By a community pharmacist
“Pharmacist, I’ve had this cough for nearly a week. It started with a sore throat and runny nose, but now it’s gone onto my chest. Do I need antibiotics?”
It is a question that comes up regularly in community pharmacy. Someone has a cough, another person has a fever, while a parent is worried because their young child is wheezing and struggling to sleep.
The difficulty is that several respiratory infections can produce very similar symptoms. A common cold, influenza (flu), bronchitis, pneumonia and RSV can all cause coughing, a sore throat, fever and general discomfort.
But they are not the same illness, and knowing the differences can help you recognise when home treatment is reasonable and when medical attention is needed.
Let’s look at what distinguishes them.
1. The common cold – usually uncomfortable but mild
A common cold is an infection of the upper respiratory tract, mainly affecting the nose and throat. It can be caused by many different viruses, including rhinoviruses.
Unlike flu, which often comes on suddenly, a cold tends to develop gradually over two or three days.
Typical symptoms include:
- Runny or blocked nose.
- Sneezing.
- Sore or scratchy throat.
- Mild cough.
- Watery eyes.
- Mild headache or body aches.
- Feeling tired or generally unwell.
Most people remain well enough to carry on with some of their normal activities, although they may feel below par.
Symptoms usually improve within one to two weeks, although a cough can sometimes linger.
Treatment
There is no specific cure for the common cold. Treatment is aimed at making the symptoms more manageable while the immune system clears the infection.
A pharmacist may recommend:
- Paracetamol for headaches, aches and fever.
- Saline nasal sprays or rinses for a blocked nose.
- Short-term decongestant treatment where suitable.
- Throat lozenges or warm drinks to soothe irritation.
- Rest and plenty of fluids.
Decongestant nasal sprays should generally not be used for more than seven days, as prolonged use can make congestion worse.
Antibiotics are not useful because the common cold is caused by viruses.
For further information, see the NHS guide to the common cold.
2. Influenza (flu) – much more than a bad cold
People often use the word flu to describe any cold or respiratory infection. However, genuine influenza can be considerably more severe.
Flu is caused by influenza viruses and often starts very suddenly. Someone can feel perfectly well in the morning and be completely wiped out by the evening.
Typical symptoms include:
- Sudden fever, often with chills and sweating.
- Significant muscle and joint aches.
- Headache.
- Dry cough.
- Sore throat.
- Extreme tiredness and exhaustion.
- Loss of appetite.
Unlike a common cold, flu tends to affect the whole body. Some people feel so unwell that they cannot get out of bed or manage their usual daily activities.
Most people begin to recover within about a week, although tiredness and coughing can last longer.
Treatment
Treatment usually involves rest, fluids and medicines to relieve symptoms.
Paracetamol can help reduce fever and ease aches and pains. Ibuprofen may be suitable for some people, but it is not appropriate for everyone, particularly those with certain kidney, stomach or cardiovascular problems.
For people at higher risk of complications, a doctor may consider antiviral medication such as oseltamivir. It works best when started early, usually within 48 hours of symptoms beginning, although it may still be considered later in certain severe or high-risk cases.
Antibiotics do not treat influenza itself.
Who is more vulnerable?
Older adults, pregnant women, young children, people with diabetes, and those with heart, lung or kidney conditions or weakened immune systems are more likely to develop complications.
This is why annual flu vaccination is particularly important for people who are eligible.
The NHS flu guidance explains symptoms, treatment and when to seek medical advice.
3. Bronchitis – when the infection moves onto the chest
Bronchitis is inflammation of the bronchial tubes, the larger airways that carry air into and out of the lungs.
It often develops after a cold or flu, when the infection affects the airways lower down.
Acute bronchitis is usually caused by a virus. The airways become irritated and inflamed, producing a cough that can be quite persistent.
Typical symptoms include:
- A chesty cough, sometimes producing mucus.
- Clear, white, yellow or green phlegm.
