How Bad is My Cough?

Ever since the pandemic swept the world in 2020, cold and flu season has been an anxious time for many. Is that a regular old sneeze or something worse? Will the sore throat stop or is it just the beginning of a more serious illness? It’s hard to look at respiratory infections the way we once did – as a sometimes-unpleasant inconvenience for all but the most vulnerable.

It’s not just COVID-19 that creates anxiety. Other seasonal respiratory viruses including influenza and respiratory syncytial virus (RSV) have returned, causing some sleepless nights for the past couple of years, especially for parents of young children. While most of these infections will come and go over a few days, some respiratory infections may be more serious. Pneumonia, an infection involving the air sacs of the lungs that is often due to bacteria, can make people particularly ill.

Garth Garrison, MD, a pulmonologist and critical care specialist at The University of Vermont Medical Center, shares his expertise about respiratory infections to ease your nerves and help you know when and how to get the care you may need.

Expert Q+A: COVID-19, RSV and Pneumonia

Q: Are more people than usual sick this winter with respiratory issues?

A: Respiratory infections tend to increase in the fall and winter, and that's a consistent pattern over time. During the pandemic, we didn't have as many respiratory infections, like RSV and influenza, because people were masked and not transmitting those germs as readily. But now we’re back to the normal pattern. We've seen a steady increase in respiratory infections since October.

Q: How do we tell the difference between different types of respiratory infections?

A: One of the most common types is a viral upper respiratory tract infection that you usually feel from the neck up. You will typically have sinus congestion, a runny nose, sneezing and maybe a cough because of mucus draining to the throat. This is what we typically call a cold.

Then there’s bronchitis, which is usually caused by a viral infection that inflames the tubes that bring air into the lungs. That may cause a more frequent cough that feels “deep” with mucous produced.

Pneumonia is an infection of the air sacs in the lungs, where the gas exchange happens that allows you to breathe. Pneumonia can have similar symptoms to bronchitis: a severe cough with sputum production. Some people with pneumonia will have a fever, shortness of breath, discomfort in the chest and even blood in their sputum.

Q: What distinguishes bronchitis and pneumonia if they share so many symptoms?

A: Compared with bronchitis, pneumonia often makes you more ill. So if you're particularly sick, feeling like you don’t have energy, and having pain – particularly when you breathe – or if you’re having trouble breathing or have a high fever, those are signs you may have pneumonia.

Q: Why is it important to know you have pneumonia rather than other illnesses?

A: Untreated pneumonia can be deadly. It can disrupt your ability to get the oxygen you need and get rid of the carbon dioxide you don’t. The bacteria from the infection can also enter your bloodstream and cause organ failure, or fluid can develop around lungs, creating a serious condition called pleural effusion. It’s important that those with pneumonia get treated with antibiotics, whereas people with upper respiratory tract infections and bronchitis typically don’t need them.

Q: If someone is worried they might have pneumonia, should they go to their primary care provider, an urgent care office or to the hospital?

A: Pneumonia is usually diagnosed with a chest x-ray, so if your primary care doctor or local urgent care can quickly get you in for an x-ray, that’s fine. But if you're notably short of breath, and it's hard to walk, hard to do your daily activities, or if you're having severe chest pain or really high fevers, the emergency room would make more sense.

Q: Is there a vaccine that can protect us from pneumonia?

A: There's a vaccine available that can help prevent a particularly severe type of pneumonia called pneumococcal pneumonia from developing into a serious illness. It’s available for adults 65 and older and for adults who have conditions that might increase their risk of severe disease. It’s now given routinely to kids under 5 years old so children should be covered.

Q: What else can we do to keep ourselves safe from respiratory infections?

A: Regular and thorough hand washing with antibacterial soap, especially before eating or touching your face, is a really effective way to stay healthy. Of course, it’s also good to try to limit contact with people who seem sick, but that can be hard at this time of year when we’re all stuck indoors.

Getting vaccinated for whatever you’re eligible to be vaccinated for is also helpful. Adults over 60 and pregnant people can get the RSV vaccine, and most people are recommended to have updated COVID and influenza vaccinations. People who have significant immune suppression or significant risks may choose to mask to help ward off sickness. At UVM Medical Center, starting in mid-January, staff members are required to mask while providing patient care.