Our Definitive Guide to Cold and Flu

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Dec 23, 2021

By One Medical

Updated December 23, 2021.

So you’ve come down with a nasty virus that’s been making the rounds. The good news? You probably don’t need to go into the doctor’s office. The bad news? You still feel awful.

If you think you have an upper respiratory infection (URI) — which includes the common cold, most sinus infections, chest colds (bronchitis), the flu (caused by the influenza virus), and COVID-19 — there’s a lot you can do at home to feel better faster. You’ll have infections like these many times throughout your life, so learning what helps the most (and the least) is worth your time.

What to Expect with an Upper Respiratory Infection

More than 90 percent of upper respiratory infections are caused by viruses. These infections create different symptoms at each stage. Most colds, flus and COVID-19 resolve in about a week, although some symptoms (like coughing) can take weeks to go away completely.

Helen (Eleni) Xenos, a One Medical doctor in Chicago, describes the typical progression of the common cold:

• Day 1: Fatigue, headache, sore or scratchy throat.
• Day 2: Sore throat worsens, low fever, mild nasal congestion.
• Day 3: Congestion worsens, sinus and ear pressure become very uncomfortable. It may be difficult to sleep.
• Day 4: Mucus may turn yellow or green (this is normal). Sore throat improves, but coughing begins.
• Days 5-7: Energy and congestion improve.
• 1 week+: Cough usually tapers off after a week, but can take up to 3-6 weeks to fully resolve.

If your symptoms are much worse than these, such as coughing so hard you throw up, coughing up bloody mucus, difficulty breathing, or if you have a fever over 102°F, you might have something more serious going on, like pertussis (whooping cough) or bacterial pneumonia.

If a cold drags on for more than 2 weeks, it can turn into a sinus infection that causes pain around the eyes, nose and/or sinus headaches. Chest colds (bronchitis) cause chest congestion and a hacking cough that drag on for a few weeks.

The flu comes with similar symptoms but features a prominent fever, chills, headache, and body aches that usually last several days.

COVID-19 can feel very similar to other colds and can sometimes have additional symptoms like loss of taste or smell which can help distinguish this virus. It’s important for folks to get tested and stay home with cold symptoms to help prevent the spread of COVID-19, keep everyone safe, and help end the pandemic. For more on COVID-19, see here.

What Helps You Feel Better

Treating the symptoms and supporting your immune system is the best course of action to feel better faster. Everyone’s experience of a cold is slightly different from the next person’s, and there are many options in the cold and flu aisle at the drugstore. How do you know which symptom remedies are right for you?

The key is to find what works best for you personally, for your symptoms, whether it’s over-the-counter cold and flu remedies or soothing herbal tea. If, for example, you experience bad sinus pressure when you have an upper respiratory infection, a decongestant like pseudoephedrine or a nasal sinus rinse might be good to have on hand. If it’s coughing that usually makes your life miserable during a chest cold, you could try inhaling hot steam from the sink or shower a few times a day to help break things up.

Your immune system’s job is to eradicate viral and bacterial infections from your body. It’s very effective as long as you provide it with the proper support. The best way to do that is to rest. Being stressed out or not getting enough sleep releases hormones that suppress your immune system.

In addition, taking one to two grams a day of vitamin C during cold season may lessen the severity and duration of your colds, although it won’t prevent you from catching them in the first place. Taking zinc lozenges during a cold also supports your immune system, but you have to start within 24 hours of symptom onset for them to work. Take one zinc lozenge or melt-away every two hours on a full stomach to avoid nausea.

Why Antibiotics Won’t Help — and Might Hurt

Almost all URIs are caused by viruses, and at present we don’t have medications that work against them. (One notable exception: There are antiviral medications for the flu. If you start them in the first 24 to 48 hours of symptoms, it might reduce the duration of your illness by about a day. )

As for the small percentage of upper respiratory infections caused by bacteria, most go away on their own — and often just as quickly — even if you don’t take antibiotics. So if there’s a chance antibiotics can help, what’s the harm?

There are many reasons to be conscientious about taking antibiotics, including breeding resistant superbugs or making your health care cost more. However, there’s another reason that’s of immediate concern: diarrhea. Antibiotics can wreak havoc in your intestines and upset the normal balance of bacteria — including the bacteria that help you digest food, which can lead to abdominal pain, bloating, gas, and alternating diarrhea and constipation. Taking multiple courses of antibiotics puts you at risk of potentially long-lasting effects on your gut.

