A guide to common respiratory illnesses prevalent at this time of year
With South Africa, and particularly the Highveld nearing the end of the coldest part of the winter, many among us may believe that the flu season is well behind us. The reality is that, as the seasons and weather patterns start changing and even throughout the warmer months, many people will unfortunately still find themselves falling ill with respiratory ailments.
The colder weather and great sport on television at present – think of the Rio 2016 Olympic Games, for example – means that people are often congregating indoors. Being in such close proximity of others makes it much easier for illness-causing viruses and bacteria to take hold. While traditional wisdom asserts that there is no cure for the common cold, Dr Neville Wellington, managing practitioner at Medicross Kenilworth in the Cape, cautions that some respiratory conditions can lead to serious complications if they do not receive the necessary medical attention and if the body is not given a chance to recover.
Antibiotics, can it offer a cure-all?
“The reality is that, as doctors, we have a fairly hard time convincing patients that they usually do not need antibiotics,” says Dr Wellington. “Antibiotics are prescribed too often. If a patient does not respond to treatment as predicted, more antibiotics may be prescribed, when time is often the best healer.”
Dr Wellington says antibiotics should be used cautiously and only when they are really required. Antibiotics are best suited to treat bacterial infections and not illnesses that are caused by a virus like common colds, flu, most sore throats or runny noses. These are often best treated using a more conservative approach.
“Because of pressure from patients, and the time it takes to educate them that they don’t really need antibiotics, some doctors may choose the path of least resistance, which is to prescribe antibiotics. However, in the case of a viral infection such as influenza, antibiotics is not the correct form of treatment. Hence, the symptoms can last from a week to 10 days even if a patient had taken antibiotics and often, when the patient does not feel better in two to three days, they may ask the doctor to prescribe a different antibiotic. Unfortunately, all this does is fuel the resistance to antibiotics,” cautions Dr Wellington.
“However, some ear infections, severe sinus, throat and chest infections, as well as urinary tract and many wound and skin infections tend to be of bacterial nature and will need to be treated with antibiotics,” he adds.
According to Dr Wellington the role of the family practitioner in identifying the need to prescribe antibiotics, when appropriate, should not be underestimated. “Correctly diagnosing clinical symptoms goes a long way in the management and treatment of illness,” says Dr Wellington.
“It is, for example, sometimes difficult to tell the difference between a viral or bacterial tonsillitis. In this instance most doctors would prescribe an antibiotic. The risk of having a virulent streptococcal throat infection which may cause rheumatic fever is a concern and, in light of this, prescribing antibiotics is necessary and has helped to reduce the incidence of this disease, which can cause severe damage to the heart.”
“In an ideal world we should be taking swabs of throats, sputum samples, urine samples or blood cultures, to accurately confirm a bacterial infection before deciding to use an antibiotic. Tests would also confirm if the bacteria is sensitive to the suggested antibiotic,” notes Dr Wellington.
Too much of a good thing!
The problem with the overuse of antibiotics is that continuous usage breeds more virulent bacterial strains which then become more resistant to the medication. Eventually these require stronger drugs to be developed to treat disease. Unfortunately, new antibiotics are not being produced fast enough while many bugs are becoming increasingly more resistant to the antibiotics we do have available.
For Dr Wellington the answer lies in rather using fewer antibiotics in order to help slow down the formation of more hardy and difficult to treat bacteria. “Ideally, the newer antibiotics should be reserved for serious infections like pneumonias, abscesses or severe tonsillitis.”
Most people cannot differentiate between the different types of respiratory illnesses. To assist in this, Dr Wellington provided a snapshot of some of the more common winter ailments.
A common seasonal infection, which can exist either on its own or as a symptom of flu, is sinusitis. This may be caused by an upper respiratory tract infection, which may be either bacterial or viral in nature. Sinusitis usually results in fever, blocked nose, headache, facial pain, and may be accompanied by a nasal discharge.
“Many patients think they have sinusitis, but in reality, in GP practice, we see far less cases of sinusitis when we do further confirmatory tests, like x-rays. Not every runny nose is sinusitis,” says Dr Wellington.
He however warns of the possible complications that may arise from this condition: “If sinuses are very blocked and fluid is not expelled, infections can occur within the sinus passageways which can become dangerous, even resulting in abscesses. In order to avoid this, doctors may request an x-ray or CT scan to establish whether there is fluid in the sinuses that needs draining. Unmanaged bouts of sinusitis may progress to chronic sinusitis, which may necessitate a referral to an ear, nose and throat [ENT] specialist.”
Sinus infections are conventionally treated with decongestants and a 10 to 14 day course of antibiotics. However, if the patient suffers allergic congestions then antihistamine or nasal steroid sprays may be used on a regular basis.
While the sinuses are often affected by the upper respiratory system, they can in turn have an effect on the health of the lower respiratory system. A post-nasal drip, if not attended to early on, is likely to result in a cough. There is, however, a difference between a persistent cough, lasting three to four weeks, and a chronic cough typically lasting more than three months.
There are several methods of conventional treatment for coughs, ranging from steam inhalation to cough mixtures or antibiotics, depending on the underlying cause and degree of severity. A visit to the doctor is recommended if a cough persists for more than three weeks so that the condition can be assessed, usually through x-rays. “The lungs are vital organs and any indication of a medical condition affecting the lungs should never be taken lightly, especially as we have such a high incidence of TB in the country,” explains Dr Wellington.
Another common ailment that occurs most frequently in winter is the general chest infection. Bronchitis and pneumonia are the most serious forms of chest infections. “Pneumonia is more dangerous than bronchitis as it involves the lung tissue itself. Different strains of pneumonia can have different levels of impact on a person’s health, and while it is thought of as a treatable illness, there are some serious cases which are fatal,” says Dr Wellington.
Pneumonia is more dangerous in individuals with underlying health conditions, but can also take its toll on an otherwise healthy person. Symptoms of fever, cough, chest pain and difficulty breathing develop fairly early following infection, and your doctor may be able to recognise pneumonia on examination through characteristic sounds in your chest. In order to positively diagnose pneumonia, however, chest x-rays may be necessary.
As pneumonia can quickly turn dangerous, it is imperative that the patient receives antibiotics as soon as possible. The doctor may prescribe faster working, intravenous antibiotics or oxygen, and the patient may require hospitalisation.
“Smokers are at increased risk of developing pneumonia and it may take them longer to successfully overcome this serious infection. This is another good reason for smokers to seek help to quit this unhealthy habit,” Dr Wellington advises.
“Many of these ailments, if left unattended, can develop into severe medical conditions. It is therefore recommended that anyone experiencing symptoms of these illnesses consult a doctor, follow their prescribed treatment to the letter, drink plenty of water and rest.”
“In the case of most viral infections, people should monitor their condition for a few days before seeking medical attention. If a patient does not have a fever, preferably confirmed with a good quality thermometer or fever scanner, has a clear nasal discharge, has a non-productive cough, and no aches and pains below the neck, they can wait at least three to five days to see if symptoms improve or worsen,” concludes Dr Wellington.