Early symptoms of respiratory disease

Mild discomfort in the nasopharynx, irritating cough without phlegm, and low-grade inflammatory reaction throughout the body. More than 90% of early infection cases will have at least one of the above symptoms. Timely intervention at this stage can shorten the course of the disease by 30% to 50% and greatly reduce the probability of developing severe disease.

Last week, I met a 28-year-old Internet operator at the fever clinic. When he arrived, his fever had reached 39.2°C. The X-ray showed mycoplasma pneumonia with mild lung consolidation. When I asked him about it, he said that three days ago, he always felt that his throat was tight in the morning. He thought it was because the air conditioner in the office was too dry. He drank iced milk tea for two days to suppress it.

These "little awkwardnesses" that are easily overlooked are actually signals that pathogens have colonized the respiratory mucosa and are beginning to cause inflammation. Most common viral and bacterial infections first start in the nasopharynx. Either the sore throat makes you unable to swallow, as everyone thinks, or when you swallow, you always feel that there is a lump of semi-dissolved phlegm stuck in your throat, and you can't cough it out. When you sniff, you can feel astringency at the back of the nasal cavity, or even Even if there is a slight itching at the base of the ears, you will most likely attribute it to "eating spicy food the day before" or "getting angry from staying up late". However, at this stage, flush your nose twice with saline and drink more warm salt water. In many cases, the pathogens can be directly removed and the fever will not develop at all.

Of course, not all infections start in the upper respiratory tract. Mycoplasma and respiratory syncytial virus, which have been popular in the past two years, often directly invade the lower respiratory tract. You don't feel anything in the nasopharynx, but occasionally you feel a tightness and itchiness in your chest. When you walk fast or are blown by a cold wind, you can't help but cough twice, but there is no phlegm. It’s the kind of cough that’s dry and itchy, and you’ll suddenly choke even if you talk too much. Many people will take this signal as “dry throat”, but it’s actually a sign of irritation of the bronchial mucosa. After two or three days, more inflammation will leak out, and you will start to cough up yellow phlegm and develop a fever.

Speaking of which, the current clinical definition of early symptoms of respiratory diseases is actually somewhat controversial. Mainstream Western medicine guidelines usually only include respiratory-related symptoms as early warning signs. However, the febrile disease school of traditional Chinese medicine has long said that "warm evil affects the lungs first, and can also directly attack the spleen and stomach." According to statistics from our outpatient clinic, about 15% of patients with influenza and mycoplasma infections have no respiratory-related discomfort in the early stage, and the symptoms that appear first are Rather, they are gastrointestinal or systemic symptoms: sudden loss of appetite, diarrhea after eating something cold, or feeling heavy all over. When I get home from get off work and school, I just want to slump. I don’t even have the energy to watch the short videos I usually like to watch. My body temperature feels a little warmer than usual, and when measured, it is only 36.9°C or 37.1°C, which is not up to the standard of clinical fever. This kind of situation is most likely to be missed. By the time many people start coughing, the inflammation has already spread.

Last month, a mother brought her 5-year-old son to the doctor. She said that the child was fine the day before, but suddenly his fever reached 39 degrees Celsius. After careful questioning, she found out that the child always complained that he was tired in the past three days. When he came back from school, he did not make the fuss of going downstairs to run and play like before. He said he was full after eating two mouthfuls of food. At that time, the mother thought that the child was throwing a tantrum and did not want to eat, and even said a few words to him. Now that I think about it, it was actually an early warning from the body.

Another sign that can easily be confused is the inexplicable itching and tearing of the eyes. Many people's first reaction is allergies or conjunctivitis. In fact, the nasolacrimal ducts and the respiratory tract are completely connected. When adenovirus and some strains of influenza are infected, the first thing to attack is the conjunctiva. If you have not changed your skin care products recently, or been exposed to new pets or pollen, and suddenly your eyes are red and itchy, you shed tears at every turn, and you feel a little heavy all over, it is best to check your temperature twice more. Don't treat it as a common allergy and just drop eye drops and pass it.

It’s interesting to note that when I got influenza A last winter, the first symptom that appeared was not a sore throat at all, but stiffness in the back of my neck. I always felt that I had a stiff neck when I slept the day before. I pinched it for a long time and applied plasters to no avail. After 12 hours, the fever directly reached 38.5°C. After talking with colleagues in the department, I found that many people had similar atypical early symptoms. However, the probability of such symptoms is too low and has not been included in the official guidelines. It is always good to be more careful.

In fact, there is no need to memorize all these symptoms verbatim. To put it bluntly, it is a little awkwardness that your body usually does not show up. It lasts for most of the day and does not relieve. If you happen to catch up with the peak period of respiratory diseases, don’t stay up late, drink iced drinks, and hit KPIs. Drink more warm water and lie down for a while, and help the body’s immune system. In many cases, it can clear out the invading pathogens. There is no need to wait until you are so burned that you can’t get up or coughed that you can’t sleep before you think about running to the hospital.