Health Library Respiratory Problems, Age 12 and OlderFrom Healthwise

Most adults and older children have several respiratory infections each year. Respiratory problems can be as minor as the common cold or as serious as pneumonia. They may affect the upper respiratory system (nose, ears, sinuses, and throat) or the lower bronchial tubes and lungs. See a picture of the respiratory system.

Upper respiratory system

The upper respiratory system includes the nose, ears, sinuses, and throat. When you have an upper respiratory infection, you may feel uncomfortable, have a stuffy nose, and sound very congested. Other symptoms of an upper respiratory infection include:

• Facial pain or pressure.
• A runny or stuffy nose, which may lead to blockage of the nasal passages and cause you to breathe through your mouth.
• A sore throat.
• Irritability, restlessness, poor appetite, and decreased activity level.
• Coughing, especially when lying down.
• Fever that occurs suddenly and may reach 103 °F (39 °C) or higher.

Lower respiratory system

The lower respiratory system includes the bronchial tubes and lungs. Respiratory problems are less common in the lower respiratory system than upper respiratory system.

The symptoms of a lower respiratory (bronchial tubes and lungs) problem usually are more severe than symptoms of an upper respiratory (ears, nose, sinuses, and throat) problem.

Symptoms of lower respiratory system infections include:

• Cough, which continues throughout the day and night, often producing green, yellow, brown, or gray mucus (sputum) from the lungs.
• Fever, which may be high with some lower respiratory system infections, such as pneumonia.
• Difficulty breathing. You may notice:
  • Shortness of breath.
  • Grunting, which is heard during the breathing out (exhaling) phase of breathing.
  • Wheezing.
  • Flaring the nostrils and using the neck, chest, and abdominal muscles to breathe, causing a "sucking in" between or under the ribs (retractions).
• Chest pain with exertion or when you take a deep breath.

Respiratory problems may have many causes.

Viral infections

Viral infections are the most common cause of upper respiratory symptoms. Symptoms of a viral illness often come on quickly (over hours to a day or two) without prior illness. Common viral illnesses include colds and influenza (flu).

• Colds are minor upper respiratory illnesses that usually go away without treatment. Symptoms may include cough, mild sore throat, nasal congestion, runny nose or sneezing, and occasionally a fever of 101 °F (38 °C) or lower.
• Influenza (flu) symptoms are usually more severe than a cold. The key symptoms in adults are fever, often 104 °F (40 °C) or higher, and body aches. Headache, eye pain, muscle aches, and cough are also common. For more information, see the topic Influenza.

Antibiotics are not used to treat viral illnesses and do not alter the course of viral infections. Unnecessary use of an antibiotic exposes you to the risks of an allergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.

Severe acute respiratory syndrome (SARS) is caused by a type of coronavirus, a family of viruses that often cause mild to moderate upper respiratory illness, such as the common cold. For more information, see the topic Severe Acute Respiratory Syndrome (SARS).

Bacterial infections

Bacterial infections may develop after a viral illness, such as a cold or influenza, and are less common than viral illnesses. Bacterial infections may affect the upper or lower respiratory system. Symptoms tend to localize to one area. In the upper respiratory system, the most common sites of bacterial infections are the ears, sinuses, and throat. In the lower respiratory system, the most common sites are the bronchial tubes (bronchitis) and the lungs ( pneumonia).

Bacterial infections are more common in smokers, people exposed to secondhand smoke, and people with chronic lung disease (such as asthma or chronic obstructive pulmonary disease [ COPD]) and other chronic medical problems. Antibiotics can effectively treat most bacterial infections.

Allergies

Allergies, especially hay fever, are another common respiratory problem. Symptoms include sneezing, clear runny drainage from the nose and eyes, itchy eyes or nose, and stuffy, congested ears and sinuses. The symptoms of allergies often last longer than a typical viral respiratory infection. For more information, see the topic Allergic Rhinitis.

Asthma

Asthma is a chronic disease of the respiratory system. It causes inflammation and narrowing in the tubes that carry air to the lungs (bronchial tubes). The inflammation leads to difficulty breathing, wheezing, tightness in the chest, and cough.

Asthma often begins during childhood and may last throughout a person's life. The cause of asthma is not clearly known. It is more common in people who also have allergies. For more information, see the topic the topic Asthma in Children or Asthma in Teens and Adults.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

• Breathing stops.

  Note:

  After calling 911 or other emergency services, see the topic Dealing With Emergencies.
• Moderate to severe difficulty breathing occurs.
• Difficulty breathing and choking on an object in the windpipe occurs.