Like everything health-related, the decision about whether to take antibiotics for a bacterial infection comes down to weighing the risks and benefits. Your provider will be happy to discuss the decision with you in detail.

Keeping Your Infection to Yourself

Colds, flus, and COVID-19 are contagious from the time you get them (even before you have symptoms) up to ten days after your symptoms start. They’re usually not contagious after ten days, even if you’re still coughing or congested.

The best way to avoid passing on a URI (or catching one in the first place) is to wash your hands frequently, cover your mouth with your arm when you cough or sneeze and wear a mask that fully covers your mouth and nose. It’s also best to take at least a couple of days off work or school while you’re most contagious.

When to Call Your Provider

Occasionally, viral infections can set the stage for more complicated bacterial infections. If you experience any of the following, call your healthcare provider:

• High fever (over 102°F)
• Shortness of breath or wheezing
• Coughing up bloody mucus
• Coughing so hard that you throw up
• Feeling worse after 7-10 days of symptoms, especially if you have worsening headache, congestion, or sinus pain
• If you don’t start to feel better after 10 days of symptoms

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Remedies for Cold and Flu Symptoms

Cough and Chest Congestion

• Antihistamine/decongestant combo (e.g., brompheniramine/pseudoephedrine)
• Cough suppressant: Dextromethorphan (Delsym)
• Expectorant (mucus thinner): Guaifenesin (Mucinex, Robitussin)
• Gentle hot tea (chamomile, licorice root, peppermint, thyme) with or without honey or lemon juice; Traditional Medicinals “Throat Coat” or “Breathe Easy” teas.
• Honey (1 tablespoon of raw honey 1 to 3 times daily). Note: honey is not safe for infants under 12 months.
• Steam inhalation: Boil 1 inch of water in a pot, remove from the stove, add 5 drops of eucalyptus oil if desired, and inhale slowly for a few minutes twice daily with a towel over your head.

Sore Throat

• Pain relievers: Acetaminophen (Tylenol). It’s OK to use the maximum dose for 1 or 2 days while your symptoms are at their worst. Follow directions on the packaging.
• Cooling or numbing medicines: Chloraseptic spray, lozenges, gargle echinacea tincture in water.
• Saltwater gargles throughout the day: 1 tablespoon of salt in a glass of warm water.
• Warm tea with honey, Traditional Medicinals “throat coat” or “breathe easy” teas, “sore throat tea“.
• Chicken soup or other clear broth.

Nasal Congestion and Sinus Pressure

• Oral decongestants: Pseudoephedrine (Sudafed) is the most effective choice., Anticipate requesting and showing ID for the medication at the pharmacist counter. Avoid decongestants if you have poorly controlled high blood pressure.
• Nasal spray decongestant: Oxymetazoline (Afrin). Don’t use this for more than 3 days, or your congestion will come back even worse.
• Pain relievers: Acetaminophen (Tylenol). It’s okay to use the maximum dose for 1 or 2 days while your symptoms are at their worst. Follow directions on the packaging.
• Nasal steroid spray: Flonase, Nasonex, Nasacort
• Nasal irrigation twice daily with warm salt water (neti pot, NeilMed Sinus Rinse, Nasaline)
• Steam inhalation: Boil 1 inch of water in a pot, remove from the stove, add 5 drops of eucalyptus oil if desired, and inhale slowly for a few minutes twice daily with a towel over your head.
• Moist heat compresses over your sinuses for several minutes a few times a day.
• Herbs: Goldenseal, Bi Yan Pian, Sinupret

Runny Nose

• Oral decongestants: Pseudoephedrine (Sudafed) is the most effective choice. Anticipate requesting and showing ID for the medication at the pharmacist counter.. If you have high blood pressure, avoid pseudoephedrine or take care to monitor your blood pressure while you take it.
• Nasal spray decongestant: Oxymetazoline (Afrin) can be used for a short time. Don’t use this for more than 3 days, or your congestion will come back even worse.
• Antihistamines: Allegra, Zyrtec, Claritin, Benadryl (all available in generic formulas) are all effective. Benadryl (diphenhydramine) will make you sleepy; the others won’t. Antihistamines tend to work better for runny noses from allergies, but they can help a bit, and they come in some of the combination cold/flu products.
• Saline nasal spray
• Steam inhalation: Boil 1 inch of water in a pot, remove from the stove, add 5 drops of eucalyptus oil if desired, and inhale slowly for a few minutes twice daily with a towel over your head.

