Persistent Cough and Wheezing Flashcards
Common causes of chronic cough I don’t think about
Vocal cord dysfunction
Non-asthmatic eosinophilic bronchitis
Causes of wheezing that i don’t think about
CHF Foreign body Persistent bronchitis Vocal cord dysfunction PE Upper Airway Cough Syndrome GERD(?)- Reflux can can bronchoconstriction
Length of time needed to dx acute sinusitis
Symptoms present for 7 to 10 days following URI
Length of time needed to dx chronic sinusitis
Symptoms present > 12 weeks
A nonintuitive comorbid condition of asthma
Stress or depression
How many symptoms for chronic sinusitis
Need at least two - Congestion - Mucopurulent drainage - Facial pain, pressure, or fullness - Decreased sense of smell Also require signs of inflammation with imagines or on exam
Severity of Asthma
Freq of symptoms Freq of awakening at night Freq of inhaler use Ability to do normal activity FEV1 value FEV1/FVC ratio
Cells involved in asthma
Mast cell
T lymphs
Macrophages
Eosinophils
Long term changes with asthma
Airway remodeling
Subepi fibrosis
Decreased responsiveness to treatment
Viral vs Bacterial sinusitis
Viral - Less than 10 days - Symptoms should not worsen Bacterial - Greater than 10 days - Symptoms progress
Dx of asthma by PFT
FEV1 Value improves by > 12%
%Predicted FEV1 improves by 10%
Dx of nonasthmatic eosinophilic bronchitis
PFT and chest x-ray will be normal
Requires sputum eosinophilia
Dx of vocal cord dysfunction
Flat inspiratory loop on PFT
No reversible findings
Dx of COPD
Non-reversible obstruction on PFT
Indications fo CT
Further evaluate findings on X-ray
Indications for Methacholine test
If PFT is normal
Ventilation perfusion scan
Used when PE is suspected…sometimes
At what % peak flow is there a medical alert?
Better step 3 protocol?
Low dose inhaled steroid and long-acting beta 2
- Medium dose inhaled steroid is also acceptable
When are high dose inhaled steroids used
Severe asthma
- Can use long acting beta 2 with medium dose steroid
When are oral steroids used
Severe exacerbations
When are leukotriene receptor antagonists used
Not often, expensive and long acting beta 2 are better
When is theophylline used
Not often, requires titration and long acting beta 2 are better
Most effective medication for allergic rhinitis
nasal steroids
Are allergy shots worth looking into?
Yes
- Decrease symptoms severity
- Help control asthma
Age to start the flu vaccine
At 6 months
Who gets PPSV23?
Adults (19 to 65) with any one of numerous comorbidities
Tx of chronic sinusitis
maximize medical therapy
- nasal steroids
- Allergen immunotherapy
- Nasal saline
- Do not use antibiotics
