Pulmonary System Flashcards
Two most common pulmonary problems people will likely come in seeking treatment for from their primary care provider.
- COPD
2. Asthma
Acute Bronchitis
- Inflammation of the lower airways (bronchioles, bronchi, and trachea).
- Common etiology for persistent, frequent cough.
- Infection is typically in the upper airways, even though inflammation is in lower airways.
- Patient with acute bronchitis typically presents with symptoms of URI for 2-3 days prior to onset of the cough.
- In an otherwise healthy, nonsmoking patient, the best course of care is treatment of symptoms only. WHY? Because 95% of the time acute bronchitis in this type of patient is of a viral etiology.
- In an unhealthy patient, someone with co-morbidities and/or smoker, it could well be a result of a bacterial etiology.
- Common viruses responsible for acute bronchitis:
1. Corona virus (types 1-3)
- Influenza/parainfluenza viruses
- RSV
- Human metapneumovirus
- Other (S. Pneumoniae, H. Flu, Mycoplasma B., pertussis, etc.)
- What is the most common symptom for a patient with acute bronchitis to have on day seven of their illness? PRODUCTIVE COUGH
Acute Bronchitis:
What are current recommendations for treatment of patient with acute bronchitis?
Treat the symptoms of acute bronchitis only.
- Antitussives
- NSAIDs
Acute Bronchitis:
True or False-Beta agonists are effective treatment for acute bronchitis?
False
Beta agonists (i.e. albuterol) have minimal benefit in treating acute bronchitis.
Cough:
When a patient comes in with a cough, what is the number one most important question you can ask them?
How long have you been coughing?
Cough duration helps you determine if it’s an ACUTE or CHRONIC condition:
ACUTE COUGH DD (cough present for <3 weeks)
- Acute respiratory infection (e.g. bronchitis, sinusitis, PND-postnatal drip)
- Exacerbation of COPD or asthma
- Pneumonia
- Pulmonary embolism
- Other
CHRONIC COUGH DD (cough present for >3 weeks):
- Asthma (second most common etiology)
- GERD (1st, 2nd, or 3rd most common etiology, depending on your source).
- Infection: Pertussis, atypical pneumonia, TB
- ACE inhibitors: Dry cough 1-3 weeks following initiation of treatment is common.
- Chronic Bronchitis (almost always smokers)
- Bronchiectasis: chronic cough; viscid sputum; bronchial wall thickening on CT scan.
- Lung cancer (<2% of cases).
Which patients warrant a chest x-ray when acute cough is present?
- Abnormal VS (increased RR, HR, or fever [temp. >38C or 100.4F).
- Rales present upon auscultation (indicative of potential consolidation).
- 75-years-old or greater
* In older adults with pneumonia, tachypnea, decreased O2 sat., and/or change in mental status or behavior are all potential indicators of pneumonia (elderly are less likely to run a fever if infection is present; in fact, tachypnea is the most sensitive indicator of pneumonia or infective respiratory process).
Community Acquired Pneumonia (CAP)
- Very different than hospital acquired pneumonia, caused by different set of microorganisms.
Which chest x-ray views are specific to ambulatory patients when looking at the pulmonary system?
Posterior-anterior (PA) and Lateral
If a patient is diagnosed with CAP, what determines which antibiotics should be selected for treatment?
The presence of comorbidities.
If patient has CAP, and otherwise healthy, and haven’t had an antibiotic in last three months, they probably have what type of pathogen?
Atypical pathogen (e.g. mycoplasma pneumonia).
If patient has CAP, and otherwise healthy, and haven’t had an antibiotic in last three months, they probably have what type of pathogen?
Atypical pathogen (e.g. mycoplasma pneumonia).
- What is the preferred antibiotic treatment for patients with pneumonia?
- What is the treatment duration for pneumonia with antibiotics?
- When should symptoms resolve?
- PNEUMONIA AND NO COMORBIDS AND NO ANTIBIOTICS IN LAST THREE months:
* Docycycline (a tetracycline)
* If unable to take doxycycline, treat with fluoroquinolones.
-Macrolides are a poor choice due to antibiotic resistance.
COMORBIDS AND/OR ANTIBIOTICS IN LAST THREE MONTHS:
If patient has comorbids or has had antibiotics in last three months, then give amoxicillin 1 g TID; amoxicillin-clavulanate XR 2 g BID; or crop do one or cefuroxime PLUS macrolide or doxy; or respiratory quinolone
- Minimal treatment period is five days; when afebrile for 48-72 hours and clinically stable.
3.
-Clinical symptoms:
Fever usually resolved by Day 3
Fatigue may persist for up to 14 days, depending on patient.
-Re-evaluate in 48-72 hours if poor response to treatment.
Is a follow up chest x-ray necessary in patients with pneumonia if they are responding to treatment?
Chest x-ray is not necessary if patient is responding appropriately to antibiotic treatment.
*However, you should consider treatment in patients older than 40-years and smokers or previous smokers to confirm resolution of pneumonia and exclude underlying diseases, malignancy.
What microorganism (which can be responsible for pneumonia) may be prevented with the PCV-13 vaccination?
*Easier to prevent pneumonia than treat it.
Strep pneumo (pneumococcal pneumonia). It is the most deadly form of pneumonia.