  Note:

  If choking is present, go to the topic Choking Rescue Procedure. Do not perform the Heimlich maneuver if the person is still coughing or able to speak.
• Chest discomfort or pain is crushing or squeezing or feels like a heavy weight on the chest.
• Chest discomfort or pain occurs with:
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain that spreads from the chest to the back, neck, jaw, upper abdomen, or one or both shoulders or arms. See an illustration of chest pain.
  • Dizziness or lightheadedness.
  • A fast, slow, or irregular heartbeat.
• Rapid swelling of the throat or tongue (angioedema) occurs.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Suspected allergic reaction (other than from a bite or sting): Go to the topic Allergic Reaction.
• Swallowed or inhaled an object: Go to the topic Swallowed Objects.
• Bite or sting: Go to the most closely related topic:
  • Insect Bites and Stings and Spider Bites
  • Tick Bites
  • Snake and Lizard Bites
• A respiratory problem after surgery: Go to the topic Postoperative Problems.
• Breathing at a fast rate and feeling anxious: Go to the topic Hyperventilation.

	Yes	Do you have new chest pain without other symptoms of a heart attack?
When to See a Doctor See significance of new chest pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Before you answer the questions below, rate the severity of your pain. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have severe chest pain with each breath? Yes Are you coughing up blood? Yes Do you have pain deep in your leg or calf? Call your health professional today if you answer "Yes" to the following question. Yes Do you have mild to moderate chest pain that seems to be getting worse? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had pain in the muscles or ribs of the chest (chest wall pain) for 24 hours or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your symptoms may be caused by a medicine?
When to See a Doctor See symptoms caused by a medicine if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Did you start wheezing after taking a medicine? Yes Did you start having mild difficulty breathing after taking a medicine? Call your health professional today if you answer "Yes" to the following question. Yes Did other symptoms begin after starting a medicine? Note: If your answer is yes: Call the doctor who prescribed the medicine the same day (before your next dose) to determine whether you should stop taking the medicine or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking it. If you feel you need to continue taking the medicine, call your doctor. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you wheezing?
When to See a Doctor See significance of wheezing if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you have a chronic respiratory disease, such as asthma or chronic obstructive pulmonary disease (COPD), compare your symptoms to what is normal for you. Your need for a doctor visit will depend on what is normal for you and what you have discussed with your doctor. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a medical condition that causes wheezing and your moderate wheezing is not responding to prescribed medicine or treatment? Yes Do you have new or increasing wheezing that is limiting your activity? Yes Do you feel short of breath, even at rest, but you can still speak in short sentences? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have new or increasing wheezing but you are still able to complete your normal activities? Yes Do you have mild wheezing, even at rest, but you do not feel short of breath and can still speak in complete sentences? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had new shortness of breath after any amount of exertion during the past 24 hours but you are able to breathe normally when you are resting? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have respiratory symptoms and a fever?
When to See a Doctor See significance of fever if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need information on how to take a temperature, see the topic Body Temperature. If you have a health risk that may put you at higher risk for a problems with a fever and respiratory symptoms, follow the instructions your doctor has given you about fever. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a severe headache with a stiff neck? Yes Do you have shaking chills? Yes Do you have mental changes, such as mild confusion or decreased alertness (lethargy)? Yes Do you have a fever of 104 °F (40 °C) or higher? Yes Do you think you have a high fever but you are unable to measure your temperature? Yes Do you have diabetes? Yes Do you have a medical condition or take a medicine that impairs your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a fever of 101 °F (38 °C) or higher that has not come down after 12 hours of home treatment? Yes Do you think you have a moderate fever that has not come down after 12 hours of home treatment but you are unable to measure your temperature? Yes Do you have a fever and a health risk that may put you at higher risk of having a serious problem? Yes Do you have symptoms of influenza and are concerned about complications of the flu? Yes Has a fever without an obvious cause recurred more than once over the past 3 weeks? Yes Have you had a recurrent or ongoing fever without an obvious cause after traveling outside your own country in the past 6 weeks? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you have a fever of 100 °F (38 °C) to 101 °F (38.3 °C) after 72 hours of home treatment? Yes Do you think you have a mild fever after 72 hours of home treatment but you are unable to measure your temperature? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have respiratory symptoms and a headache or body aches but you do not have a fever?
When to See a Doctor See significance of headache and body aches if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have mental changes, such as mild confusion or decreased alertness (lethargy)? Yes Do you have a severe headache that started gradually and differs from other headaches you have had in the past? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have severe generalized body aches? Yes Do you have symptoms of influenza and concern about complications of the flu? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you taking an antibiotic for an infection and your symptoms have not improved or new symptoms have developed?
When to See a Doctor See significance of symptoms that do not improve with antibiotic treatment if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Note: If you answered "Yes" to any of the following questions, call your doctor to discuss your symptoms. An appointment may not be necessary. Yes Have your symptoms become worse after 24 hours of antibiotic treatment? Yes Have your symptoms not improved after 72 hours of treatment? Yes Have you developed a rash while taking antibiotics? Yes Have you developed severe diarrhea? Yes Have you developed vomiting that limits your ability to take your medicine as ordered? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have mild difficulty breathing?
When to See a Doctor See significance of mild difficulty breathing if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you have a chronic respiratory disease, such as asthma or chronic obstructive pulmonary disease (COPD), compare your symptoms to what is normal for you. Your need for a doctor visit will depend on what is normal for you and what you have discussed with your doctor. Call your health professional today if you answer "Yes" to the following question. Yes Do you have new or increasing mild difficulty breathing, even at rest, but you can still speak in complete sentences? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had new shortness of breath after any amount of exertion during the past 24 hours but you are able to breathe normally when you are resting? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you have chronic mild breathing problems that have been stable and now are slowly getting worse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a runny nose?
When to See a Doctor See significance of a runny nose if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had thick yellow nasal drainage for 24 hours or longer and feel worse than you would expect? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had thick yellow nasal drainage for 5 days or longer? Yes Do you have a runny nose, persistent sneezing, and watery eyes without other cold symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Ear pain or discomfort: Go to the topic Ear Problems and Injuries, Age 12 and Older.
• A cough: Go to the topic Coughs.
• A runny nose: Go to the topic Facial Problems, Noninjury.
• Sore throat: Go to the topic Sore Throat.
• Nosebleed: Go to the topic Nosebleeds.
• Hay fever symptoms: Go to the topic Allergic Reaction or Allergic Rhinitis.
• Itchy, red, draining, or swollen eyes: Go to the topic Eye Problems, Noninjury or Pinkeye.
• Sleep problems: Go to the topic Sleep Problems, Age 12 and Older.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment can help you feel more comfortable when you have mild to moderate respiratory symptoms.

