What Is a Lower Respiratory Tract Infection

As summer turns to fall and then to winter, coughs and sniffles start to set in and circulate. Respiratory infections can be divided intoupper respiratory infections(colds, runny noses, sore throats, and sinus) and lower respiratory tract infections.

Most of these infections are caused by viruses. And, most of these infections are mild and can be treated at home.

But sometimes, lower respiratory tract infections, or LRTIs, require a visit to a healthcare professional or treatment in the hospital. Here's how to understand the difference between different types of lower respiratory tract infections, and what kind of treatment they require.

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Types of lower respiratory tract infections

Thelower respiratory tractis made up of the windpipe (trachea), large airways of the lungs (bronchi), small airways of the lungs (bronchioles), and air sacs of the lungs (alveoli). The lower respiratory tract is important in delivering oxygen to the blood.

During colder months, the lower respiratory tract can become infected with viruses and, sometimes, bacteria. This results in a few different types of lower respiratory infections.

BronchitisBronchitisis a common type of respiratory tract infection. It's defined as inflammation of the large airways of the lung. Bronchitis happens most of the time in older children and adults, but it can affect all ages. People with bronchitis oftendescribe itas having a chest cold.

PneumoniaPneumoniais an infection of the air sacs of the lungs. Pneumonia can affect people of any age. It can be very serious in older people, babies, and those with a weakened immune system. There are various causes of pneumonia, and pneumonia can have a wide range of symptoms - from mild to life-threatening.

Bronchiolitis Bronchiolitis is inflammation of the small airways of the lungs. This illness is more common in infants and toddlers under 2 years old. Bronchiolitis is one of thetop reasonsfor hospitalization in small children during the fall and winter months.

Bronchitis vs. pneumonia vs. bronchiolitis

 	Likely cause	Usually affects	Common symptoms	Treatment	Timeline to recovery
Bronchitis	Virus	Older children and adults	Cough, chest pain, fatigue, congestion	OTC decongestants, antiviral medication	1 to 2 weeks
Pneumonia	Virus or bacteria	Any ages	Fever, cough, shortness of breath, chest pain	Antibiotics, if bacterial	2 to 4 weeks
Bronchiolitis	Virus	Infants and young children	Congestion, cough, fever, labored breathing	Supportive care, may need oxygen in the hospital in severe cases	7 to 10 days

Lower respiratory infections vs. upper respiratory infections

The difference between lower respiratory tract infections andupper respiratory tractinfections (URTI) is the location of the infection and symptoms.

The upper respiratory tract is made up of the nose, sinuses, throat, and voice box. Symptoms of URTIs include sneezing, runny nose, sore throat, and sinus pressure. Different types of URTIs include:

• Sinusitis
• Common cold
• Pharyngitis
• Laryngitis

Causes of lower respiratory infections

The number onecause of lower respiratory tract infectionsare viruses that invade the respiratory tract. Bacteria are the next most common cause. Let's look at the causes of different types of lower respiratory tract infections.

Bronchitis The most common cause of bronchitis are viruses, specifically the viruses that cause influenza ("the flu") and the rhinovirus (which causes the common cold).

PneumoniaBacteria and viruses(and fungi) can all cause pneumonia. The most common bacteria to cause pneumonia is calledStreptococcus pneumoniae. Thepneumonia vaccineprotects against this bacteria.

The most common viruses to cause pneumonia are influenza viruses, the virus that causesCOVID-19(SARS-CoV-2), and respiratory syncytial virus (RSV). There are vaccines that protect against all of these viruses.

Bronchiolitis The most common cause of bronchiolitis ischildhood RSV. The best thing you can do to protect your young child is to getvaccinated against RSVduring your third trimester of pregnancy.

Other viruses that cause bronchiolitis include rhinovirus, coronaviruses, human metapneumovirus, adenovirus, and parainfluenza virus.

Symptoms of lower respiratory infections

Common symptoms of all lower respiratory tract infections are cough, fever, chest discomfort, and shortness of breath. Depending on the type of illness, your age, and other medical problems, these symptoms can be more or less severe.

Bronchitis Typical symptoms of bronchitis include:

• Cough
• Muscular chest pain
• Fatigue
• Mild shortness of breath

A bronchitis cough can be dry or bring up mucus. The cough usually lasts 1 to 3 weeks and is the last symptom to go away. Bronchitis symptoms are often mild enough to be treated at home.

But, in a person with a lung condition like asthma or chronic obstructive pulmonary disease (COPD), it can lead to a severe illness that needs hospitalization. Older age, having a weakerimmune system, and smoking increase the chances of severe illness.

Pneumonia Typical symptoms of pneumonia are:

• Fever
• Cough
• Shortness of breath
• Chest pain
• Fatigue

A viral pneumonia has a more dry cough (without mucus), and the symptoms tend to be mild to moderate. Bacterial pneumonia is more likely to cause more severe symptoms, such as fever and cough with mucus. Viral pneumonia tends to go away on its own, while bacterial pneumonia gets worse without antibiotic treatment.

