Respiratory Infections & Breathing Emergencies: When to Go to the ER

By Dr. Christopher L Huerta, MD.

Your nose is stuffed, your chest feels tight, and a cough keeps you up at night. Most of the time, a respiratory infection is annoying but harmless. Once in a while, it turns into a real breathing emergency.

Knowing the difference protects you and your family. This guide walks through symptoms, home treatment, how long you stay contagious, and the warning signs that mean you should head to the emergency room (ER) right away.

What is a Respiratory Infection?

A respiratory infection is an infection of your airways or lungs. Most are viral, mild, and clear in one to two weeks. Get emergency care if breathing becomes hard, lips or face turn blue, or a high fever does not break.

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Upper vs Lower Respiratory Infection

A respiratory infection happens when a virus or bacteria invades your breathing system. Doctors sort these infections by where they settle. The medical name for the whole group is respiratory tract infection.

An upper respiratory infection, often shortened to URI, affects the nose, sinuses, and throat. The common cold is the classic example. Symptoms are usually mild and pass on their own.

A lower respiratory infection reaches deeper, into the main airways and the lungs. Bronchitis and pneumonia belong here. These are more serious and require closer attention, especially in young kids and older adults.

The line between the two matters because it changes how worried you should be. A head cold rarely needs tests. A suspected lung infection may require a chest X-ray to rule out pneumonia, which is why a new, deep cough with fever warrants a second look.

Respiratory Infection Symptoms to Watch For

Upper respiratory infection symptoms tend to stay in the head and throat. Most people feel run down for a few days, then slowly improve.

• Stuffy or runny nose
• Sore or scratchy throat
• Sneezing and a mild cough
• Low-grade fever, headache, and tiredness

Lower respiratory infection symptoms reach the chest. These signs deserve more respect because they can indicate bronchitis or pneumonia.

• Deep, wet, or painful cough
• Chest tightness or wheezing
• Shortness of breath
• Higher fever and chills

Timing tells a story, too. Cold symptoms usually build over a day or two, then ease within a week. Symptoms that spike fast, or that get better and then come roaring back, deserve a closer look.

People often ask how to tell a viral infection from a bacterial one. The honest answer is that mucus color does not prove much. Green snot does not mean you need antibiotics. Here is a more useful comparison.

What Causes Respiratory Infections?

Viruses cause most respiratory infections. A smaller share comes from bacteria. Each germ tends to trigger a familiar illness.

• Rhinovirus causes the common cold.
• The influenza virus causes the flu.
• RSV (respiratory syncytial virus) causes cold-like illness, but it turns serious in babies and seniors.
• SARS-CoV-2 causes COVID-19.
• Strep bacteria cause strep throat and can lead to pneumonia.

These germs spread through coughs, sneezes, and shared surfaces. One sick person in a house can pass it around within days. Cold weather plays a role, too, because people crowd indoors and viruses survive longer in dry air. That is why fall and winter seasons bring the heaviest waves of flu, RSV, and colds.

Is a Respiratory Infection Contagious? How Long?

Yes. Most upper respiratory infections spread easily. You can pass the virus one to two days before symptoms manifest, and you stay contagious for roughly a week after they begin.

You are usually less contagious once you have gone 24 hours without a fever and without fever medicine. Lingering coughs can persist, but the most infectious window is the first few days. Wash your hands often and stay home when you can.

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Fastest Way to Get Rid of a Respiratory Infection

There is no instant cure for a viral respiratory infection. The fastest path is rest, fluids, and over-the-counter relief while your body does the real work. Most colds clear within 7 to 10 days.

• Rest. Sleep gives your immune system room to fight.
• Drink water, broth, or warm tea to stay hydrated and loosen mucus.
• Use over-the-counter pain and fever reducers as directed.
• Try a saline spray or a decongestant for a blocked nose.
• A spoon of honey can calm a cough in anyone over age one.
• Run a humidifier and skip cigarettes and vaping.

A few things do not help, no matter what the internet says. Old antibiotics in your cabinet will not touch a virus. Steamy showers and propping your head up at night, on the other hand, really do ease congestion.

If you are deep in flu season, these same steps help you feel human faster. For the flu specifically, antiviral medicine can shorten the illness if you start it early. Call a doctor or visit an emergency room near you if you are not improving by day 10, or sooner if you feel worse.

