We now know that about half of exacerbations of bronchiectasis, interstitial lung disease (ILD), pulmonary fibrosis and other chronic lung conditions are caused by infection with a respiratory virus. Viruses are the smallest living organisms and have to invade into human cells to survive. Respiratory viruses are viruses that invade the cells lining the nose, throat, windpipe or lungs, where they cause infections that are usually only relatively mild. However, the viral infection stirs up inflammation in the lungs and this can upset underlying lung conditions. In all lung diseases, but particularly in bronchiectasis, the respiratory virus infection allows the bacteria present in the lungs to increase in number and cause an infective exacerbation. As a consequence, preventing respiratory virus infections will help prevent people with chronic lung diseases having an infective exacerbation needing antibiotics or worsening their fibrosis.
There are many types of respiratory viruses, but the most important is influenza (the ‘flu’). Other important respiratory viruses are COVID, respiratory syncytial virus (RSV) and rhinovirus (the main cause of the common cold), but there are several more that are less common. Most respiratory viral infections peak in winter. For example, flu peaks usually occur between November and February and can affect up to 10% of the population each winter, increasing to 25-30% during a ‘flu epidemic’ year when a particularly nasty strain is circulating. In addition, on average, adults have about 2 to 3 colds per year; children have more, on average 5 to 6 colds per year. Although COVID is a respiratory virus, at the moment, it causes peaks of infections every three to four months year-round and as yet not just in winter; this may change over time with COVID behaving more like flu and RSV and causing a peak of infections only in winter.
Do I Have Flu, a Cold or COVID?
This is not easy to work out as they all cause an upper respiratory tract infection with cough, sore throat, a runny nose, fevers, and feeling ill. Flu and COVID tend to cause a more severe illness than other viruses, making the patient feel more unwell. If the respiratory virus infection causes a flare of the bronchiectasis, then the cough will become more productive of greener, thicker phlegm in larger amounts than usual and this requires treatment with rescue antibiotics (should be detailed in the letters from your Respiratory Clinic). If you have pulmonary fibrosis or ILD and your cough becomes more severe or you are more short of breath with a change in amount or colour of sputum, you also may need antibiotics.
Preventing Respiratory Virus Infections
Respiratory viruses are caught by inhaling minute droplets of water produced by someone with a viral infection coughing or sneezing. Avoiding catching a respiratory virus will help prevent exacerbations of the underlying lung disease, but is tricky given how common these infections are. Avoiding crowds, especially in closed in spaces (eg. the Tube during rush hour), is important for people with more severe lung disease that usually reduces their ability to walk around without taking frequent rests. In addition, patients should avoid family members who have a cold or flu or, if that is not possible, both the patient and the affected family member should wear a face mask.
Vaccines
Viral infections can be prevented using vaccines. We have vaccines for both flu and COVID, and recently the UK has introduced a new vaccine to prevent RSV infections. The UK is fortunate to have a safe and effective vaccination against the flu, which is provided free of charge by the NHS usually from October every year to:
- Everyone over the age of 65.
- People of any age with lung diseases, heart disease, kidney disease, liver disease, diabetes or lowered immunity.
- Anyone living in a residential or nursing home.
- Carers of those at risk.
- Children aged 2 to 18.
Flu vaccination is advised annually as the type of flu virus causing infections changes every year. Despite popular belief, the flu vaccination can not give you flu. It’s true that some people experience symptoms of a heavy cold at the same time or just after they’ve had the flu jab – this is simply a coincidence and the symptoms are caused by one of the many other respiratory viruses causing colds and flu-like illnesses in the autumn and winter. Although the flu vaccine makes the chance of catching flu a lot lower, it is not 100% effective against flu and does not protect against the other respiratory viruses. Hence, even when you have had the vaccine, you can still occasionally catch a heavy cold or flu-like illness. The specific flu strains causing infection also change every year, which is why the exact content of the flu vaccine has to be changed and the vaccine given every year. Flu vaccination is available from October each year, and anyone who thinks they need it should talk to their doctor or nurse.
COVID vaccinations are offered at the same time as flu vaccination, ie. every autumn, to roughly the same people as those that receive the flu vaccine. Now that almost everyone has had COVID and/or been given the COVID vaccines on several occasions, COVID is very unlikely to cause the severe pneumonia that it used to cause in 2020 and 2021. The exception are the rare people with very damaged immune systems due to having had a transplant or strong treatments for auto-immune diseases (which are common in some of our patients with ILD) or cancers; they can still develop COVID pneumonia as their immune response is less able to generate a strong defence against the infection. Fortunately, even in these people, COVID pneumonia mainly remains mild. However, COVID is still able to cause mild upper respiratory tract infections in almost anyone despite being vaccinated or having had COVID before. These infections are very mild but, like other respiratory viruses, can cause flare ups of underlying lung diseases, such as bronchiectasis, ILD/pulmonary fibrosis and COPD. The COVID vaccine does help prevent these mild infections for a few months so is useful for people with chronic lung disease to reduce the chance of them ending up in hospital over winter due to their lung problems flaring up.
RSV Vaccine: Everyone aged between 75 to 79 years on 1st September 2024 are being offered a single dose of the new RSV vaccine. This vaccine is very effective, probably preventing 80% of RSV infections. RSV reliably causes a peak of infections in the early winter, so the vaccine will be given in the autumn starting from 1st September. People not in the 75 to 79 year age group who are likely to be more susceptible to RSV, such as those aged 80+ or who have underlying diseases like COPD, bronchiectasis or ILD, are not yet being offered the RSV vaccine as there was not enough data on the effects of RSV infections in these groups. These groups may be offered the RSV vaccine in the future when more information becomes available on how common RSV infections actually are and how these infections may affect younger people with comorbidities, such as lung diseases, and those aged 80 or over.
How to Treat the Flu, COVID and other Respiratory Viral Infections
The best ways to treat symptoms are to:
- Get plenty of rest. The body uses a lot of energy fighting infections, so resting for the first couple of days gets it off to a good start.
- Keep warm.
- Make sure you drink plenty of water to avoid dehydration, and try hot water with lemon, ginger and honey to relieve symptoms such as a sore throat.
- Take paracetamol or anti-inflammatory medicines, such as ibuprofen, to lower a high temperature and relieve aches.
For patients with bronchiectasis, ILD/pulmonary fibrosis and /or COPD, if the cough becomes more productive of discoloured phlegm, then this indicates the virus has allowed a bacterial infection of the lungs to develop and antibiotics are likely to be needed. Many patients will have rescue packs of antibiotics at home and are well able to judge from previous experience when the antibiotics need to be started. Contact your doctor if you have a high fever or cough that is not improving after 3 or 4 days (especially if you have already started your rescue pack of antibiotics) or if you are unduly short of breath.
How to Keep Healthy and Avoid Getting the Flu or Other Respiratory Viruses
- Have the flu, COVID, and/or RSV vaccines if you are in an eligible group.
- Keep your immune system strong by eating a healthy diet, possibly supplemented with vitamins to bump up your vitamin C.
- Get enough rest and relaxation.
- Do not smoke.
- Take regular exercise.
- Avoid travelling on very crowded trains, tubes or buses.
- Use a face mask when out and about, especially in closed in places with lots of people, such as cinemas and theatres.
- Wash your hands often and keep a bottle of antibacterial hand cleanser around.
- Avoid people who are coughing and sneezing, especially if they’re not covering their mouth and nose.
- Use and bin your tissues.