DOCSLIB.ORG

Bronchitis) 2013 Update

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bronchitis) 2013 Update Care Process Model DECEMBER 2013 DIAGNOSIS AND MANAGEMENT OF Acute Cough (Bronchitis) 2013 update This care process model (CPM) is produced by Intermountain Healthcare’s Lower Respiratory Tract Infection Team, a workgroup of the Primary Care Clinical Program. The CPM provides best-practice recommendations for differential IN THIS UPDATE? diagnosis and management of acute cough and bronchitis. WHAT’S NEW Germ Watch is available at • New data showing an upward trend in unnecessary KEY POINTS intermountainphysician.org use of antibiotics for treatment of acute bronchitis — • Diagnosis of acute bronchitis should be made only after ruling reinforcing our need to do better! out other sources of cough — including pneumonia, asthma, influenza, pertussis, • Updated information on sinusitis, and acute exacerbations of chronic bronchitis (AECB). 1 The algorithm on pages 2 and 3 influenza, and pertussis testing and treatment, guides that evaluation and diagnostic process. Local infection surveillance programs such as with links to more information. Germ Watch can provide up-to-date information about communicable diseases that routinely • Summary of evidence base for symptom affect our communities. relief of acute cough (see ACUTE BRONCHITIS • If acute bronchitis is the diagnosis, antibiotics are TREATMENT RECOMMENDATIONS box inside). Unnecessary Antibiotic Use NOT the answer! Despite ongoing evidence that antibiotics • New and revised provider and patient NOT are needed for acute bronchitis, latest data show that their % of adults with acute bronchitis who received an antibiotic education materials to support physicians in prescription within 3 days of office visit (based on SelectHealth data) use is actually increasing. SelectHealth rates rose from 70% in differential diagnosis and evidence-based treatment 2008 to nearly 75% in 2010 (see graph at right), which mirrors 76 74.87% of acute cough (bronchitis) and related illnesses. the national trend. 2,3 Unnecessary antibiotic use increases risk 75 for disease complications related to drug-resistance pathogens, 74 and increases healthcare costs. 73 GOALS 72 71% • 71 The goal is to Help providers improve accuracy of • Withholding antibiotics has no significant effect cent % 70.15% r 70 reverse this diagnosis of acute bronchitis and other lower on patient satisfaction or return visits. Studies Pe 69 respiratory tract infections. show that education efforts and the time a healthcare provider trend! 68 spends with the patient are the biggest determinants of patient • Reduce the unnecessary use of antibiotics 4,6 67 satisfaction results. See the ACUTE BRONCHITIS TREATMENT 2008 2009 2010 for treatment of acute bronchitis, RECOMMENDATIONS box in the algorithm inside for tips Years thereby sparing patients the additional risks and on communicating with patients about cough illnesses and associated costs. antibiotic resistance. % of adults with acute bronchitis who received an antibiotic prescription within 3 days of office visit (based on SelectHealth data) The inside pages of this tool provide 76an algorithm and associated notes, and can be folded open and posted in your office or clinic. 74.87% The back page summarizes vaccine recommendations,75 references, and resources. 74 73 72 71% 71 cent % 70.15% r 70 Pe 69 68 67 2008 2009 2010 Years DIAGNOSIS AND MANAGEMENT OF Acute Cough (Bronchitis) (a) ACUTE COUGH/BRONCHITIS symptoms: Patient presents with • Acute bronchitis is defined by the CDC as “an acute ACUTE COUGH (BRONCHITIS) symptoms (a) respiratory infection with a normal chest radiograph that is manifested by cough with or without phlegm production that lasts for up to 3 weeks.” 1,4 See Intermountain’s Possible PNEUMONIA (b)? Chest (b) PNEUMONIA is NOT likely if all of the following are absent:1 YES x-ray POSITIVE Pneumonia CPM • Fever 37.8°C (100°F) or greater • O2 sat 88% or less Care Process Model FEBRUARY 2012 Available on the DIAGNOSIS AND MANAGEMENT OF Community Acquired Pneumonia (CAP) • • February 2012 update Heart rate 100 bpm or greater Focal rales This care process model (CPM) is produced by Intermountain Healthcare’s Lower Respiratory Tract Infection Team, a subgroup of the Primary Care Clinical Program. The CPM summarizes and updates evaluation and treatment WHAT’S NEW IN THIS UPDATE? recommendations for community-acquired pneumonia (CAP) in immunocompetent patients 18 years and older, though Pneumonia topic page at many of the recommendations also apply to younger patients. Recommendations are based on recent local susceptibility • Updated antibiotic sensitivity data and shortened length of antibiotic treatment. NO data and practice patterns, along with the most recent consensus guidelines of the Infectious