• Prevent dehydration. Hot fluids, such as tea or soup, may help relieve congestion in your nose and throat. If you have a productive cough, fluids may help thin the mucus in your lungs so your cough can clear it out.
• Get extra rest; let your symptoms be your guide. If you have a cold, you may be able to stick to your usual routine and just get some extra sleep.
• Let yourself cough if you have a cough that brings up mucus from the lungs. It can help prevent bacterial infections. People who have chronic bronchitis or emphysema need to cough to help clear mucus from their lungs.
• For a sore throat, gargle at least once each hour with warm salt water [1 tsp (5 g) of salt in 8 fl oz (237 mL) of water] to reduce swelling and discomfort. For more information, see the topic Sore Throat.

Keep in mind the following guidelines for taking nonprescription medicine for your symptoms:

• Use decongestant nasal sprays sparingly and for only 3 days or less. Continued use may lead to a rebound effect, which causes the mucous membranes to become more swollen than they were before you started using the spray. Learn how to make saline nose drops at home that will not cause a rebound effect.
• For more detailed information on decongestants or antihistamines and cough medicines, go to the Cold and Allergy Remedies section of the topic Nonprescription Medicines and Products. Studies show that over-the-counter cough medicines do not work very well. And some of these medicines can cause problems if you use too much of them. It is important to use medicines correctly and to keep them out of the reach of children to prevent accidental use.
• If you have a dry, hacking cough that does not bring up any sputum, ask your doctor about an effective cough suppressant medicine. For more information, see the topic Coughs.

Alternative medicines or supplements

Many people use alternative medicines or supplements to prevent colds or to shorten their cold symptoms. Before using any treatment for your cold symptoms, it is important to consider the risks and benefits of the treatment. For more information, see the topic Complementary Medicine. Some of the common alternative medicines or supplements used are:

• Echinacea. Studies show echinacea may keep you from getting a cold and may help you get better faster.¹ Echinacea can cause severe allergic reactions in some people with a history of asthma, allergies, hay fever, or eczema.
• Vitamin C. Long-term daily use of vitamin C in large doses does not appear to prevent colds. There may be a slight reduction in the length of time cold symptoms last when high doses are taken. Additional studies must be done to determine how much vitamin C is needed to reduce the length of time cold symptoms are present.
• Zinc. Experts disagree about the usefulness of zinc to shorten the duration of common cold symptoms. In adults, the use of zinc nasal gel has been shown to reduce the length of a cold. But zinc products that you use in your nose to treat cold symptoms may cause a permanent loss of the ability to smell in a very small number of people.