Do You Need Antibiotics?

Usually no. Antibiotics fight bacteria, not viruses, and most respiratory infections are viral. They only help once a doctor confirms a bacterial cause, such as strep throat or bacterial pneumonia.

People search for the best antibiotic for an upper respiratory infection, but there is no single answer. When a bacterial infection is confirmed, doctors often choose amoxicillin or a similar drug. Taking antibiotics for a virus does nothing and feeds antibiotic resistance, so they are prescribed only when truly needed.

How Bad Is It? Respiratory Rate & Oxygen by Age

Two simple numbers tell you a lot about how serious breathing trouble is. The first is respiratory rate, the breaths per minute. The second is oxygen saturation, which a home pulse oximeter reads as SpO2.

A normal respiratory rate for adults is 12 to 20 breaths per minute, and a healthy oxygen level sits at 95 to 100 percent. Breathing that runs much faster, or oxygen below 90 percent, is a warning sign.

Rates dip a little lower during sleep, which is normal. Count for a full minute when the person is calm, since talking or crying can throw the count off. With a baby, watch the belly rise and fall.

Fast, shallow breathing is one of the earliest signs that an infection is winning. If breathing runs well above the range for that age, or a pulse oximeter reading keeps sliding toward 90 percent, do not wait for it to fix itself. Get checked.

Breathing Emergencies: Distress, Failure & Red Flags

Sometimes an infection puts too much strain on the lungs. Three terms describe how this escalates. Respiratory distress is the body visibly struggling to breathe. Respiratory failure occurs when the lungs can no longer take in oxygen or clear carbon dioxide. Respiratory arrest is when breathing stops.

You do not need to name the stage. You need to spot the red flags. Severe cases, including acute respiratory distress syndrome (ARDS), often start with the signs below.

• Cannot speak in full sentences or gasp for air
• Lips, face, or fingertips turning blue (cyanosis)
• Skin pulling in around the ribs or neck with each breath (retractions)
• Nostrils flaring or grunting, especially in children
• Confusion, extreme drowsiness, or hard to wake
• Breathing much faster than normal, or chest pain when breathing

Wheezing that will not ease can also signal trouble, which is why asthma attacks deserve fast action.

Why the rush? When oxygen drops, the brain and heart feel it within minutes. Early treatment with oxygen and breathing medicine can stop a slide toward respiratory failure, which is far harder to reverse once it sets in.

Call 911 if someone stops breathing, turns blue, or becomes unresponsive. Do not drive yourself if you are having difficulty breathing.

ER vs Urgent Care vs Home Care

Most respiratory infections never require a visit to the clinic or emergency room. The trick is matching your symptoms to the right level of care. This table keeps it simple.

Urgent care fits the in-between, when you are uncomfortable but breathing normally. It is not built for true breathing emergencies. Those need an ER with imaging, oxygen, and physicians on hand. When in doubt about breathing, visit the emergency room (ER). Lungs can change fast, and minutes matter.

One important exception: some people should come in on the first day, no matter how mild it feels. See below.

Feeling Sick and Around Vulnerable People? Come In on Day One

If you are an essential worker, if you work or live with a vulnerable person, or if you are a vulnerable person, we advise you to come to SignatureCare Emergency Center immediately, not an urgent care clinic, and not a telehealth visit, on the first day you feel sick. Show up on day one so we can perform a highly sensitive respiratory panel and strep screening.

It does not matter if your symptoms are mild or severe. It does not matter if you are infected with an upper or lower respiratory pathogen. If you test positive for certain pathogens, for example, strep, flu, and certain atypical bacteria, immediate treatment is necessary on the first day.

This type of testing is not available online, at your doctor's office, or at an urgent care clinic. If you are young and healthy, that is great. But if you are an essential worker or around a vulnerable person, you could cause their illness or death.

Who's at Highest Risk

Anyone can catch a respiratory infection. Some groups are far more likely to get seriously ill and should seek care sooner.

• Infants and young children
• Adults age 65 and older
• Pregnant people
• People with asthma or COPD, including adult-onset asthma
• Anyone with a weakened immune system, heart disease, or diabetes
• Smokers and people exposed to heavy smoke

Common Respiratory Conditions We Cover

Respiratory infections come in many forms, from the flu to pneumonia. Explore our library below for deeper guides on each condition, written or reviewed by emergency physicians.