- Wheezing.
- Chest discomfort, particularly when coughing.
- Sore throat.
- Mild fever.
- Tiredness and general aches.
One of the frustrating things about bronchitis is how long the cough can last. Although the person may otherwise feel better, the cough can continue for around three weeks.
A point worth emphasising is that yellow or green mucus does not automatically mean the infection is bacterial or that antibiotics are needed.
Treatment
Most cases of acute bronchitis improve without antibiotics.
Treatment focuses on:
- Rest and adequate fluids.
- Paracetamol for discomfort or fever.
- Warm drinks, with honey for adults and children over one year old.
- Avoiding smoking and cigarette smoke.
- Seeking advice if wheezing or breathlessness develops.
Antibiotics are generally not recommended for uncomplicated acute bronchitis because it is usually viral. They may be considered in selected cases if a clinician suspects a bacterial infection or the person is at particular risk of complications.
It is also important to distinguish acute bronchitis from chronic bronchitis, which is a long-term condition associated with chronic obstructive pulmonary disease (COPD), often linked to smoking.
The NHS bronchitis guidance provides further information.
4. Pneumonia – when the infection affects the lungs themselves
Pneumonia is more serious because it involves infection and inflammation of the lung tissue, particularly the tiny air sacs called alveoli where oxygen passes into the bloodstream.
These air sacs can fill with fluid or inflammatory material, making it harder for the lungs to transfer oxygen effectively.
Pneumonia can be caused by bacteria or viruses. Some cases develop after an ordinary respiratory infection.
Typical symptoms include:
- Persistent cough, sometimes producing phlegm.
- Fever, chills and sweating.
- Shortness of breath.
- Chest pain, particularly when breathing deeply or coughing.
- Significant tiredness.
- Loss of appetite.
- Rapid breathing.
- Confusion, particularly in older adults.
Not everyone develops all these symptoms. In older people, pneumonia can sometimes present with confusion, weakness or a sudden decline in general health rather than an obvious high temperature.
Unlike an ordinary cold or uncomplicated bronchitis, pneumonia can become serious and may require hospital treatment.
Treatment
Treatment depends on the cause and severity.
- Bacterial pneumonia: Usually treated with antibiotics prescribed by a doctor.
- Viral pneumonia: Antibiotics do not treat the virus itself. Treatment may involve supportive care and, in selected cases, specific antiviral treatment.
- Severe pneumonia: Hospital treatment may be needed, including oxygen, intravenous fluids and other supportive treatment.
Recovery varies. Some people improve within two to four weeks, while tiredness and cough can take considerably longer to disappear.
People over 65 and those with heart disease, diabetes, chronic lung disease or weakened immunity are particularly vulnerable.
The NHS pneumonia guidance explains the symptoms and treatment options.
5. RSV – a virus that can be particularly dangerous for babies and older adults
RSV stands for respiratory syncytial virus. It is a common respiratory virus that can affect people of all ages.
In many healthy adults and older children, RSV produces symptoms much like an ordinary cold. However, it can cause more serious illness in young babies, older adults and people with certain underlying health conditions.
In babies and young children, RSV can cause bronchiolitis, an infection affecting the small airways in the lungs. It can also cause pneumonia.
Typical symptoms include:
- Runny or blocked nose.
- Cough.
- Sneezing.
- Fever.
- Reduced appetite.
- Wheezing.
- Tiredness.
In very young babies, the signs can be less obvious. They may become irritable, feed less than usual, breathe rapidly or develop pauses in breathing.
This is why parents should take changes in a baby’s feeding or breathing seriously.
In older adults, RSV can cause a more significant chest infection and may worsen existing conditions such as asthma, COPD or heart disease.
Treatment
There is no routinely used specific antiviral treatment for ordinary RSV infection. Most cases are managed with supportive care, including fluids, rest and appropriate fever relief.
