Respiratory Tract Infections: The Most Common Human Diseases

Akutne respiratorne infekcije (ARI), odnosno akutne upalne bolesti dišnoga sustava najučestalije su infekcije i najčešće bolesti čovjeka uopće. Bolesnici s ARI, posebno gornjeg dijela dišnog sustava, najčešći su posjetitelji pedijatrijskih i drugih ordinacija primarne zdravstvene zaštite. Osobito često obolijevaju mala djeca. Razlozi za ovako veliku učestalost ARI nalaze se u građi i položaju dišnog sustava, u mnoštvu različitih uzročnika koji se vrlo lako prenose te u još uvijek skromnim mogućnostima sprječavanja i liječenja. Klinički se ARI očituju cijelim spektrom različitih sindroma i različitom težinom bolesti. To su najčešće blage infekcije gornjeg dijela dišnog sustava uzrokovane virusima, a katkad se pojavljuju njihove komplikacije (otitis, sinusitis). Infl uenca je još uvijek vrlo česta i teška bolest, koja se svake godine pojavljuje epidemijski, a praćena je brojnim komplikacijama, osobito u starijih ljudi i u drugih kroničnih bolesnika. Klinički je relativno lako, a neobično važno, razlikovati streptokoknu anginu od drugih (virusnih) angina. Infekcije u donjem dijelu dišnog sustava nisu najčešće uzrokovane virusima, osim akutnog bronhitisa i bronhiolitisa. Akutni se bronhitis najčešće pojavljuje u sklopu virusnih infekcija gornjeg dijela dišnog sustava u djece, pa ga ne treba liječiti antibioticima. Bronhiolitis je težak klinički sindrom sa zahvaćenošću donjeg dijela dišnog sustava u dojenčadi i u male djece, a najčešće ga uzrokuje respiratorni sincicijski virus (RSV). Akutna egzacerbacija kronične opstruktivne plućne bolesti (AE-KOPB) defi nirana je kliničkim znakovima, a zahtijeva primjenu antibiotika. Pneumonija je najteža infekcija dišnog sustava pa zaslužuje posebnu pozornost, iako sudjeluje samo s jednim postotkom u svim ARI. Zahvaća sve dobne skupine i osobe s različitim kroničnim bolestima i oštećenjem imuniteta, a uzrokuju je brojni i raznovrsni mikroorganizmi. Zato se pneumonija očituje vrlo različitim simptomima i kliničkim oblicima pojavnosti i težine bolesti. Najčešća je i najteža u krajnjim dobnim skupinama. Osnovni problem u liječenju bolesnika s ARI proizlazi iz nemogućnosti točnog etiološkog dijagnosticiranja brojnih i raznovrsnih uzročnika. Posljedica je neprikladno, često nepotrebno, neracionalno i neučinkovito liječenje s brojnim neželjenim događajima. Zacijelo najveća zloporaba antibiotika događa se pri nepotrebnom liječenju virusnih infekcija gornjeg dijela dišnog sustava, najčešće obične prehlade, posebno u male djece.Acute respiratory infections (ARI), i.e. acute infl ammatory diseases of the respiratory system, are the most common human infections and diseases. The patients with ARI, and especially those with upper respiratory infections, are the most frequent visitors of paediatric and other primary care units. The incidence is especially high amongst small children. The reason for such a high incidence of ARI lies in the structure and position of the respiratory system, as well as in a myriad of easily transmitted pathogens and modest possibilities of ARI prophylaxis and treatment. ARI are manifested in a number of syndromes and degrees of severity. Most often, they are mild viral infections of the upper respiratory system. Sometimes, they are accompanied with complications (otitis, sinusitis). Infl uenza is still a very common and severe disease which occurs every year in the form of epidemic. It is accompanied with numerous complications, especially in the elderly and chronic patients. It is easy, and very important, to make a clinical distinction between streptococcal angina and viral anginas. Most often, lower respiratory infections are not caused by viruses, except for acute bronchitis and bronchiolitis. Acute bronchitis is most often reported in viral infections of the upper respiratory tract in children and therefore should not be treated with antibiotics. Bronchiolitis is a severe clinical syndrome affecting the lower respiratory tract in newborns and infants, and it is most often caused by respiratory syncytial virus (RSV). The acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is defi ned by clinical symptoms and requires antibiotic treatment. Pneumonia is the most severe respiratory infection and as such requires special attention although it accounts for only one per cent of all ARI. It affects all age groups and patients with chronic diseases and compromised immunity. It is caused by numerous and various pathogens. Therefore, it is manifested in various symptoms and degrees of severity. It is most severe in the elderly and small children. The main problem in the treatment of ARI patients lies in the impossibility of making a precise etiological diagnosis of numerous and various pathogens. This results in inadequate and often unnecessary, irrational and ineffi cient treatment with numerous adverse events. The abuse of antibiotics is most often reported in the unnecessary treatment of viral infections of the upper respiratory system, most frequently common cold, especially in small children