Flu & vaccination: Flu outbreak and vaccination  ·  Vaccinate children as flu deaths spike  ·  Five ways to protect against the flu  ·  Stay healthy when family has the flu  ·  Minimize flu season misery  ·  Fight the flu faster  ·  Reasons to get the flu vaccine  ·  Houston flu season basics  ·  How effective are whooping cough vaccines

Asthma: Adult-onset asthma  ·  Asthma causes and treatments  ·  Dealing with asthma attacks

COVID-19: COVID-19 vaccinate or not  ·  Is it safe to fly during COVID  ·  Uptick in COVID-19 cases

Lungs & prevention: Avoiding pneumonia  ·  Quit smoking

How SignatureCare Emergency Center Treats Respiratory Emergencies

At SignatureCare Emergency Center, board-certified ER physicians are on-site 24/7, ready for serious breathing problems the moment you walk in. There is no appointment required, and no long wait while your lungs struggle.

• Pulse oximetry and continuous monitoring to track oxygen in real time
• On-site chest X-ray and CT scan to spot pneumonia and other lung problems
• Rapid lab testing for flu, COVID-19, RSV, and bacterial infections
• Highly sensitive respiratory panel and rapid strep screening, often not available at urgent care or by telehealth
• Nebulizer and bronchodilator treatments to open tight airways
• Supplemental oxygen, IV fluids, and medication when you need them fast

All of this sits under one roof, so you are not shuttled between buildings while you fight for air. Our facilities hold The Joint Commission Gold Seal of Approval and CIHQ accreditation, with locations across Texas, including College Station, Bryan, Aggieland, Midland, Odessa, Killeen, Frisco, Plano, and Texarkana.

How to Prevent Respiratory Infections

You cannot dodge every germ, but a few habits cut your risk and lower the odds of a serious infection.

• Stay current on vaccines, including the flu vaccine, plus COVID-19 and RSV shots when recommended.
• Wash your hands well and often
• Cover coughs and sneezes, and avoid close contact with sick people
• Do not smoke, and keep kids away from secondhand smoke
• Stay home and rest when you feel sick

The Bottom Line

Most respiratory infections fade with rest and fluids. The skill is spotting the few that do not. Watch the breathing, watch the oxygen, and trust your gut. If breathing turns hard, do not wait it out. SignatureCare ER physicians are ready around the clock, every day of the year.

Find a 24/7 Respiratory ER Near You in Texas

SignatureCare operates pediatric emergency rooms across Texas. Find the ER location nearest you and walk in any time.

North Texas: Frisco  ·  Allen  ·  Flower Mound  ·  McKinney ·  Preston - Plano

Central Texas: College Station  ·  Killeen

West Texas: Odessa  ·  Midland

East Texas: Texarkana

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Frequently Asked Questions

Is an upper respiratory infection contagious?

Yes. You can spread it 1 to 2 days before symptoms start and stay contagious for about a week after they begin.

What is the fastest way to get rid of a respiratory infection?

Rest, fluids, and over-the-counter relief. Most viral colds clear in 7 to 10 days; there is no instant cure.

Do I need antibiotics for a respiratory infection?

Usually no. Most are viral. Antibiotics only help when a doctor confirms a bacterial cause like strep throat.

How long does a respiratory infection last?

Most upper respiratory infections last 7 to 10 days. A cough or fatigue can linger up to two weeks.

What is a normal respiratory rate by age?

Adults breathe 12 to 20 times a minute. Children and newborns breathe faster, up to 60 for a newborn.

When should I go to the ER for a respiratory infection?

Go for trouble breathing, blue lips, chest pain, confusion, or very fast breathing. Call 911 if breathing stops.

Should I get tested on the first day I feel sick?

If you are an essential worker or around vulnerable people, yes. Come to SignatureCare on day one for a respiratory panel and strep test. Early treatment matters.

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Dr. Christopher L Huerta, MD,  is a board-certified emergency medicine specialist based in Midland, TX, and the Medical Director of SignatureCare Emergency Center in Midland, TX. He received his medical degree from Washington University in St. Louis School of Medicine and has been in practice for more than 40 years.