Fever

• Fever reducers: Acetaminophen (Tylenol), ibuprofen (Motrin, Advil)
• Drink lots of water.
• Take a warm or cool shower.
• Warm tea (chamomile, peppermint)

Headache and Body Aches

• Pain relievers: Acetaminophen (Tylenol), ibuprofen (Motrin, Advil). It’s okay to use the maximum dose for 1 or 2 days while your symptoms are at their worst, as long as there are no contraindications. Follow directions on the packaging.
• Moist heat compresses or cold packs.
• Rub on Tiger Balm.
• Take a nap.
• Take a warm bath with Epsom salts.

Have more questions about these symptoms or upper respiratory infections, colds, flus, or COVID-19? Join One Medical today to talk to a provider.

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A Look at the Life Cycle of a Cold

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The common cold typically has three stages, during which you may experience different symptoms. The cold can often spread to others as long as you have active symptoms.

You might think cold season is only active during the winter, but that’s not the case. According to the Mayo Clinic, though you have a higher chance of developing a cold in the fall and winter, you can get a cold anytime during the year.

The CDC reports that adults have an average of two to three colds each year, while children can have even more.

And while you might be familiar with the symptoms and effects of the common cold, there’s a chance you’re unaware of:

• how this upper respiratory virus progresses
• how to treat it
• when to call the doctor

While you can’t cure the common cold, there’s a lot to be said for prevention and self-care tips as your body works to rid itself of the virus.

If you’re concerned you might be at risk of catching a cold or you currently have one, we’ve got you covered. Below, we’ve compiled an overview of everything from stages and symptoms to recovery tips.

The tickle of an impending cold is all too familiar and can cause the desperate need to down glasses of orange juice and use lots of hand sanitizer.

Unfortunately, if your throat is already tingling or scratchy, it’s likely one of the 200 strains of the common cold virus — most commonly the rhinovirus — has already settled in for the next 7 to 10 days.

The most common symptoms to look out for during this stage are:

• tingling or scratchy throat
• body aches
• tiredness or fatigue

Dr. Doug Nunamaker, a family practice physician and chief medical officer forAtlas MD, explains that it’s in these first days of a cold that most people don’t do enough to care for their symptoms.

Though there are a number of over-the-counter (OTC) treatments and remedies that can ease the symptoms of a cold during this stage, Nunamaker also suggests reaching for one of the most common dishes for people with a cold or flu: chicken noodle soup.

“It’s easy on the stomach, soothes the throat, [and] provides fluid for hydration,” he explains. If you have a fever or are sweating, he adds, chicken soup can also help replenish some of the salt your body might lose.

In terms of contagion levels, Nunamaker says your cold is contagious if you present “active symptoms.” So, the tickle in your throat, runny nose, body aches, and even low-grade fever mean you’re at risk of spreading the bug to everyone around you.

Recovery tips

• Take decongestants and cough syrup but avoid mixing combination medications (e. g., don’t take ibuprofen separately if it’s also included in your cold medicine).
• Get plenty of sleep and rest.
• Stay hydrated.
• OTC Zinc supplements or lozenges have been shown to reduce the duration and severity of symptoms, when taken soon after the onset of symptoms. However, a side effect may be a bad taste or nausea.

Ways to avoid spreading the cold virus while you’re still contagious:

• Avoid public contact if at all possible by staying home from work and school.
• Avoid physical contact with other people, such as kissing or shaking hands.
• Wash your hands often with soap and water.
• Fully cover your cough and sneeze in your elbow or a tissue. Immediately dispose of the tissue and wash your hands.

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This is when the virus is at its peak intensity. You might find during this time that everything hurts, and your face feels like a running faucet. You may even experience a fever, which can be alarming.

Because you have a virus, however, you have a compromised immune system. A fever, explains Nunamaker, is your body’s way of defending your immune system.

“[A fever is] nature’s antibiotic. Let it ride,” he explains.