Diseases Society of America Azithromycin is recommended for 3 days, levofloxacin 1 and the American Thoracic Society. The guidelines do NOT apply to health-care-associated pneumonia (HCAP). for 5 days, and other antibiotics for 7 days unless cavitation, empyema, or extra-pulmonary disease are present. See algorithm on page 2. • • WHY FOCUS ON PNEUMONIA? • Clarification and emphasis on timing of • Pneumonia remains common, serious, and costly. In the U.S., pneumonia is the 8th leading cause of death overall, Respiratory rate 24 or greater Decreased breath sounds blood cultures and antibiotics. the 5th leading cause of death over age 65, and the 2nd leading reason for hospitalization of Medicare patients.2,3 See algorithm on page 2. 1,4,5 NEGATIVE Treatment costs for pneumonia are estimated at $10 billion per year. • Vaccination reminder. Continued emphasis on importance of influenza and pneumonoccal vaccines • Site-of-care decisions can dramatically affect mortality and cost of care. The cost of inpatient care for pneumonia intermountainphysician.org/ before discharge. is up to 25 times greater than the cost of outpatient care,4 representing most of the estimated $10 billion in yearly 1,4 • Updated order sets, both paper and electronic, treatment costs. Although not hospitalizing sicker, higher-risk patients can result in higher mortality (both for patients to reflect changes to treatment recommendations. hospitalized after initial outpatient treatment6 and for severely ill patients not initially admitted to ICU7), patients at low risk for death treated in the outpatient setting are able to resume normal activity faster than if hospitalized.8,9 GOALS • Diagnosis and severity assessment cannot be made consistently and accurately using only the physical exam • Prompt and correct diagnosis, including a chest and clinical judgment. Chest x-ray should be performed whenever possible for diagnosis, and objective severity-of-illness x-ray whenever possible. scores (CURB-65) should be used to identify patients with CAP who are candidates for outpatient treatment.1,10 • Consistent use of objective severity-of-illness clinicalprograms • Antibiotics should be administered as early as possible. In-hospital mortality, length of stay, and 30-day mortality criteria (CURB-65) to guide site-of-care decisions. decrease when antibiotics are administered within 4 to 6 hours of diagnosis.3 Ideally, patients being admitted to the • Prompt administration of appropriate hospital for CAP should receive their first dose of antibiotics before they leave the emergency room or clinic.1 antibiotics (using CPM recommendations based on local sensitivity data) • Well designed and implemented local treatment guidelines decrease mortality and improve other clinical • Influenza and pneumococcal vaccines for all 11-14 outcomes. Data shows that Intermountain hospitals with the highest level of compliance with the pneumonia appropriate inpatients and outpatients. 11 signs and symptoms: CPM and associated order sets have the lowest mortality rates. • Venous thromboembolism (VTE) prophylaxis (c) ASTHMA and early ambulation for all inpatients. The inside pages of this tool provide an algorithm and associated reference notes, and can be folded open and posted in your office or clinic.The back page provides a discussion of antibiotic recommendation and a list of resources and references. • History of recurrent lower respiratory infection • History of recurrent wheezing and/or cough, especially at night • History of allergic rhinitis or eczema See Intermountain’s Possible ASTHMA (c)? YES • Exertional dyspnea Asthma CPM • Variation of symptoms from day to day Care Process Model AUGUST 2012 (minor update 5/13) Available on the Asthma topic page at Management of Asthma 2012 Update This care process model (CPM) was created by the Intermountain Healthcare’s Primary Care and Pediatric Specialty Clinical Programs. It summarizes clinical literature and provides expert advice regarding the diagnosis and management of asthma in pediatric and adult patients. This update builds on previous versions of Intermountain’s CPM as well as on the Expert Panel Report 3: Guidelines intermountainphysician.org/clinicalprograms for the Diagnosis and Management of Asthma (EPR-3), a 2007 publication of the National Heart, Lung, and Blood Institute (NHLBI).1 7 What’s new IN THIS UPDATE? WHAT’S INSIDE Intermountain’s model remains closely aligned with the 2007 EPR-3 guidelines. This 2012 (d) RHINOSINUSITIS ALGORITHM ..................2 update includes updated information on testing (exhaled nitric oxide and pulmonary function testing) and medication (formulations, dosages, prices) and highlights patient TREATMENT SUMMARIES and provider tools recently developed at Intermountain to support this standard of care. Ages 0 to 4 years .................
