It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.

Melanie Cole, MS (Host): Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And today, we are talking about respiratory illness season. Joining me, as always, fan favorite, Dr. Anirudh Rai. He's a primary care physician at Henry Mayo Newhall Primary Care. Dr. Rai, thank you so much for being with us today.

So, what are the most common respiratory illnesses you see around this time of year and most of the year that you see them? And how are they different from each other? And we'll talk about the different ones, but do you see most commonly now?

Anirudh Rai, MD: Yeah, that's a great question. I was happy to be on board to talk about these things. Nowadays, the seasons, since it's closer to summer, we see more of the common cold. And sometimes we are seeing a little bit of flu and COVID. But more often than not, we are seeing more of these common "cold-like symptoms," which is caused by the most common one usually is caused by rhinovirus, which is essentially symptoms of the classic runny nose, a little bit of a cough, a little bit of sore throat. More often than not, sometimes maybe absent of fever. So, one of the main difference from at least the common cold during the summer is you may not see fevers as much, compared to our flus and our COVIDs in which fever may be present.

Melanie Cole, MS: When we think of respiratory illnesses, Dr. Rai, we tend to think of people that are maybe immunocompromised. But I mean, anybody can come up with them and they're so easily spread. Can you speak a little bit about who's most at risk and vulnerable and how many of these are spread? Are they spread through the air and touching surfaces? We learned a lot about COVID during those days, but tell us a little bit about some of that.

Anirudh Rai, MD: Absolutely. So, given the season is summer and people are going back to school, particularly kids, you're going to see a lot more of it rise up because kids tend to, let's just say, it's easier for them to pass to others than, let's say, adults who are a bit more conscientious about their hygiene. So usually, when kids come back from school is when we get more of this uptick in these common cold-like symptoms, runny nose.

The rhinovirus, again, like we mentioned, is the most common one. And that is what we tend to see in our parents, because they tend to say, "Hey, my kids have this condition. Now I seem to have gotten it too." And it seems to be a little more prominent, I would say a bit more painful, or our adults, they have a higher symptom rate, so to speak. The best way to describe it. They tend to complain a little bit more than, let's say, the kids.

The other thing to watch out for in these conditions would be the hygiene exposure. So since kids are coming together in daycare, it's better if adults tend to kind of watch their hygiene among the family as well. But I would say from my perspective, we tend to seeing more of kids having symptoms, but we tend to see adults who complain more about it, so we tend to look at it a bit more closely. And those patients that tend to be, well, I would say adults majority of the time are not immunocompromised, but the fact is, since kids have more exposure to these viruses, their immune system is more used to it.

Adults, on the other hand, don't tend to see these viruses as often, so I wouldn't call them immunocompromised, more like, I would say, immuno-naive would be the best way to describe it. They tend to have these reactions that are a bit more robust. But our immunocompromised patients, like the ones who are undergoing cancer treatment, who are actively on medications that depress their immune system, like prednisone, are at higher risk for getting these similar bugs, and in fact, tend to have a higher rate of even having longer symptoms.

Melanie Cole, MS: When we think of transmission and we think of respiratory and coughing, right? So, are most of these coughing? Do they cause coughing? Are they transmitted through the air, floating little droplets? Tell us about the cough.

Anirudh Rai, MD: The second part of the question, specifically how they're spread, would be through what we call respiratory droplets. A lot of the viruses tend to be spread in that regard because viruses are quite small, incredibly small, that they could sometimes just be blown out of people's mouth in droplets or even just aerosolized in some cases.

But honestly, touching from, let's say, mouth to eyes or to other folks, and there's another mode of transmission may not be as prevalent, but it is something that we do see. That's why it's important to clean your hands or any time you have someone sick, just to be a bit more cautious. But each virus, I would say majority of the time do have aerosolized components, but I wouldn't say all viruses by definition have that sort of spread. For example, like rhino flu can be spread somewhat aerosolized, but it, I would say the majority of the time, it can be spread just by touching someone who has that sort of virus on their hands. Flu is notorious for being aerosolized. So, it is very known to have that component to spread around and be easily spread in that regard. But to be just cautious and just an overall warning, anyone who is sick, hygiene is important and making sure you're also up to date on your immune vaccines, which we'll probably talk about later down the line, I'm sure.