Nunamaker adds that a fever isn’t a concern until it’s 102 to 103°F (39°C). In fact, up to 100.4°F (38°C), you’re considered to have an “elevated temperature,” not a fever.

Fevers with a cold can be easily confused with the flu. You should remember that the flu has radically different, and far more severe symptoms, which come on hard, fast, and usually include a headache.

The most common symptoms to look out for during this stage of a cold are:

• sore throat
• cough
• congestion or runny nose
• fatigue
• aches
• chills or low-grade fever

As was the case in stage 1, if your symptoms are still active, you’re still contagious. During this time, you should continue to be mindful about being around others and avoid physical interactions.

Recovery tips

• Avoid smoking, if you smoke, as it paralyzes the cilia in the lungs and takes longer to heal.
• Avoid asking your healthcare provider for an antibiotic. This is a viral infection and an antibiotic will not help. In fact, it could make things worse.
• Use a cough suppressant if you find it difficult to sleep.
• Take ibuprofen for body aches.
• Get your daily amount of vitamin C (1 to 2 grams per day) via fresh fruit or supplements.
• Gargle with salt water.
• Use a humidifier, or take a steam bath or shower.
• Use Chloraseptic or Cepacol lozenges. The benzocaine is a topical numbing agent and can help soothe sore throats.
• Continue to take zinc supplements or lozenges.

While your body fights the cold virus, it’s vital to stay hydrated throughout all three stages of your cold.

A cold typically wraps up around day 10. There are, of course, exceptions. If you’re still feeling the effects, your symptoms worsen, or your fever increases then it’s time to re-evaluate and think about a different course of treatment.

When should I call a doctor?

1. While it’s tempting to call the doctor when you’re feeling crummy for a couple of days, it’s best to avoid doing so until after your symptoms have persisted for longer than 10. Call a doctor if your symptoms worsen after this time.

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Some people might also experience what’s known as the post-infectious cough, which is a nagging cough that can last an average of 18 days after your cold subsides. If, however, all your other symptoms have ended, you can consider yourself free and clear.

If the other “active” symptoms are still present, you’re still contagious and should continue to follow the tips to prevent spreading the virus.

The most common symptoms to look out for during this stage are the following:

• cough
• congestion
• runny nose
• fatigue

Recovery tips

• Continue to cover your cough with your sleeve at the elbow or with a tissue, and wash your hands.
• Continue taking an OTC ibuprofen, decongestant, cough suppressant, or antihistamine, as needed.

Here’s a list of cold remedies you can buy now:

• ibuprofen
• Chloraseptic or Cepacol lozenges
• OTC zinc supplements or lozenges
• decongestants
• cough syrup
• vitamin C
• antihistamine

You can also shop online for humidifiers and hand sanitizers.

Be sure to talk to your healthcare provider before adding any treatment options to your current healthcare regimen to avoid any potential negative interactions.

When it comes to a cold, you’ve got to accept that it’s happening and ride it out. The very best thing you can do is take actions to prevent a cold by:

• washing your hands frequently with soap and water
• avoiding any unnecessary physical contact where you could contract the virus
• staying hydrated and well-rested

Finally, be mindful of how your health affects other people, especially those with compromised immune systems, and stay home when you’re contagious.

Brandi Koskie is the founder of Banter Strategy, where she serves as a content strategist and health journalist for dynamic clients. She’s got a wanderlust spirit, believes in the power of kindness, and works and plays in the foothills of Denver with her family.

How not to get sick at the first sign of a cold

Published: 05.02.2021

Runny nose, sore throat, cough, rise in temperature… “Well, that cold again!” – we sigh, open the first-aid kit and start drinking, dripping, lubricating, rubbing … We use all possible means indiscriminately. Or we go to the other extreme and do absolutely nothing. After all, everyone knows: if you treat a cold, it will pass in a week, and if not treated, in seven days. We will tell you about 5 typical mistakes in acute respiratory infections and give you 5 correct tips from Evalar on how not to get sick at the first sign of a cold.

How to recognize a cold: the first signs of SARS

The common cold is an acute respiratory disease that most often occurs when infections enter our body and affect the upper respiratory tract. In most cases, viruses cause colds – you can get infected from a sick person when he sneezes or coughs next to you. The virus enters the mucous membranes of the nose, mouth, eyes. There are no symptoms immediately after exposure. The incubation period of viruses is on average 2-4 days, individual strains can asymptomatically attack the body for two weeks.

