Outpatient Acute Bronchitis Treatment Algroithm for Adults

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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. Erythromycin 500 mg QID x14 • Consider Beta2-Agonists if 3. Clarithromycin 500 mg BID x14 ll ll underlying history of lung 4. If macrolide contraindicated: disease or wheezing or airway Bactrim®DS BID x14 Refer to CAP/HAP obstruction on exam guidelines • Analgesics/Antipyretics: APAP or Pediatric: ibuprofen for fever and pain 1. Azithromycin 10 mg/kg x1 (Max Pneumonia ruled 500), then 5 mg/kg x4 (Max 250) out of differential 2. Erythromycin 40-50 mg/kg/day in Cold and cough medications are not 4 divided doses (Max 2 g/day) recommended in children under 4 3. Clarithromycin 7.5 mg/kg/dose years old: Q12H x7 (Max 500/dose) Fluids, APAP/ibuprofen (fever/pain 4. Bactrim® 4mg/kg/dose Q12H x14 control), saline nasal spray, and if >1 year honey (antitussive). .

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Bronchiolitis
6 Sand Hill Road, Suite 102 Flemington, NJ 08822 PHONE 908-782-6700 FAX 908-788-5861 hunterdonpediatrics.org BRONCHIOLITIS Bronchiolitis is an infection of the small breathing tubes (bronchioles) that lead to the lung. Bronchiolitis is not the same as bronchitis, which is an infection in the large breathing tubes (bronchi). Bronchiolitis is usually seen in infants and young toddlers. It is not usually seen in older children or adults. A virus causes bronchiolitis. The most common virus is RSV (respiratory syncytial virus). Since RSV infection does not usually result in immunity, people can get it again; however, beyond the age of two, RSV usually causes just a bad cold. RSV is very contagious and spreads rapidly through childcare groups and families from October through April. Some studies suggest that babies who get RSV are more likely to have asthma in the future. Also, people with asthma who get RSV infection may trigger an asthma attack. Babies with RSV have severe nasal congestion, usually followed by a worsening cough. There may be a mild fever at the beginning of the illness. Signs of trouble with RSV include: ● Poor feeding/decreased urine output ● Rapid breathing ● Grunting sound with breathing ● Tightening of chest or stomach muscles with breathing ● Wheezing (high pitched whistling sound with breathing out) ● Blue tint around mouth or fingers/toes ● Fever lasting more than two days, or over 104 The vast majority of patients with bronchiolitis recover well. Certain children are especially likely to have trouble with bronchiolitis: ● Infants under two months of age ● Infants who were premature and have not reached their “due date” yet ● Patients with lung diseases like cystic fibrosis or bronchopulmonary dysplasia (BPD) ● Patients with severe heart disease ● Patients with AIDS or other immunity problems ● Patients on chemotherapy or with organ transplants Treatment for bronchiolitis is mostly supportive; that is, treatment is aimed at helping the patient breathe better.
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Respiratory Syncytial Virus Bronchiolitis in Children DUSTIN K
Respiratory Syncytial Virus Bronchiolitis in Children DUSTIN K. SMITH, DO; SAJEEWANE SEALES, MD, MPH; and CAROL BUDZIK, MD Naval Hospital Jacksonville, Jacksonville, Florida Bronchiolitis is a common lower respiratory tract infection in infants and young children, and respiratory syncytial virus (RSV) is the most common cause of this infection. RSV is transmitted through contact with respiratory droplets either directly from an infected person or self-inoculation by contaminated secretions on surfaces. Patients with RSV bronchiolitis usually present with two to four days of upper respiratory tract symptoms such as fever, rhinorrhea, and congestion, followed by lower respiratory tract symptoms such as increasing cough, wheezing, and increased respira- tory effort. In 2014, the American Academy of Pediatrics updated its clinical practice guideline for diagnosis and man- agement of RSV bronchiolitis to minimize unnecessary diagnostic testing and interventions. Bronchiolitis remains a clinical diagnosis, and diagnostic testing is not routinely recommended. Treatment of RSV infection is mainly sup- portive, and modalities such as bronchodilators, epinephrine, corticosteroids, hypertonic saline, and antibiotics are generally not useful. Evidence supports using supplemental oxygen to maintain adequate oxygen saturation; however, continuous pulse oximetry is no longer required. The other mainstay of therapy is intravenous or nasogastric admin- istration of fluids for infants who cannot maintain their hydration status with oral fluid intake. Educating parents on reducing the risk of infection is one of the most important things a physician can do to help prevent RSV infection, especially early in life. Children at risk of severe lower respiratory tract infection should receive immunoprophy- laxis with palivizumab, a humanized monoclonal antibody, in up to five monthly doses.