Load more

Recommended publications
  • Acute (Serious) Bronchitis
    Acute (serious) Bronchitis This is an infection of the air tubes that go down to your lungs. It often follows a cold or the flu. Most people do not need treatment for this. The infection normally goes away in 7-10 days. We make every effort to make sure the information is correct (right). However, we cannot be responsible for any actions as a result of using this information. Getting Acute Bronchitis How the lungs work Your lungs are like two large sponges filled with tubes. As you breathe in, you suck oxygen through your nose and mouth into a tube in your neck. Bacteria and viruses in the air can travel into your lungs. Normally, this does not cause a problem as your body kills the bacteria, or viruses. However, sometimes infection can get through. If you smoke or if you have had another illness, infections are more likely to get through. Acute Bronchitis Acute bronchitis is when the large airways (breathing tubes) to the lungs get inflamed (swollen and sore). The infection makes the airways swell and you get a build up of phlegm (thick mucus). Coughing is a way of getting the phlegm out of your airways. The cough can sometimes last for up to 3 weeks. Acute Bronchitis usually goes away on its own and does not need treatment. We make every effort to make sure the information is correct (right). However, we cannot be responsible for any actions as a result of using this information. Symptoms (feelings that show you may have the illness) Symptoms of Acute Bronchitis include: • A chesty cough • Coughing up mucus, which is usually yellow, or green • Breathlessness when doing more energetic activities • Wheeziness • Dry mouth • High temperature • Headache • Loss of appetite The cough usually lasts between 7-10 days.
    [Show full text]
  • Octreotide Treatment of Idiopathic Pulmonary Fibrosis: a Proof-Of-Concept Study
    drugs, while two patients underwent surgery in addition to Roncaccio 16, 21049, Tradate, Italy. E-mail: giovannibattista. chemotherapy. [email protected] As in other reference centres, the E. Morelli Hospital needs to transfer out all admitted cases to the hospitals referring them for Support Statement: This study was supported by the current specialised treatment, when culture conversion and clinical research funds of the participating institutions. For this stability have been achieved. Patients were transferred out after publication, the research leading to these results has received a median (IQR) hospital stay of 75.5 (51.5–127.5) days; 12 (100%) funding from the European Community’s Seventh Framework out of 12 and nine (75%) out of 12 achieved sputum-smear and Programme (FP7/2007-2013) under grant agreement FP7- culture conversion, after a median (IQR) time of 40.5 (24–64) and 223681. 70 (44–95) days, respectively. As of June 2011, one patient was cured, two had died and nine were still under treatment. Statement of Interest: None declared. Four (33.3%) cases reported adverse events, two being major (16.7%; neuropathy and low platelet count, needing temporary REFERENCES interruption of linezolid) and two minor (neuropathy and mild 1 Villar M, Sotgiu G, D’Ambrosio L, et al. Linezolid safety, anaemia). All adverse events were reversible. tolerability and efficacy to treat multidrug- and extensively drug-resistant tuberculosis. Eur Respir J 2011; 38: 730–733. In conclusion, despite the intrinsic difficulty of evaluating the 2 World Health Organization. Multidrug and extensively drug safety and tolerability of linezolid (administered within different resistant TB (M/XDR-TB): 2010 global report on surveillance and regimens including multiple anti-TB drugs guided by drug response.