The first symptoms in which you need to start treatment may appear 3-5 days after infection. It could be:

• Weakness, fatigue, headache.

• Chills, feeling of ache in the joints and muscles.

• Cutting in the eyes, increased sensitivity of the eyes to light, lacrimation.

• Sneezing, rhinitis, nasal congestion, decreased sense of smell.

• Perspiration, dry throat, cough.

• Temperature increase.

When one or more symptoms appear, it is better to start therapy immediately in order to alleviate your condition and speed up recovery. The main task of treatment for a viral infection or flu is to help the immune system cope with the causative agent of the disease with the help of properly selected means. The treatment regimen for ARVI and influenza should be made by a doctor. Next, we figure out what to do at the first sign of a cold, and what not to do.

Error #1. Uncontrolled intake of antibiotics.

How many times have they told the world that antibiotics act on bacteria, but they are useless against influenza and SARS viruses! Such drugs can be used if a bacterial infection has joined the viral infection, but only a doctor can prescribe them. Moreover, it is impossible to self-medicate with these remedies when the first signs of a cold have barely appeared. So you do not give the body a chance to form the correct immune response and develop antibodies to infection. In addition, uncontrolled use of antibiotics leads to the fact that sooner or later they cease to help, because bacteria become resistant to them. Self-medication with antibiotics increases the risk of developing side effects from these drugs: allergic reactions, gastrointestinal disorders, drug-induced liver damage, etc.

Mistake #2. Blind trust in grandmother’s advice.

Milk with soda, iodine and butter, vodka with pepper, onion drops, steam inhalations with potatoes … Folk recipes for colds are apparently invisible, and they are extremely popular, despite the lack of scientific data on effectiveness. Many consider such methods of treatment to be safer than pharmacy “chemistry”. However, miracle drugs and procedures from folk healers can cause allergic reactions, poisoning, burns of the respiratory tract, progression of inflammation and other consequences.

We do not claim that all anti-cold methods from traditional medicine are useless and dangerous. It is necessary to exercise reasonable care and not to apply them without consulting a specialist. Moreover, one cannot independently replace his recommendations with a “grandmother’s approach”.

Mistake #3. Abuse of vasoconstrictor drops.

With a runny nose, many of us resort to the help of such drugs in the first place. But abuse of them threatens with unpleasant consequences. One of them is dependence on vasoconstrictor drops and drug-induced rhinitis. It is based on persistent expansion of the vessels of the nasal mucosa, which swells and blocks the nasal passages. This encourages a person to use drugs again and again, without which he simply cannot breathe normally.

Mistake #4. Cough relief.

A wet cough in acute respiratory infection helps to clear the respiratory tract of sputum and microbes contained in it, so it can not be suppressed with antitussives. On the contrary, when the sputum is viscous and difficult to pass, a specialist may recommend you expectorants. Such drugs help to thin and remove sputum – make the cough productive.

Mistake #5. Insufficient fluid intake.

Drinking plenty of water is one of the main recommendations during an acute respiratory infection. With high temperatures, rapid breathing and increased sweating, we lose moisture that needs to be replenished. In addition, drinking plenty of water contributes to the faster removal of microbial toxins from the body.

Effervescent vitamins and herbal teas will help you solve two problems at once: keep drinking during illness and provide the body with vitamins, minerals and other biologically active substances to maintain immunity and protect against viruses.

If you notice the first signs of a cold in yourself, remember: how to treat them in adults and especially in children should be prescribed by a doctor. Do not make mistakes in the treatment of colds and trust only proven remedies and recommendations! This will make it easier to transfer the infection and avoid complications.

Updated: 01/12/2023

Information on influenza – Belovskaya ambulance station

INFORMATION FOR EMERGENCY STAFF.

Clinical management of patients infected with pandemic influenza (h2N1) virus.

Influenza is an acute viral disease characterized by a short incubation period, severe general intoxication, catarrhal changes in the respiratory tract and a tendency to bacterial superinfections.

