Respiratory tract infections | Pokenga atewharowharo

Key points about respiratory tract infections (RTIs)

  • Respiratory tract infections (RTIs or pokenga atewharowharo) can affect any part of your body involved in breathing.
  • They often occur after you get a cold or  the flu. 
  • RTIs can be upper or lower – upper RTIs (eg, colds or sinus infections) can mostly be treated at home, but lower RTIs (eg, pneumonia) are more serious and generally need medical help. 
  • People at greater risk of serious illness may need to consult their healthcare provider. 
  • Reduce the spread with good hygiene and flu vaccination.


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COVID-19 pandemic

If you have any respiratory symptoms such as a cough, sore throat, shortness of breath, head cold or loss of smell, with or without fever, call your GP or Healthline's dedicated COVID-19 number 0800 358 5453 to check whether you need to be tested for COVID-19.


  • RTIs are divided into 2 categories: upper and lower.
  • Lower RTIs, such as pneumonia, tend to be more serious than upper RTIs, such as colds or a sinus infection.
  • Most upper RTIs can be treated at home, but young children, older adults, pregnant women or people with long-term health conditions who get a lower RTI may need to see a doctor.
  • You can reduce the spread of RTIs by washing your hands and covering your coughs and sneezes.
  • You can reduce your risk of catching RTIs by having an annual flu vaccination, and healthy lifestyle habits such as regular exercise, quitting smoking, eating well and getting plenty of sleep. 

Upper RTIs are very common and affect your nose, sinuses, throat (pharynx) and voice box (larynx). Symptoms of upper URIs include a cough, sore throat, runny nose, nasal congestion, headache, low-grade fever and facial pressure.

Common upper RTIs include:

Lower RTIs are also known as chest infections. They affect your larger airways (bronchial tubes and bronchioles) and your lungs.

Lower RTIs are generally more serious than upper RTIs. Symptoms of lower RTIs include shortness of breath, weakness, fever, coughing with green or brown phlegm, and fatigue.

Common lower RTIs include: 

Most upper RTIs get better in 1–2 weeks. You can usually treat your symptoms at home. However, a lower RTI can be serious. Those most at risk are young children, older adults, pregnant women or people with long-term health conditions.

See a doctor if you or someone you are caring for has a respiratory tract infection and:

  • feels very unwell or symptoms get worse
  • has had a cough for more than 3 weeks
  • is pregnant
  • is over 65
  • is a child under 2 years
  • had a weakened immune system
  • had a long-term health condition, such as diabetes, heart disease, asthma, COPD.

See a doctor immediately if you or another adult has:

  • a high fever that doesn’t come down (sweating, shivering, chills)
  • fast or difficult breathing
  • chest pain
  • signs of dehydration.

See a doctor immediately if your baby or child:

  • is breathing fast or noisily or if they are wheezing or grunting
  • is very pale, drowsy, limp or difficult to wake
  • is severely irritable, not wanting to be held
  • has dry nappies or no tears when they are crying, which means they are dehydrated
  • you are worried that something is not right.

Most upper RTIs are caused by a virus, which cannot be treated with antibiotics (these only work on bacterial infections). Your immune system will be able to fight off most viral infections. Misusing antibiotics to treat viral infections contributes to the problem of antibiotic resistance.

Some lower RTIs are caused by bacteria. If your immune system is having difficulty fighting off the infection your doctor may prescribe a course of antibiotics. 

You should always take antibiotics according to your doctor’s instructions, making sure to complete the entire course even once you’re feeling better. This helps to minimise the risk of the development of bacteria resistant to that antibiotic. 

To help you or the person you are caring for feel more comfortable and speed your recovery, take the following self-care steps:

  • Get plenty of rest.
  • Drink lots of water to stay hydrated and loosen mucous.
  • Take paracetamol or ibuprofen for pain and fever.
  • Drink warm lemon and honey for a sore throat and cough.
  • Gargle warm salty water for a sore throat.
  • Take a teaspoon of honey for a cough.
  • Inhale steam (adults only).
  • Rub mentholated ointment onto your chest.
  • Try decongestants and nasal sprays for a blocked or runny nose.
  • Use a saline nose rinse for sinus congestion.
  • If you have been prescribed any medications, take these as directed.

Contact your doctor immediately or call Healthline free on 0800 611 116 if you or your child have trouble breathing, have a high fever or show other signs that the infection is getting worse.

  • Wash your hands often.
  • Cover your coughs and sneezes, eg, by using your elbow.
  • Use disposable tissues and put them in a bin straight away.
  • Clean surfaces around the house more often.
  • Stay at home if you are unwell.

Vaccination can protect against certain viruses. However, not all viruses can be vaccinated against. Get the annual flu vaccination – find out if you're eligible for the free flu vaccine.

If you keep getting RTIs or you're at a high risk of getting one (eg, because you're over the age of 65 or have a serious long-term health condition) ask your GP about the pneumococcal vaccine – this helps prevent pneumonia.

Taking the following steps also reduces your risk of getting an RTI:

  • wash your hands often
  • avoid close contact with people who have a cold or the flu
  • eat a healthy diet, get plenty of sleep and exercise regularly
  • stop smoking if you smoke.

Clinical resources

Navigating uncertainty – managing respiratory tract infections(external link) BPAC, NZ, 2019
Cold season in primary care(external link) BPAC, NZ, 2013
Management of specific respiratory tract infections(external link) Free clinical e-Audit, NPS MedicineWise, Australia, 2018
Te ha ora – the breath of life – national respiratory strategy(external link) Asthma & Respiratory Foundation, NZ, 2015
Respiratory tract infections (self-limiting) – reducing antibiotic prescribing(external link) BPAC, NZ, 2015 


Practical prescribing for respiratory infections(external link) (Goodfellow Unit, NZ, 2017)

Video: Goodfellow Unit MedTalk: Respiratory Infections

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(Goodfellow Unit, NZ, 2017)

Clinical guidelines

Patients with symptoms of respiratory tract infection – a collaborative approach

The Royal New Zealand College of General Practitioners and the Pharmaceutical Society of New Zealand have developed this algorithm to highlight potential cross-over points and communication considerations for care transitions between general practice and community pharmacy. 

The aim is to help ensure that patients and whānau experience a smooth healthcare journey and to reduce risk of transmission of infection to other patients and staff.

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Helen Kenealy, geriatrician and general physician

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