy breathing when inhaling and exhaling.
- Drooling and/or difficulty swallowing.
- If there is undue shortness of breath and/or wheeze, for example difficulty talking.
- Hallitosis, discoloured sputum.
- If the patient is obviously ill or running a high temperature which does not come down after a few hours.
- Throat, tongue or lip swelling
Is there wheeze and shortness of breath?
If so, see Acute asthma
Are antibiotics needed?
It is impossible to say whether infection is due to virus or bacteria just by looking.
One obvious sign is hallitosis. Often the patient notices this first: a foul smelling breath on exhalation. As a child I had mild asthma, but I knew exactly when there was infection simply by the smell. I also used to baby sit for two children with cystic fibrosis who were very prone to chest infections and I knew exactly from the smell in the house how ill they were.
Sputum changing colour: if the patient coughs up discoloured sputum, either yellow or green or rusty coloured, this suggests infection. Sputum culture: this is worth doing because if antibiotics are prescribed on a "best guess" basis and the patient is no better then at least one can see from the sputum culture whether there is a bug and if so to which antibiotic it is sensitive.
Slow to recover?
Simple viral infections usually last a few days, then there is recovery. If the symptoms persist for more than 7 days then it is likely that secondary infection with bacteria has taken place.
Is there lung damage already present?
If so, (eg smokers, chronic asthmatics, bronchiectesis) then I would have a lower threshold for prescribing antibiotics.
Sometimes it is an "old friend" rearing its ugly head and the patient knows exactly which antibiotic does the trick. I usually prescribe on a best guess and take sputum cultures so that if there is no response, I can check to see if an appropriate antibiotic has been prescribed. I like all my patients who are prone to chest infections to hold a supply of the correct antibiotic so they can use it to nip problems in the bud!
Antibiotics are a two edged sword. Whilst they do have side effects, untreated bacterial lung infections leave damaged lung behind which is more likely to get infected in the future. Antibiotics do have a role to play! Whenever antibiotics are given, always use probiotics - this is to protect the gut and prevent opportunistic infections with candida or clostridium difficile.
When to use steroids?
Again these are a two edged sword because they may be essential in reducing "useless" and life threatening swelling as can occur in acute allergic attacks, acute asthma and occasionally croup. However they also suppress the immune system and stop the body responding appropriately to infections: therefore often antibiotic cover is required. Seek professional advice!
To prevent chest infections
KEEP WARM - bacteria and viruses flourish in the cold.
A recent article suggested that colds and infections are more common in the winter, not because it is cold, but because there is no sunshine and we become vitamin D deficient. Vitamin D is highly protective against infection. Take at least 2,000 i.u. daily and up to 5,000 i.u. - I do!
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