The 2009 pandemic (h2N1) influenza virus differs in its pathogenicity from seasonal influenza in two key respects: the infection affects a wider age range, especially children and young people, the virus can infect the lower respiratory tract and cause rapidly progressive pneumonia.

A wide clinical spectrum has been described ranging from non-febrile, mild upper respiratory illness, febrile influenza-like illness (ILI) to severe or even fatal complications, including rapidly progressive pneumonia. The most commonly reported symptoms include cough, fever, sore throat, muscle pain, malaise and headache. Some patients had gastrointestinal symptoms (nausea, vomiting and/or diarrhea).

Approximately 10-30% of hospitalized patients required treatment in intensive care units. Critically ill patients were defined as those with rapidly progressive lower respiratory disease, respiratory failure, and acute respiratory distress syndrome (ARDS) with persistent hypoxemia.

The risk groups include the following:

* Infants and young children, especially children under 3 years of age

* ​ Pregnant women with asthma, COPD)

* ​ Persons of any age with chronic heart disease (eg, congestive heart failure)

* Persons 65 years of age and older

Uncomplicated influenza

• ​ILI symptoms include: high fever, cough, sore throat, rhinorrhea, headache, muscle pain and malaise, without shortness of breath or difficulty breathing. Patients may have some or all of these symptoms.
• Gastrointestinal disease may also be present, such as diarrhea and/or vomiting, especially in children, but without signs of dehydration.

Complicated or severe influenza

Clinical (eg, dyspnea/difficulty breathing, rapid breathing, hypoxia) and/or radiological evidence of lower respiratory disease (eg, pneumonia), central nervous system (CNS) damage (eg, encephalopathy, encephalitis), severe dehydration, or the presence of secondary complications such as renal failure, multiple organ failure, and septic shock. Other complications may include acute skeletal muscle necrosis and myocarditis.

Exacerbation of an existing chronic disease, including asthma, COPD, chronic liver or kidney failure, diabetes, or other cardiovascular disease.

Presence of any other disease or clinical manifestation requiring hospitalization for clinical treatment.

Presence of any of the signs of disease progression mentioned below.

Signs and symptoms of progressive disease

In patients who initially show symptoms of uncomplicated influenza, the disease may progress to a more severe form. Progression can be rapid (i.e., within 24 hours). The following are some of the indicators of progressive disease that will require an urgent review of patient management:

• Signs and symptoms that may indicate poor oxygen supply or cardiopulmonary failure:

– Shortness of breath (when moving or at rest), shortness of breath, cyanosis, bloody or colored sputum, chest pain and low blood pressure;

– In children: frequent or labored breathing;

– Hypoxia, determined by the readings of a pulse oximeter.

• Signs and symptoms that may indicate CNS complications:

– Altered mental state, unconsciousness, drowsiness or difficulty waking up and periodic or persistent convulsions (convulsions), confusion, severe weakness or paralysis.

​

Pregnant women, especially those with comorbidities, are at increased risk of complications from influenza virus infection. Influenza during pregnancy is associated with an increased risk of adverse pregnancy outcomes such as miscarriage, preterm birth, and fetal distress. Therefore, pregnant women require closer monitoring and early initiation of antiviral treatment. Paracetamol is recommended to reduce high fever and pain in pregnant women, as non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin ⁷ are associated with fetal risks and maternal bleeding and are therefore contraindicated in pregnancy.

Infants and young children (especially children <2 years of age) have the highest rates of hospitalization, especially among children with pre-existing chronic conditions. Neonates and young children often present with less typical symptoms of ILI, such as shortness of breath, low grade fever, rapid breathing, blueness, excessive sleep, lethargy, poor appetite, and dehydration. Such symptoms are nonspecific and the diagnosis cannot be made on the basis of these features alone.

Antiviral therapy

The 2009 pandemic influenza (h2N1) virus is currently susceptible to the neuraminidase inhibitors (NAIs) oseltamivir (TAMIFLU) and zanamivir (RELENZA).

The following is a summary of treatment recommendations:

• Patients with severe or progressive clinical disease should be treated with oseltamivir. Treatment should begin as soon as possible.

This recommendation applies to all patient groups, including pregnant women and children under 2 years of age, including neonates.

In patients with severe or progressive disease who do not respond to normal treatment regimens, higher doses of oseltamivir (TAMIFLU) and longer treatment may be appropriate. In some situations for adults, a dose of 150 mg twice a day is used.

