17 Osteopathic Family Physician (2017) 17 - 25 Osteopathic Considerations in the Infections of the Respiratory Tract Sheldon Yao, DO, Nardine Mikhail, OMS III, George Koutsouras, OMS III, Allison Coombs, OMS III, & Michael J. Terzella, DO New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York Respiratory tract infections are a common reason for offce visits in primary care set- tings. Respiratory tract infections can often be managed in an outpatient setting, however hospitalization may be necessary in some more emergent and life threatening cases. A thorough history and physical will often help guide physicians on the proper course and setting for management. Furthermore, a thorough osteopathic assessment will guide the physician in diagnosing and treating somatic dysfunctions caused by respiratory infection. Osteopathic manipulative treatment can aid in recovery by providing relief of symptoms, and restoring proper structure and function of the respiratory system. CORRESPONDENCE: Sheldon Yao, DO | syao@nyit.edu 1877-5773X/$ - see front matter. © 2017 ACOFP. All rights reserved. INTRODUCTION Acute respiratory infections (ARI) are currently the most common reason for seeking ambulatory care. 1 Additionally ARI’s are the leading cause of seeking medical treatment in returning travelers. 2 Because the realm of ARI’s is so broad, it is important to be able to correctly differentiate between cases that can be adequately treated in an outpatient setting, and those that will require hos- pitalization. Accounting for such a high number of offce visits, it is important for osteopathic family physicians to be knowledge- able and confdent in their approach to a patient with an (ARI). Understanding the interplay between the various components of the respiratory system, and the effect somatic dysfunctions have on function is central to the proper management of a patient with an ARI. STRUCTURAL & FUNCTIONAL CONSIDERATIONS OF THE RESPIRATORY TRACT The respiratory system is composed of the oropharynx, conduct- ing airways, lungs, muscles of respiration, and the chest wall. 3 The distinction between upper and lower respiratory infections is an anatomical one. The nose, mouth, pharynx and larynx comprise the upper airway, which is also connected to the middle ear via the Eustachian tube. 3 Infections in these areas are considered upper respiratory infections. Lower respiratory infections can potentially include infections that extend from the bronchus to the alveoli. Keywords: Respiratory Infectons Respiratory Tract Antbiotc Use Disease Preventon & Wellness Osteopathic Manipulatve Medicine Community Acquired Pneumonia REVIEW ARTICLE The upper respiratory tract humidifes inspired air, and offers pro- tective measures against entering microorganisms. 3,4 Inspiration brings exogenous microorganisms, dust, gases, and smoke into the lungs. 3 Because of this, the respiratory tract has to have a system of fltration for removal of harmful inspired material. Cilia and mu- cus entrap entering microorganisms, while tonsils and adenoids provide immunologic defense against biologically active mate- rial. 3 Smaller particles that escape to the trachea and bronchial airways get trapped in the mucus which is ultimately removed by mucociliary transport to the pharynx and mechanical expulsion via coughing and sneezing. 5 In the lower respiratory tract, alveolar macrophages engulf and destroy inhaled microorganisms and par- ticles. 5 Somatic dysfunctions disrupting structural and functional relationships of the face and thoracic cage can therefore impede host defenses against infection. EPIDEMIOLOGY Infections of the upper and lower respiratory tract affect all indi- viduals, but the probability of severe disease is observed in a bi- modal distribution, as the young and the elderly are at greatest risk. In the United States, respiratory infections are currently the leading infectious cause of hospitalization and death among adults, and are the overall leading cause of hospitalization in children. 6,7 Acute respiratory infections are also one of the leading causes of death in children under 5 years of age. 8,9 Risk factors that result in more severe illness include being male, inhalation of pollutants, malnutrition, and extremes of age. 8 Upper respiratory tract infec- tions, which are summarized in Table 1 (page 18), contribute to disability and days lost from school or work. 9 In 2016, just twelve