Melanie Cole, MS: We definitely will. Now, I think the big question, and we talked about this a lot during COVID too, how do we know the difference, Dr. Rai, between a cold, the flu, COVID, RSV, and even something really more serious like pneumonia or bronchitis? You know, people get these respiratory things and right away, they think, "Oh, bronchitis," or they're looking for the color of sputum or the cough, the type of cough. Is it dry? Is it wet? Tell us, how do we know what we've got?

Anirudh Rai, MD: That's quite a lot to unpack. So, let's start off with the top. You mentioned another category of patients who are at high risk, which are our smokers and our asthma patients, who tend to have a more robust reaction to these kind of viruses. And you mentioned some of the side effects, or I would say more of the symptoms. You get what we call a wet or a productive cough. A productive cough being that there's something in your lungs causing it to secrete inflammatory secretions, which your body is a normal response to these kind of virus, and you try to cough it out. And we do sometimes ask our patients if the color has changed, and that gives us some clues.

But overall, studies have shown it's not really the most reliable test. We go by physical exam findings. If there's wheezing or if there's what we call rales, meaning there's signs of fluid in, that area, then that's a more of a incentive for us to say, "Hey, there's a bacteria likely present." And that's when we say bronchitis likely is, the culprit. And bronchitis by definition is just a cough that's productive for a certain time length. It doesn't really define the cause, but more often than not, it is a bacterial component.

But when it comes to other symptoms, like between the common cold and let's say the flu, the more evident would be the body aches and the fever, which we see in the flu. More often than not, you may not see fevers, chills, or even body aches with something with a common cold or some of these more common viruses we see. And the more common one we're seeing in kids is the human metapneumovirus, which again, is very common, and adults can get it as well. And it has similar symptoms to what we get with the common cold.

But the main difference we look for when we come to signs and symptoms is fever, chills, and the cough could also be evident. But majority of the time, most of these viruses with bronchitis and even with bacterial component, you will have a cough present. And you may even get a runny, nose and of course, a sore throat. But a lot of these symptoms have a lot of overlap. But the one thing that defines majority of them, let's say a flu from the common cold, would be the fever and chills and sweats.

Melanie Cole, MS: They do overlap. And because there's seems to be so many more of them, but I'm glad you mentioned body aches and the difference between the coughs, the productive and the drier coughs. So, all of this is so important. You're always so knowledgeable. You have such a vast experience of knowledge.

Now, when we think of the best ways, you mentioned vaccines earlier. So, speak a little bit about some of the vaccines that are available for these respiratory illnesses and some of the best ways. Obviously, we're going to talk about hand washing and hand hygiene, but there are other ways. I mean, my kids taught me back when they were little, cough into your elbow, because I mean, I just used to cough into my hand. So, tell us some of the best ways that we can hopefully prevent these things.

Anirudh Rai, MD: Absolutely. And you mentioned one of them, which is coughing in a more ergonomic way, which is avoiding your hands because they tend to go around, touch everything. Your elbow, it's very hard to have someone touch your elbows. But usually, I would recommend any time you're coughing or sneezing, definitely sneezing into your elbow is the best practice because it prevents the spread via touching.

But at the same time, covering your mouth is important as well. So, definitely not blowing in the air is something we don't recommend, especially if you're in a crowd or in a room. And just honestly, washing your hands even if you don't touch anything would be good because hygiene is important.

When it comes to vaccines, I would say in the winter is when a lot of these vaccines get implemented, and that's when we have the more up-to-date vaccines. And there's a lot of theories around it, but we always try our best to keep our vaccines up to date. The flu is still the standard where we see what flu virus is most common and attempt to make a vaccine to combat that. And that is the best way for preventative and even some ways to help lessen the disease if you do get it.

And when that vaccine does come out, I highly do recommend all of our patients to get the flu vaccine. Of course, these other newer vaccines like the COVID and the RSV, I would recommend talking to your provider to see if you're a good candidate. Just because these vaccines are a bit newer, side effects tend to be a bit more severe, and we want to make sure we hand them to patients who are at higher risk, mainly those who are immunocompromised. And having that discussion with your doctor is the best way to start that.