Babies or adults with more severe illness may need hospital care, oxygen or help maintaining hydration.
Prevention is important. RSV vaccination is now available for eligible groups in some countries, including older adults and pregnant women under specific national programmes. Eligibility and recommendations differ between countries, so check local guidance.
The NHS RSV information and CDC RSV guidance explain the infection and those most at risk.
So how do you tell them apart?
The following comparison gives a useful general guide. However, symptoms overlap, and it is not always possible to identify the infection without clinical assessment or testing.
| Infection | Typical onset | Main features | Usual course |
| Common cold | Gradual | Runny nose, sneezing, sore throat | 1–2 weeks |
| Flu | Sudden | Fever, severe aches, exhaustion, dry cough | Around 1 week, tiredness may last longer |
| Acute bronchitis | Often follows a cold or flu | Persistent chesty cough, mucus, wheeze | Cough around 3 weeks |
| Pneumonia | Sudden or gradual | Fever, breathlessness, chest pain, significant illness | Often 2–4 weeks or longer |
| RSV | Usually gradual | Cold-like symptoms, sometimes wheezing; can cause bronchiolitis or pneumonia | Often 1–2 weeks, longer if severe |
COVID-19 can also produce symptoms that overlap with all of these infections. Symptoms alone cannot reliably distinguish every respiratory virus, so testing may be appropriate in certain circumstances.
When should you seek medical attention?
Most mild respiratory infections can be managed at home. However, there are certain warning signs that should never be ignored.
Emergency – call 999
Seek emergency help if someone:
- Is struggling to breathe, gasping or unable to speak normally.
- Has blue, grey or unusually pale lips or skin.
- Develops sudden confusion or becomes difficult to wake.
- Has severe or persistent chest pain.
- Is coughing up significant amounts of blood.
Urgent medical assessment
Contact a doctor promptly if:
- Breathlessness develops or is getting worse.
- There is chest pain when breathing or coughing.
- A fever persists or the person is becoming increasingly unwell.
- A cough is not improving after three weeks.
- A baby is feeding poorly, has fewer wet nappies or is breathing faster than usual.
- An older person or someone with a long-term medical condition develops a new chest infection.
Do not wait for a high fever before seeking help. Older adults and people with weakened immune systems may have serious infections without a typical temperature response.
A few practical points from the pharmacy counter
There are some common mistakes worth avoiding when treating respiratory infections.
Do not double up on paracetamol. Many cold and flu sachets already contain it. Taking these alongside separate paracetamol tablets can lead to an accidental overdose and liver damage.
Be careful with decongestants. Some oral products can raise blood pressure or affect heart rate. They may not be suitable for people with hypertension, heart disease or certain other conditions.
Not every cough needs suppressing. A productive cough helps clear mucus from the airways. A pharmacist can advise whether a cough preparation is appropriate.
Children need particular care. Cough and cold medicines are not suitable for all ages. Honey can help soothe a cough in children over one year, but must never be given to babies under 12 months. Never give aspirin to children under 16 unless specifically prescribed.
Antibiotics are not a cure for every chest infection. They work against bacteria, not viruses. Taking them unnecessarily can cause side effects and contribute to antibiotic resistance.
My advice as a pharmacist
When someone comes into the pharmacy with a cough, the first thing I want to understand is not simply how long they have been coughing, but how unwell they actually feel.
Are they breathing comfortably? Do they have a fever? Are they eating and drinking? Is the cough getting worse? Do they have an underlying heart or lung condition?
These questions help identify people who may need a medical assessment rather than another bottle of cough mixture.
The main message is this: a common cold, flu, bronchitis, pneumonia and RSV may share some symptoms, but their severity and treatment can be very different.
Most infections settle with time and supportive care. The important thing is recognising when something is more than an ordinary cough or cold.
Never ignore worsening breathlessness, chest pain or a person who is becoming unusually weak or confused. Early assessment can make a real difference.
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