Pneumonia can be mild, often referred to as a "walking pneumonia," but it can also send you to the hospital on a ventilator - and everything in between.

You should always get emergency medical care for signs of severe pneumonia, including:

• Difficulty catching your breath
• Intense chest pain
• A high fever that won't come down
• A cough that's getting worse
• Extreme fatigue, weakness, or drowsiness

This is especially true for older people (over 65 years) and young children (2 years and under), people with chronic health conditions or a weakened immune system, and pregnant women.

BronchiolitisBronchiolitisusually starts as a common cold in the first 2 to 3 days.

Early symptoms include:

• Nasal congestion
• Runny nose
• Cough
• Fever

On days 3 through 5, the illness will reach its peak severity. At this stage, a child may start breathing faster than normal, using their rib and neck muscles to breathe, and having trouble feeding and playing. If these symptoms happen, the child needs to be seen by a doctor or other healthcare professional immediately.

Diagnosing and treating lower respiratory tract infections

In most cases, lower respiratory tract infections can be diagnosed clinically. This means that a trained healthcare professional, like a doctor or physician assistant (PA), can make the diagnosis by asking about your symptoms and listening to your lungs.

More testing or imaging may be needed, for example:

• A chest X-ray or CT scan to diagnose pneumonia
• Nasal swabs to detect respiratory viruses

Medications for lower respiratory tract infections

The best medications to treat a lower respiratory tract infection will depend on which type you have, what's likely causing it, your own health, and the symptoms you're experiencing. Let's take a look.

Bronchitis There's no specific treatment for bronchitis, only supportive care to relieve symptoms, such as:

• Over-the-counter (OTC) decongestants likeguaifenesincan help thin mucus, making it easier to cough up phlegm.
• Albuterolinhalers and oral steroids such asprednisonefor bronchitis may be helpful for those withasthma.
• If your bronchitis could be caused by the flu virus (influenza), anantiviral medicationlikeTamiflumay be prescribed.

Even without treatment, bronchitis usually goes away on its own in most healthy people within 1 to 3 weeks. Because most cases of bronchitis are caused by viruses (not bacteria), antibiotics are not helpful.

Pneumonia Treatment for pneumonia is less clear-cut. It depends on the likely underlying cause - whether it's viral or bacterial. Viral pneumonia doesn't require any specific medication, only supportive care. But pneumonia caused by a bacteria needs treatment with antibiotic medication.

But, it's possible to have a bacterial pneumonia on top of a viral one. And the flu can cause pneumonia, too. So in some cases,antiviral medications to treat the flumay be prescribed.

Common antibiotics for bacterial pneumonia include:

• Amoxicillin
• Augmentin
• Azithromycin
• Levofloxacin

Pneumonia that causes breathing difficulty or worsens despite oral antibiotics may require treatment in the hospital with intravenous (IV) antibiotics.

Bronchiolitis There's no specific treatment for bronchiolitis. Treatment involves keeping a child well-hydrated and comfortable.

• For infants with nasal congestion, saline drops and a suction bulb can help to clear their nose to improve their breathing.
• Baby acetaminophen(Tylenol) can help lower a fever.
• If a child is wheezing, analbuterolnebulizer may help.
• When a child is having difficulty breathing, treatment with oxygen may need oxygen support andhospitalization.

Mild to moderate bronchiolitis symptoms usually go away after 7 to 10 days.

Frequently asked questions

How do you tell if a respiratory infection is viral or bacterial?expand_more The simple answer is you can't. Not accurately. Certain types of respiratory infections are more likely to be viral or bacterial. And at certain times of life, and in certain seasons, healthcare professionals can make educated guesses about whether an infection is most likely to be viral or bacterial.

Most upper respiratory infections, bronchitis, and bronchiolitis are likely to be viral. Sinusitis and pneumonia can be either bacterial or viral, or both at the same time. If your symptoms are getting worse instead of better after 7 to 10 days, or they improved but then got worse again, then you could have a bacterial infection that requires antibiotics.

If you're hospitalized with a pneumonia, there are specialized tests that can diagnose a bacterial or a viral pneumonia - but these tests are not usually done during a routine checkup.

How long should a lower respiratory infection last?expand_more

How contagious is a lower respiratory infection?expand_more

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" data-qa="ContentCalloutH2Title" The bottom line

Lower respiratory illnesses are very common, particularly during the colder months of the year. They can affect people of all ages, but older people, younger children, and people with underlying medical conditions are most at risk.

Most lower respiratory tract infections are caused by common circulating respiratory viruses and don't need specific treatment. Pneumonia and bronchiolitis (in young children) are an exception: Both can make you very unwell, very fast. If you or your child have symptoms of severe respiratory infection, you need to get emergency medical care.

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