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The Common Cold.Pdf
PATIENT TEACHING AID The Common Cold PERFORATION ALONG TEAR Everyone has experienced the misery of the common Rhinovirus Infection cold. A cold causes familiar symptoms such as a runny nose, sore throat, congestion, postnasal drip, and cough. For most sufferers, these symptoms are annoying, but not serious. Cold symptoms gradually improve and disappear over 7 to 10 days without complications. Colds are viral infections, so treatment with an antibiotic is not helpful. The best treatment for a cold is rest, fluids, and nonprescription medicines to help relieve symptoms. Although there is no vaccine to prevent colds, the spread of cold viruses can be slowed by frequent hand washing and avoiding close contact with those suffering from a cold. ILLUSTRATION: KRISTEN WIENANDT MARZEJON 2016 MARZEJON WIENANDT KRISTEN ILLUSTRATION: Copyright Jobson Medical Information LLC, 2016 continued MEDICAL PATIENT TEACHING AID Antibiotics Should Not Be Used to Treat a Cold Colds are caused by a variety of viruses, most commonly rhinoviruses. These viruses are highly contagious, and they are spread through the air or when someone is in contact with an infected person or contaminated object. There is no good evidence that exposure to cold or being overheated © Jobson Medical Information LLC, 2016 LLC, Information Medical Jobson © increases the risk of contracting a cold. Although most Wash your hands thoroughly and frequently colds occur in the winter months, some viruses that cause to prevent the spread of cold viruses. colds are more common in the fall or spring. Infants and young children are more prone to colds, as are people with weakened immunity.
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SEPTOPLASTY SURGICAL INFORMED CONSENT the Nasal
.SEPTOPLASTY SURGICAL INFORMED CONSENT The nasal septum is the wall inside your nose that divides it into two separate nasal passages. It is made of cartilage and bone. In a healthy nose, there is usually nearly equal airflow on both sides. Sometimes, the nasal septum is crooked or twisted. This condition is called a deviated nasal septum, and it can be caused by trauma to the nose, or patients can be born this way. The primary problem with a deviated nasal septum is nasal blockage, either on one or both sides. This nasal blockage can also contribute to nosebleeds, sinus infections, and often worsens obstructive sleep apnea. Occasionally, a deviated septum can be associated with a specific type of headache. A deviated septum can be surgically repaired with an operation called a septoplasty. This is typically done through a closed approach, which takes about one hour. More complicated or severely deviated septa may require an open approach, which can take up to 2-3 hours. In either case, septoplasty surgery is done under general anesthesia. It is an outpatient procedure so patients will be discharged home the same day. Some patients have multiple causes of nasal obstruction. Aside from a deviated septum, other reasons for a stuffy nose include chronic sinusitis, turbinate hypertrophy, nasal polyps, or nasal valve collapse. In these cases, septoplasty surgery may be performed in conjunction with other procedures such as endoscopic sinus surgery, turbinate reduction, or insertion of alar batten or spreader grafts. These procedures are discussed in their own individual sections on our website. Your physician will discuss what surgery is most appropriate for you.
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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.
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Intranasal Ipratropium Bromide Reduced Rhinorrhea and Improved Cold Symptoms
/:*-..= S Evid Based Med: first published as 10.1136/ebm.1996.1.205 on 1 December 1996. Downloaded from Intranasal ipratropium bromide reduced rhinorrhea and improved cold symptoms Hayden FG, Diamond L, Wood PB, 0.06% in a buffered salt solution (P = 0.003). {This 17% absolute dif- KortsDC, Wecker MT. Effectiveness (2 sprays/nostril [84 u,g] 3 times/d ference in improvement between the and safety of intranasal ipratropium for 4 d) (n = 137), the same nasal ipratropium and placebo groups bromide in common colds. A ran- spray without ipratropium in = 137), means that 6 patients (95% CI, 4 to domized, double-blind, placebo- or no medication (n = 137). No cold 16) would need to be treated with controlled trial. Ann Intern Med. medications other than analgesics ipratropium (rather than placebo) for 1996JullS;12S:89-91. and antitussives were allowed. 4 days to result in improvement for 1 additional patient; the relative risk Main outcome measures improvement was 26%, CI 9% to Objective 47%* }. Rates of nasal dryness (12% To determine whether intxanasal ipra- The main outcome measure was a vs 4%), blood-tinged mucus (17% vs tropium bromide is effective and safe global assessment of overall improve- 4%), and headache (9% vs 2%) were for reducing common cold symptoms. ment (report by patients of being better or much better). Rhinorrhea greater in the ipratropium group than Design was monitored in the clinic hourly in the placebo group. 6-day, randomized, double-blind, for the first 6 hours on day 1 and Conclusion placebo-controlled trial. hourly for 3 hours on day 2.