In cases where (1) oseltamivir is not available or cannot be used, or (2) if the virus is resistant to oseltamivir, patients who have severe or progressive clinical disease should be treated with zanamivir (RELENZA).

*Patients who are at increased risk for severe or complicated illness but who have uncomplicated illness due to influenza virus infection should be treated with oseltamivir or zanamivir. Treatment should begin as soon as possible after the onset of the disease.

When antiviral therapy is used, it should ideally be started early after the onset of symptoms, but it can be used at any stage of active disease.

Mothers who are breastfeeding may continue breastfeeding while sick and receiving treatment with oseltamivir or zanamivir.

Pneumonia is the most common severe complication of influenza.

There are three forms of pneumonia complicating influenza: primary viral pneumonia, viral-bacterial (secondary) pneumonia, bacterial (tertiary) pneumonia.

Primary viral pneumonia develops on 1st day from the onset of the disease. A significant proportion of lethal pneumonias may be associated not with a concomitant bacterial infection, but directly with the invasion and reproduction of the virus in the lungs. The initial symptoms of the disease are typical of influenza, but already within 12-36 hours, patients notice an increase in shortness of breath, which is often accompanied by a cough with a meager amount of sputum and streaks of blood. In rare cases, massive hemoptysis is possible. Pleural pain is rare. At the time of hospitalization most often manifest the phenomena of respiratory failure. Expressed tachypnea, tachycardia, cyanosis.

Viral-bacterial (secondary) pneumonia develops by the end of the first week from the onset of influenza. With this type of pneumonia, the interval between the onset of the first respiratory symptoms and signs and involvement in the process of the lung parenchyma can be up to 4 days, during this period even some improvement in the patient’s condition is possible. In most cases, the cough is productive with purulent or bloody sputum, accompanied by tremendous chills and pleural pain. As a rule, by the time of hospitalization, there are signs of severe respiratory failure: severe dyspnea, tachypnea, cyanosis.

Tertiary bacterial pneumonia develops in the second week from the onset of influenza. This is the most common complication that occurs due to damage to the ciliary epithelium by the virus, slowing down the mobilization of leukocytes, and impaired neutralization of bacteria by polymorphonuclear phagocytes. In most patients, the diagnosis of secondary bacterial pneumonia can be made based on the history. Usually the patient suffers a typical flu, followed by a period of apparent improvement, some patients even have time to get to work. However, 3-14 days after the first flu symptoms, the patient’s condition deteriorates rapidly: a second wave of fever with chills, pleural chest pain, cough with purulent sputum, and possibly hemoptysis. In about 2/3 of cases, the disease does not have a two-phase character, and the symptoms of pneumonia “superimpose” on the symptoms of influenza.

CONCLUSIONS:

– when working with patients with fever, a medical worker must wear a mask pulmonology departments of medical organizations

– early start of antiviral therapy is necessary, drugs with proven efficacy are TAMIFLU and RELENZA

– paracetamol is recommended as an antipyretic for fever in pregnant women, while other drugs increase the risk of obstetric bleeding

– compulsory hospitalization of children under 3 years of age with signs of acute respiratory disease

– mandatory pulse oximetry for patients (if a pulse oximeter is available) for early detection of respiratory disorders

Appendix

The degree of intoxication in children.

I degree. Decreased emotional tone, decreased appetite, liver enlargement by 1.0-2.0 cm, decreased muscle tone, subfebrile condition.

II degree. The child is restless or very lethargic, loses interest in others, refuses to eat, is pale, muscle hypotension, muffled heart sounds, temperature 38-39C, the liver is enlarged by 2.0-3.0 cm, there may be vomiting, regurgitation.

III degree. Sopor.

Degrees of respiratory failure in children (RD).

DN I degree. Respiratory distress with moderate exercise, breathing quickens by 10-2%. Tachycardia is moderate. HR:RR = 3:1 (normally 3.5:1). The gas composition of the blood is almost not disturbed.

DN II degree. Dyspnea and cyanosis at rest. Breathing speeded up by 20-30%. The pulse is frequent. HR:HR=2:1. Participation of auxiliary muscles in the act of breathing. In the blood, persistent hypoxia and hypercapnia. The child is restless.