    [Show full text]
  • Bronchitis, Acute Chest Cold/ Bronchiolitis
    SCHOOL HEALTH/ CHILDCARE PROVIDER BRONCHITIS, ACUTE CHEST COLD/ BRONCHIOLITIS Bronchitis and bronchiolitis are respiratory conditions that tend to occur more often in the fall and winter months. When infants and young children experience common respiratory viruses and are exposed to secondhand tobacco smoke, they are at risk of developing bronchiolitis, bronchitis, pneumonia, and middle ear infections. CAUSE Many different viruses, such as respiratory syncytial virus (RSV), parainfluenza, influenza, and adenoviruses; Mycoplasma pneumoniae; and some bacteria. Most of these organisms can cause other illnesses and not all persons exposed to the same organism will develop bronchitis or bronchiolitis. SYMPTOMS Usually starts with a runny nose, fever, and a dry, harsh cough that becomes looser as the illness progresses. Older children may cough up green or yellow sputum. Sore throat can occur in some cases. It may take 1 to 2 weeks for the cough to stop. SPREAD Respiratory viruses and bacteria are spread when an infected person coughs or sneezes tiny droplets into the air, and another person breathes them in. Also can be spread by touching the secretions from the nose and mouth of an infected person or by touching hands, tissues, or other items soiled with these secretions and then touching one’s eyes, nose, or mouth. INCUBATION Depends upon the organism that is causing illness. CONTAGIOUS Until shortly before symptoms begin and for the duration of acute symptoms. PERIOD EXCLUSION Childcare and School: Until fever is gone without the aid of fever reducing medication and the child is well enough to participate in routine activities. DIAGNOSIS Recommend parents/guardians call their health care provider if their child has a high fever, persistent sore throat, or persistent cough.
    [Show full text]
  • Antibiotic Prescribing for Acute Bronchitis: How Low Can We Go?
    J Am Board Fam Pract: first published as 10.3122/15572625-13-6-462 on 1 November 2000. Downloaded from Antibiotic Prescribing for Acute Bronchitis: How Low Can We Go? By the time I graduated from medical school in of that wise philosopher Pogo, "We have seen the 1975, I had learned that most respiratory tract enemy, and he is us." infections in otherwise healthy children and adults No doubt, we can do better. Several investiga­ were caused by viruses, such as parainfiuenza, in­ tors have described successful methods of reducing fluenza, adenovirus, and respiratory syncytial virus. antibiotic use for respiratory tract infections. This learning was reinforced during my family Gonzales et al2 found that combined patient and practice residency training in Charleston, Se. I was clinician education was effective in reducing anti­ taught that the challenge of primary care practice is biotic use for acute bronchitis from 74% to 48% in to distinguish the many patients with benign, self­ a health maintenance organization setting. Using a limited respiratory tract infections from those pa­ quality improvement approach and a computer­ tients who are more seriously ill with bacterial based patient record in an academic family practice pneumonia and who need an antibiotic to recover setting, Ornstein and colleagues3 reduced antibi­ more quickly and more certainly. Anned with this otic prescribing for acute bronchitis from 60% to scientific knowledge, I marched valiantly into prac­ less than 30%. tice, determined to base my prescribing on good These and other initiatives show that it is pos­ science. It was only in rural practice that I clearly sible to reduce use of antibiotics for acute respira­ recall regularly confronting syndromes called tory tract infections, but how low can we go? The 4 "acute bronchitis" and "sinusitis," for which pa­ report by Hueston et al in this issue of the JABFP suggests that, for patients with the diagnosis of tients seemed to expect an antibiotic and for which acute bronchitis, the answer might not be 0%.
    [Show full text]
  • ACOI Board Review Course Bronchitis, Pneumonia and TB
    ACOI Board Review Course Bronchitis, Pneumonia and TB MarkAlain Déry, DO, MPH, FACOI Chief Innovation Officer Medical Director of HIV and Hepatitis Services Access Health Louisiana; FQHC Medical Director AIDS Educational Training Center (AETC) Medical Director Southern Center for Health Equities Executive Director; 102.3FM WHIV-LP Human Rights and Social Justice Radio [email protected] Disclosures Objectives At the conclusion of this section, participants; Will recognize the common clinical features of community acquired pneumonia include cough, fever, pleuritic chest pain, dyspnea, and sputum production. Will comprehend that most initial treatment regimens for community-acquired pneumonia are empiric and that a local epidemiology, travel history, and other epidemiologic and clinical clues should be considered when selecting an empiric regimen. At the end of the presentation the attendee will recognize that pulmonary complications of TB include hemoptysis, pneumothorax, bronchiectasis, extensive pulmonary destruction (including pulmonary gangrene), malignancy, venous thromboembolism, and chronic pulmonary aspergillosis. Dr. Derys’ Rule’s for the Boards MEMORIZE; Topics that save lives. Topics that prevent morbidity and mortality. Bronchitis, Pneumonia and TB; Acute Bronchitis- Pathogens Acute Bronchitis PATHOGENS; Viruses: most common • Rhinovirus • Parainfluenza virus • Coronavirus • Respiratory syncytial virus (RSV) • Influenza: the only realistically treatable virus • Common non-infectious offenders: allergens, smoke/smoking, toxic
    [Show full text]
  • What Is Acute Bronchitis?