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Allergic/Non-Allergic Rhinitis
Tips to Remember: Rhinitis Do you have a runny or stuffy nose that doesn't seem to go away? If so, you may have rhinitis, which is an inflammation of the mucous membranes of the nose. Rhinitis is one of the most common allergic conditions in the United States, affecting about 40 million people. It often coexists with other allergic disorders, such as asthma. It is important to treat rhinitis because it can contribute to other conditions such as sleep disorders, fatigue and learning problems. There are two general types of rhinitis: Allergic rhinitis is caused by substances called allergens. Allergens are often common, usually harmless substances that can cause an allergic reaction in some people. Causes • When allergic rhinitis is caused by common outdoor allergens, such as airborne tree, grass and weed pollens or mold, it is called seasonal allergic rhinitis, or "hay fever." • Allergic rhinitis is also triggered by common indoor allergens, such as animal dander (dried skin flakes and saliva), indoor mold or droppings from cockroaches or dust mites. This is called perennial allergic rhinitis. Symptoms • Sneezing • Congestion • Runny nose • Itchiness in the nose, roof of the mouth, throat, eyes and ears Diagnosis If you have symptoms of allergic rhinitis, an allergist/immunologist can help determine which specific allergens are triggering your reaction. He or she will take a thorough health history, and then test you to determine if you have allergies. Skin tests or Blood (RAST) tests are the most common methods for determining your allergic triggers. Treatment Once your allergic triggers are determined, your physician or nurse will work with you to develop a plan to avoid the allergens that trigger your symptoms.
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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.
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Allergic Fungal Airway Disease Rick EM, Woolnough K, Pashley CH, Wardlaw AJ
REVIEWS Allergic Fungal Airway Disease Rick EM, Woolnough K, Pashley CH, Wardlaw AJ Institute for Lung Health, Department of Infection, Immunity & Inflammation, University of Leicester and Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK J Investig Allergol Clin Immunol 2016; Vol. 26(6): 344-354 doi: 10.18176/jiaci.0122 Abstract Fungi are ubiquitous and form their own kingdom. Up to 80 genera of fungi have been linked to type I allergic disease, and yet, commercial reagents to test for sensitization are available for relatively few species. In terms of asthma, it is important to distinguish between species unable to grow at body temperature and those that can (thermotolerant) and thereby have the potential to colonize the respiratory tract. The former, which include the commonly studied Alternaria and Cladosporium genera, can act as aeroallergens whose clinical effects are predictably related to exposure levels. In contrast, thermotolerant species, which include fungi from the Candida, Aspergillus, and Penicillium genera, can cause a persistent allergenic stimulus independent of their airborne concentrations. Moreover, their ability to germinate in the airways provides a more diverse allergenic stimulus, and may result in noninvasive infection, which enhances inflammation. The close association between IgE sensitization to thermotolerant filamentous fungi and fixed airflow obstruction, bronchiectasis, and lung fibrosis suggests a much more tissue-damaging process than that seen with aeroallergens. This review provides an overview of fungal allergens and the patterns of clinical disease associated with exposure. It clarifies the various terminologies associated with fungal allergy in asthma and makes the case for a new term (allergic fungal airway disease) to include all people with asthma at risk of developing lung damage as a result of their fungal allergy.
