The upper respiratory tract includes the nose, nasopharynx, and larynx. It is lined by vascular mucous membrane with ciliated epithelium on the surface. The lower respiratory tract includes the trachea and bronchi. These form an interconnecting tree of conducting airways eventually joining via around 64,000 terminal bronchioles, with the alveoli to form acini. The lower respiratory tract is lined with ciliated epithelium as far as the terminal bronchioles. The larynx and large bronchi are richly supplied with sensory nerve receptors involved in the cough reflex. The acinus is the gas exchange unit of the lung and comprises of branching respiratory bronchioles leading to cluster of alveoli. The alveoli are lined mostly with flattened epithelial cells (type I pneumocytes).
Upper Respiratory Tract Infections
Clinically following major conditions are included in URI:
|Acute Coryza (Common Cold)||Rapid onset. Burning and tickling sensation in nose. Sneezing. Sore throat. Blocked nose with watery discharge. Discharge usually green/yellow after 24/48 hrs due to sec infection.||Sinusitis. Lower respiratory tract infection (bronchitis/pneumonia)Hearing impairment. Otitis media.|
|Acute laryngitis||Often a complication of acute coryza. Dry sore throat. Hoarse voice or loss of voice. Pain on speaking. Painful and unproductive cough. Stridor.||Chronic laryngitis. LRI.|
|Acute laryngotracheo-bronchitis (Croup)||Initial symptoms like common cold. Sudden paroxysms of cough accompanied by stridor and breathlessness. Cyanosis and asphyxia in small children.||Asphyxia. Death.|
|Acute Epiglottitis||Fever and sore throat. Stridor and cough in absence of much hoarseness||Death from asphyxia.|
|Acute Bronchitis||Often follows acute coryza. Irritating unproductive cough accompanied by retrosternal discomfort of tracheitis. Chest tightness, wheeze and breathlessness. Sputum is initially scanty, mucoid, viscid and may be streaked with blood. After a day or two, sputum becomes mucopurulent and more copious. May be associated with pyrexia.||Bronchopneumonia.|
|Influenza||Sudden onset of pyrexia associated with generalized aches and pains, anorexia, nausea and vomiting. Usually harsh unproductive cough. Post-influenza asthenia||Tracheitis, bronchitis, bronchiolitis and bronchopneumonia.|
So we see that influenza and acute bronchitis (considered in URI because it is often a sequel of common cold) are the two most common reasons for URI pyrexia. We also see that most of the URI’s are interrelated as cause, complication, or symptomatology. Therefore clinically it may not always be possible to delineate just one URI for a patient.
And also it hardly matters because in Allopathy the treatment is nearly same, whatever be the name and in Homoeopathy we treat the patient guided by the symptoms, whatever be the name of the disease.
Symptoms of Upper Respiratory Infections
- Burning and tickling sensation in nose
- Blocked nose with watery discharge or
- Greenish/yellow discharge
- Sore throat
- Hoarse voice
- Chest tightness, wheeze and breathlessness
- Dry unproductive cough
- Sputum scanty, mucoid, viscid or
- Mucopurulent and copious
- Generalized aches and pains
- Nausea and vomiting
- Pyrexia, usually of sudden onset
Although many symptoms may be considered for upper respiratory infections but we will here consider only those rubrics, which suggest that the URI is associated with fever.
Rubrics in Kent
- Catarrhal fever – Acon, Bry, Hep, Merc / ars, ferr p, kali i, rhus t, sabad.
- Coryza, fever with – Bry, Merc / acon, ars, bell, hep, sang // all c, gels.
- Pain extremities, influenza during – Bry, Eup p / acon, caust, chel, euph, gels
Rubrics in Boericke
- Influenza – Acon, Ars, Ars I, Bapt, Bell, Brom, Bry, Carb ac, Cepa, Ahin s, Dulc, Eucal, Eup p, Gels, Lob p, Nat s, Nux v, Phos, Rhus t, Sabad, Sang n, Sticta.
- Bronchitis – Acon, Ant t, Bell, Brom, Bry, Caust, Dulc, Ferr p, Hep, Ipec, Kali bi, Merc s, Phos, Puls, Rumex, Sang, Sang n, Scilla, Sticta, Sul.
- Cough, causes influenza – Eriod, Kali bi, Kreos, Pix l, Sang.
Based on the above rubrics we will discuss the following commonly indicated medicines in URI pyrexia:
- Arsenic alb.
- Eupatorium p.
- Ferrum phos.
- Hepar sulph.
- Merc sol.
- Natrum mur.
- Rhus tox
Exposure to dry cold air, dry North or West wind.
Exposure to draught of cold air, while in perspiration.
Bad effects of fright, heat of sun, excitement.
Symptoms indicating URI pyrexia
- Mucus membrane dry, nose stopped up; dry or with scanty watery coryza.
- Pain at root of nose
- Coryza; much sneezing; throbbing in nostrils.
- Throat red, dry, constricted, numb, prickling, burning, stinging.
- Tonsils swollen and dry.
- Hoarse, dry, croupy cough.
- Cough dry, short, hacking; worse at night and after midnight.
- Fever: chill and heat alternate.
- Hot hands and cold feet.
- Cold stage marked. Cold sweat and icy coldness of face.
- Cold waves pass through him.
- Thirst and restlessness.
- Sweat absent or on parts lain upon.
- Fear, anxiety, and restlessness.
- Smell acutely sensitive.
- Intense thirst for cold water.
- Retention of urine
< In warm room, in evening and night, dry-cold winds.
> In open air.
Exposure to draught of cold air, uncovering the head, from hair cut, summer sun.
Symptoms indicating URI pyrexia
- Nose red and swollen
- Coryza; mucus mixed with blood
- Throat dry, as if glazed; red, worse on right side
- Tonsils enlarged; throat feels constricted; difficult deglutition; worse liquids
- Oesophagus dry, feels contracted
- Sensation of a lump. Continual inclination to swallow.
- Dryness in throat, fauces, larynx and trachea.
- Tickling, dry, short cough; worse at night.
- Larynx ver painful.
- Fever, high, with sudden rise.
- Fever with burning, steaming heat.
- No thirst with fever
- Perspiration only on covered parts or absent.
- Skin red, hot esp. red face with throbbing of carotids.
- Pulse strong and quick
- Acuteness of all senses.
- Headache from suppressed catarrhal flow.
- Headache and congestion, esp. in forehead, also in occiput and temples.
- Headache with throbbing of carotids.
- Pain worse light, noise, and jar, lying down and in afternoon; better by pressure.
- Conjunctiva red; dry, burning, with photophobia.
- Sleeplessness, with drowsiness.
< Touch, jar, noise, draught, after noon, lying down