If you decide to use an alternative medicine or supplement, follow these precautions.

• As with all conventional medicines and supplements, it is important to follow the directions on the label.
• Do not exceed the maximum recommended dose.
• If you are or could be pregnant, talk with your doctor before taking any medicine or supplement.
• If you have another health problem or take prescription medicines, talk with your doctor before taking an alternative medicine or supplement.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Increasing difficulty breathing develops.
• Wheezing develops.
• New pain develops or pain localizes to one area, such as a sinus area, ear, throat, or chest.
• Symptoms persist in spite of home treatment.
• Symptoms become more severe or frequent.

There is no sure way to prevent respiratory illnesses. To help reduce your risk:

• Wash your hands often, especially when you are around people with colds.
• Keep your hands away from your nose, eyes, and mouth. These are the places where viruses are most likely to enter your body.
• Do not smoke or use other tobacco products. Smoking irritates the mucous membranes of the nose, sinuses, and lungs, which may make them more susceptible to infections. For more information, see the topic Quitting Tobacco Use.
• If you live an area that has problems with air pollution or smoke from wildfires:
  • Stay indoors and avoid breathing in smoke, ashes, or polluted air.
  • Do not exercise outdoors if you smell smoke or notice irritation of your eyes, nose, or throat.
  • Keep your motor vehicle windows rolled up and the vents closed when driving.
• Avoid cleanup activities, such as raking leaves or cutting brush.
• Avoid exposure to chemicals. Do not spray or apply chemicals unless you are wearing protective clothing, such as a particle-filtering respirator, safety goggles, and gloves.
• Exercise regularly. For more information, see the topic Fitness.
• Get an influenza (flu) vaccine each autumn if you are older than age 50 or have a health risk that increases your risk for a serious problem. For more information, see the topic Influenza.
• Get a pneumococcal vaccine(What is a PDF document?) if you are older than 65; you have chronic lung disease, such as chronic obstructive pulmonary disease (COPD); or you have a condition or disease that increases your risk of a serious problem.
• Make sure your immunizations are current, such as pertussis to reduce your risk of getting whooping cough. For more information, see the topic Immunizations.
• For information on preventing allergies or asthma, see the topic Allergic Rhinitis or Asthma in Teens and Adults.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• When did your symptoms start?
• Is your respiratory problem localized, such as involving only one ear, one side of your sinuses, or the lungs?
• Did symptoms start as a cold but now appear to be worse than you would expect from a cold?
• Have you had similar symptoms before? How were they treated?
• Do you have a productive cough? Are you coughing up clear, white, green, yellow, or blood-tinged mucus? How much mucus are you bringing up? Are you coughing up mucus all day long or mostly at nighttime?
• Have you had fever and chills?
• Are you wheezing, or do you have new or worsening shortness of breath?
• Do you have severe headache, earache, or sore throat?
• Do any other members of your family or work group have similar symptoms?
• Have you recently been exposed to large amounts of dust, fumes, smoke, or chemicals?
• Do you smoke or use other tobacco products?
• Have you recently used an indoor hot tub, pool, or spa?
• What home treatment have you tried? Did it help?
• What prescription, nonprescription, or alternative medicines have you tried? Did they help?
• Have you recently traveled inside or outside of your home country?
• Do you have any health risks?

• Acute Bronchitis
• Allergic Reaction
• Allergic Rhinitis
• Asthma in Children
• Asthma in Teens and Adults
• Chest Pain
• Complementary Medicine
• Coughs
• Ear Canal Problems (Swimmer's Ear)
• Ear Infections
• Ear Problems and Injuries, Age 11 and Younger
• Ear Problems and Injuries, Age 12 and Older
• Earwax
• Facial Problems, Noninjury
• Fever, Age 4 and Older
• Fitness
• Healthy Eating
• Heartburn
• Immunizations
• Influenza
• Nonprescription Medicines and Products
• Pneumonia
• Quitting Tobacco Use
• Respiratory Problems, Age 11 and Younger
• Ringing in the Ears (Tinnitus)
• Sinusitis
• Sore Throat
• Strep Throat
• Stress Management
• Swallowed Objects
• Swollen Glands and Other Lumps Under the Skin

Citations

1. Shah SA, et al. (2007). Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infectious Diseases, 7(7): 473-480.

Author:	Jan Nissl, RN, BS	Last Updated: February 25, 2008
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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