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Influenza (PDF)
INFLUENZA Outbreaks of influenza, or “flu”, typically occur every winter. Colds may occur at any time of year with seasonal peaks occurring in fall and spring. Influenza is a respiratory illness usually caused by infection with one of two influenza viruses – influenza A or influenza B. Outbreaks of influenza (flu) typically occur every winter. Influenza is characterized by an abrupt onset of fever, chills, headache, body aches, and lack of energy accompanied by respiratory symptoms, most frequently cough and sore throat. Most people are largely recovered in one week, although many feel fatigued for several weeks. Serious complications of flu, such as pneumonia, however, can occur, especially if the body’s defenses are weakened by age or disease. Influenza is spread by inhaling the influenza virus which is usually carried on tiny, invisible water droplets in the air generated by coughs and sneezes. Hand-to-hand contact as well as contact with infected secretions on a hard surface may also cause transmission of the virus. Each year influenza viruses change and new vaccines are made to combat the particular strains that are expected to cause illness that year. The flu vaccine may reduce the chance of getting the flu by 60-80%, and lessen the severity of illness in the person who does get the flu. According to the Centers for Disease Control (CDC), everyone 6 months or order should get a yearly flu vaccine. The following people are at high risk for complications of flu and are especially urged to get vaccinated: Individuals with chronic heart or lung problems that have required regular medical follow-up or hospitalization during the last year.
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Bronchiolitis
Bronchiolitis What is bronchiolitis? Bronchiolitis is a viral infection of the lungs that usually affects infants. There is swelling in the smaller airways or bronchioles of the lung, which causes coughing and wheezing. Bronchiolitis is the most common reason for children under 1 year old to be admitted to the hospital. What are the symptoms of bronchiolitis? The following are the most common symptoms of bronchiolitis. However, each child may experience symptoms differently. Symptoms may include: Runny nose or nasal congestion Fever Cough Changes in breathing patterns (wheezing and breathing faster or harder are common) Decreased appetite Fussiness Vomiting What causes bronchiolitis? Bronchiolitis is a common illness caused by different viruses. The most common virus causing this infection is Respiratory Syncytial Virus (RSV). However, many other viruses can cause bronchiolitis including: Influenza, Parainfluenza, Rhinovirus, Adenovirus, and Human metapneumovirus. Initially, the virus causes an infection in the upper airways, and then spreads downward into the lower airways of the lungs. The virus causes swelling of the airways. Mucus is also produced in the airways. This narrowing of the airways can make it difficult for your child to breath, eat, or nurse. How is bronchiolitis diagnosed? Bronchiolitis is usually diagnosed on the history and physical examination of the child. Antibiotics are not helpful in treating viruses and are not needed to treat bronchiolitis. Because there is no cure for the disease, the goal of treatment is to make your child comfortable and to support their symptoms. This treatment may include suctioning to keep the airways clear, extra oxygen if the blood oxygen levels are low, or hydration if your child is not able to feed well.
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New Medical Treatments for Nasal Polyps
New Medical Treatments for Nasal Polyps February 7, 2020 Brian Modena, MD, MSc 1 Disclosures Research support: NHLBI‐Supported Researcher Self Care Catalysts: architect of Health StorylinesTM app Personal Fees: AstraZeneca, GSK, Regeneron, Sanofi 42nd Annual Pulmonary and Allergy Update Objectives 1. Discuss the epidemiology, biology, pathophysiology, and symptoms of CRS with nasal polyposis (CRSwNP). 2. Review treatment guidelines and recommendations for CRSwNP. 3. Review the many scoring systems used to evaluate CRSwNP. 4. Discuss in detail the Phase II and Phase III clinical trials using biologics for treatment of CRSwNP. Nasal Polyposis Epidemiology Prevalence = ~4%1; (CRS = ~11‐12%)2 Costs: Genetic inheritance = ~14% 2 Increases with age; peak ~50 years CRS = ~$8 billion/year Caucasians = Th2‐driven inflammation. Per patient per year: $13,000; Male to female = 2:1 $26,000 if surgery performed. Asians = Th1‐driven inflammation. Association with allergic rhinitis is weak. Surgeries/year = ~500,000 Disease Prevalence estimates 1. Hastan, Fokkens, et al, 2011 Allergic rhinitis Adult: 0.1%; Children 1.5%1 2. Lange, Holst, et al., Clin Otolaryngol 2013. 3. Mygind. JACI. 1990 Dec;86(6 Pt 1):827‐9. Asthma 5‐22% 4. Schleimer RP. Annu Rev Pathol. 2017;12:331‐57. 5. Hunter TD, DeConde AS, Manes RP. J Med Econ. 2018;21(6):610‐5. CRS 20‐25%1‐4 6. Palmer JN, Messina JC, Biletch R, et al. Allergy Asthma Proc. 2018;39:1‐9. NSAID intolerance 36‐72% 7. Pearlman AN, Chandra RK, Chang D, et al. Am J Rhinol Allergy. 2009;23(2):145‐8. NSAID intolerance and asthma 80% 8.
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