    What is acute bronchitis? FACT SHEET prepared by The Asthma and Respiratory Foundation NZ Acute bronchitis is an infection of the large bronchi (airways) in the lungs. The airways swell and thick mucus builds up inside them. It is often caused by the same viruses that cause the common cold. A minority of cases are caused by bacteria. How do I know that I have acute bronchitis? Acute bronchitis may accompany or closely follow a cold or influenza or may occur on its own. The major symptom of acute bronchitis is a productive cough that may bring up yellow or green sputum (phlegm). This cough can last several weeks. Some people may have shortness of breath and a wheeze. There may be other symptoms associated with the viral cause such as a runny nose, sore throat, fever, muscle aches and pains, sore eyes or headache, particularly early in the illness. Chest pain is not usually associated with bronchitis. Who gets acute bronchitis? Anyone can get acute bronchitis. It is more common in winter, especially during influenza outbreaks. Tobacco smoke and other air pollutants appear to worsen symptoms and may prolong the cough. People with a chronic lung disease can also get acute bronchitis, but may need different treatment. How is acute bronchitis treated? Most cases will go away after a few days or a week though the cough may linger for several weeks or months. This indicates that the airways are taking a longer time to heal. As most cases of acute bronchitis are caused by virus’s, antibiotics are usually not effective.
    [Show full text]
  • Bronchitis, Acute
    ADULT BEST PRACTICE FLASH CARD Bronchitis, Acute Reference DIAGNOSIS Link Acute Cough Symptoms Possible yes Chest (+) Pneumonia pneumonia? x-ray CPM no (-) Asthma yes Possible asthma? CPM no Antibiotics ONLY if severe Possible rhinosinusitis? yes or persistent symptoms no • Symptom relief, education Possible influenza? yes • Consider flu test, antiviral Check if within 48 hrs of onset Germ no Watch • Test & treat ONLY if sx with known exposure or Possible pertussis? yes local outbreak no • Get vaccination up to date Possible exacerbation yes COPD of chronic bronchitis? CPM no Treat acute bronchitis (chest cold) ©2013 Intermountain Healthcare. CPM014fca - 12/13 Reference: Acute Cough (Bronchitis) (CPM014) Not intended to replace physician judgment with respect to individual variations and needs. ADULT BEST PRACTICE FLASH CARD Bronchitis, Acute Reference TREATMENT Link Acute Bronchitis (Chest Cold) MANAGE with NO antibiotics • Withhold antibiotics. NO antibiotics. • Provide education: – Refer to illness as a “chest cold” (not bronchitis). – Explain antibiotic risks (see Colds and Coughs in Adults: Managing Viral Infections fact sheet). – Offer contingency plan if cough worsens. • Recommend symptom relief: – Fever, aches, pains: NSAIDs, acetaminophen. – Nasal congestion: decongestant may help. – Cough: ipratropium (Atrovent), tiotropium (Spiriva), guaifenesin (Mucinex, Robitussin) may help; albuterol (Proventil) if wheezing or asthma. Other remedies not proven effective. FOLLOW UP • Follow-up appt. for new/worsening symptoms, or if cough lasts longer than 3 weeks total. • Re-evaluate; consider chest x-ray. • If cough lasts 3 to 8 weeks, CXR is normal, and pertussis ruled out, consider diagnosis of post- infectious cough. Avoid antibiotics; consider ipratropium (or if ineffective, inhaled corticosteroids). ©2013 Intermountain Healthcare.
    [Show full text]
  • 986.Full.Pdf
    Copyright ©ERS Journals Ltd 1998 Eur Respir J 1998; 11: 986–991 European Respiratory Journal DOI: 10.1183/09031936.98.11040986 ISSN 0903 - 1936 Printed in UK - all rights reserved ERS TASK FORCE REPORT Guidelines for management of adult community-acquired lower respiratory tract infections European Study on Community-acquired Pneumonia (ESOCAP) Committee Chairmen: G. Huchon1, M. Woodhead2 Members of ESOCAP study group: G. Gialdroni-Grassi3, P. Léophonte4, F. Manresa5, T. Schaberg6, A. Torres7 Other members of ESOCAP committee: A. Didier4, J. Dorca5, M. El Ebiary7, N. Roche1 The following guidelines are based on a systematic analysis of the literative which has been discussed by members of the ESOCAP committee and by external reviewers. The literature review and detailed methods of guideline development will be published in the European Respiratory Review, along with the list of external reviewers Initial clinical assessment and decision helpful outside hospital, since several studies have demon- on hospital referral strated that the sensitivity and specificity of clinical signs and symptoms are low for establishing such a classifica- The management of a community-acquired lower respi- tion. Therefore, the main goal of initial clinical evaluation ratory tract infection (LRTI) should follow a systematic is to determine whether the patient can be managed at step-by-step process (fig. 1), beginning with a detailed home or whether there is evidence that suggests potential history and clinical examination. Attempts to identify the or immediate severity, or that the illness will follow a com- type of LRTI (pneumonia, acute bronchitis, superinfection plicated course (table 1, fig. 2). All these features will guide of chronic bronchitis, or viral infection) are probably un- the decision on hospital referral and admission (fig.
    [Show full text]
  • ABIM Pulmonary Disease Certification Exam Blueprint
    Pulmonary Disease Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified pulmonologist in the broad domain of the discipline. The ability to make appropriate diagnostic and management decisions that have important consequences for patients will be assessed. The exam may require recognition of common as well as rare clinical problems for which patients may consult a certified pulmonologist. Exam content Exam content is determined by a pre-established blueprint, or table of specifications. The blueprint is developed by ABIM and is reviewed annually and updated as needed for currency. Trainees, training program directors, and certified practitioners in the discipline are surveyed periodically to provide feedback and inform the blueprinting process. The primary medical content categories of the blueprint are shown below, with the percentage assigned to each for a typical exam: Medical Content Category % of Exam Obstructive Lung Disease 17.5% Critical Care Medicine 15% Diffuse Parenchymal Lung Disease (DPLD) 10% Sleep Medicine, Neuromuscular and Skeletal 10% Epidemiology 2% Infections 12% Neoplasia 9.5% Pleural Disease 5% Quality, Safety, and Complications 5% Transplantation 2% Vascular Diseases 6% Respiratory Physiology and Pulmonary Symptoms 4% Occupational and Environmental Diseases 2% 100% Exam questions in the content areas above may also address clinical topics in general internal medicine that are relevant to
    [Show full text]
  • Common Respiratory Disorders in Primary Care
    © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR Chapter SALE OR DISTRIBUTION 3 NOT FOR SALE OR DISTRIBUTION Common© Jones Respiratory & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC DisordersNOT FOR in SALE Primary OR DISTRIBUTION Care NOT FOR SALE OR DISTRIBUTION Joanne L. Thanavaro © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE Chapter OR DISTRIBUTION Outline NOT FOR SALE OR DISTRIBUTION Case 1 - Influenza D. Guidelines to direct care: Global Initiative for Asthma 2015 and National Heart Lung and Blood Institute (NHLBI) Guide- A. History and Physical© Exam Jones & Bartlett Learning, LLClines for the Diagnosis and Management© Jones of & Asthma Bartlett (EPR-3) Learning, LLC B. Recommended Lab/DiagnosticsNOT FOR SALE OR DISTRIBUTIONE. Treatment Plan NOT FOR SALE OR DISTRIBUTION C. Pathophysiology D. Guidelines to direct care: Prevention and control of seasonal Case 4 - Chronic Obstructive Pulmonary influenza with vaccines: recommendation of the Advisory Disease (COPD) Committee on Immunization Practices (ACIP) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC E. Treatment Plan A. History and Physical Exam NOT FOR SALE OR DISTRIBUTION B. RecommendedNOT FORabs/Diagnostics SALE OR DISTRIBUTION Case 2 - Acute Bronchitis C. Pathophysiology D. Guidelines to direct care: Global Initiative for Chronic A. History and Physical Exam Obstructive Lung Disease (2015) B. © Jones & Bartlett Recommended Learning, Labs/Diagnostics LLC © JonesE. Treatment & Bartlett Plan Learning, LLC NOT FOR C.SALE Pathophysiology OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION D. Guidelines to direct care: Chronic Cough Due to Acute Case 5 - Community-Acquired Pneumonia (CAP) Bronchitis: American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines A.
    [Show full text]
  • Health Care Provider Supplemental Guide to “Talk to Your Health Care Provider About Antibiotics”
    Health Care Provider Supplemental Guide to “Talk to Your Health Care Provider About Antibiotics” Antibiotic resistance doesn’t mean your body is resistant to antibiotics. It means the bacteria 1 that make you sick are changing so that some antibiotics can’t kill them. • ASK YOUR HEALTH CARE PROVIDER how this happens and what it might mean for you. Each year in the U.S., at least 2 million people are infected with antibiotic-resistant bacteria, and at least 23,000 people die as a result1. The time between the discovery of a new drug and the development of resistance to that drug is gradually decreasing1. Teaching points for patients: A few bacteria have random mutations that make them resistant to certain antibiotics. If one of those antibiotics is used, it will kill the bacteria without the mutation, but the mutated, resistant bacteria will survive and take the place of the non-mutated bacteria that were killed. REFERENCES 1. CDC. What Exactly is Antibiotic Resistance? Centers for Disease Control and Prevention. https://www.cdc.gov/drugresistance/about.html. Published September 10, 2018. Accessed February 25, 2019. About 30% of the antibiotics we take in the U.S. are not needed. 2 • ASK YOUR HEALTH CARE PROVIDER if you really need an antibiotic and what you can do to feel better if you don’t. At least 30% of prescriptions provided in U.S. doctors’ offices and emergency departments are unnecessary, based on national guidelines for common conditions1. • 90-98% of acute rhinosinusitis cases are viral. Even when caused by bacteria, antibiotics may not help2.
    [Show full text]
  • Outpatient Acute Bronchitis Treatment Algroithm for Adults
    Acute Bronchitis for Adult and Pediatric Patients Algorithm Strategies to reduce antibiotic use for acute bronchitis: Symptoms consistent with acute bronchitis lasting > 5 days: 1. Use delayed prescription Conduct Differential Diagnosis: Cough, sputum production, strategies Pneumonia, asthma, exacerbation of dyspnea, nasal congestion, COPD, heart failure, upper respiratory 2. Discuss the expected course headache, and fever tract infection of illness and cough duration (2-3 weeks) Symptoms are not consistent 3. Explain that the illness is Acute bronchitis is likely either with acute bronchitis typically caused by a virus viral or Mycoplasma or (Bronchitis is ruled out as a (90%) and not bacteria Chlamydia pneumonia diagnosis) 4. Explain that antibiotics do not significantly shorten illness Are the following Antibiotics are not duration and are associated Are the following symptoms present: indicated for treatment. with adverse effects and symptoms present: Dyspnea, bloody or rusty antibiotic resistance malaise, rhinorrhea, mild sputum, pulse > 100 or paroxysmal cough, bpm, RR > 24 bpm, File TM. Acute bronchitis in Adults. In: excessive lacrimation, T > 100°F (37.8°C), Focal UpToDate, Bond S, Aronson MD (Ed), conjunctival infection? UpToDate, Waltham, MA. (Accessed on consolidation, egophony, April 13, 2017.) Kinkade S, Long NA. Acute or fremitus on chest Bronchitis. Am Fam Physician. Yes 2016;94(7):560-565. Lexicomp Online® , examination, delirium if Dosing: Adult and Pediatric, Hudson, Ohio: age > 75? Lexi-Comp, Inc.; April 13, 2017. Yes, pertussis is likely No Supportive care and symptom management Chest radiography • Antitussives: Dextromethorphan, is indicated Adult: guaifenesin (adults only), 1. Azithromycin 500 mg x1 day, then benzonatate (Rx only) 250 mg x4 • Expectorants: Guaifenesin Infiltrate No Infiltrate 2.
    [Show full text]