Melanie Cole, MS: What about the pneumonia vaccine, Dr. Rai? I have people that wonder about that. I'm wondering about it myself. I'm 62, and the winter is coming up, here in Chicago anyway, and tell us a little bit about the pneumonia vaccine. Is that something we should be getting? Should I be getting that?

Anirudh Rai, MD: The pneumonia vaccine has been well-studied as well. Usually, I would recommend patients who reach around 65. By that time, we would say, "Okay, your immune system has gotten a good run of most of the viruses and bacteria." And around that timeframe we do see some form of immunosenescence where your immune system tends to be a little bit more blunted. And the pneumonia vaccine just wakes up those immune cells.

Also, I would recommend patients who are immunocompromised who are going through like chemotherapy, cancers, or even are missing a spleen or have their spleen removed, then yes, the pneumonia vaccine is highly recommended because when those components are involved, your body loses its ability to combat particularly the pneumococcal virus or that strain of viruses.

And the reason for that is been known. We don't have to delve too deeply into that. Part of the reason is the complement components of your immune system tend to be declining. So, this immune system response is blunted. So, that's why this vaccine tends to help with that. But usually, again, it's not for everyone. It's those who are immunocompromised who are less than 65, and anyone who is above 65 would recommend getting the pneumonia shot to get your body ready for these things.

Melanie Cole, MS: I mean, that's really what these are all about, these podcasts and videos, is about me being able to ask you these questions so that I know the answer to them for me. But we're all getting this medical advice together, and it's just such important information that you always give us. So when is it time to call our primary care or even visit urgent care if we think that we have one of these respiratory illnesses that start to go around?

Anirudh Rai, MD: Yeah, absolutely. So when you have signs and symptoms of a cough, right, it's been going for over, let's say, three or four days, then I would say talk to either your primary care or go to the urgent care where they could get tested for a lot of these viruses. The flu is a very common test or swab, even strep, COVID. And there's a lot of ways we could test for these right away. But I would say wait around three to four days. Usually, around that timeframe, we'll know if it's a virus or a bacteria. By that timeframe, talk to your doctor. Even if the symptoms are really bad and it's been less than three to four days, call them just to be sure. And definitely, it's no problem visiting the urgent care because they'll take good care of you.

When it comes to vaccines, usually it'll be the end of the year, closer to fall and winter when I would say talk to your doctor. They may have their new strains of these vaccines ready, particularly for the normal population. It'll be the normal dose of the flu. And for our older population, more the high-dose flu shot tends to be a bit better just because their immune system tends to react better to it, and you tend to be prepared for it. So, I would say the winter's the best time to talk about vaccines. But no matter what, going to your doctor and having data received and getting any questions answered is never the wrong choice.

Melanie Cole, MS: Do you want to give us a final thought, Dr. Rai, on hygiene and the respiratory illnesses and what you really want us to know?

Anirudh Rai, MD: Yeah, absolutely. So, hygiene is vital. If you were to keep your hands clean, that would prevent majority of the cases of people just getting sick. And if you are sick, visit your urgent care, talk to your doctor. They could have more insight and even test for many of these viruses. But if symptoms are really bad, like you have a fever, chill, cough, sweats, you're coughing up all this green sputum, or you just feel bad at all, go to your primary care, go to the urgent care. And if it's really bad, definitely go to the emergency room, just because it's better to have it looked at rather than sitting upon it.

And when winter comes, or if it's even before winter, talk to your doctor. Vaccines are important. It's a great way to prevent your body from getting that sick, and it also helps you to stay ready for these kind of things, because the winter, we never know what comes, but the vaccines, thankfully, are there to keep your immune system ready.

So no matter what, any questions, concerns, go to your doctors. Never a wrong answer to go to the emergency room, urgent care, or your own primary care.

Melanie Cole, MS: Thank you so much, Dr. Rai. Always great information. Thank you again for joining us. And to book an appointment with Dr. Anirudh Rai, visit our website at henrymayoprimarycare.com. You can also visit the free Henry Mayo Newhall Hospital online health information library at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole.