Asthma

A 29-year-old Ukrainian man presents with a mildly pruritic generalized rash, which started 4 days earlier as a widespread eruption. The patient has no contacts who have a similar rash.

In adults who present with persistent cough following an upper respiratory tract infection but who have no history of asthma or chronic obstructive pulmonary disease, lung findings are usually “normal” on auscultation.

Many pharmacological options exist for allergic rhinitis. Intranasal corticosteroids are the most effective medication class for patients with moderate to severe symptoms; those with milder intermittent symptoms can be treated with a second-generation oral or intranasal antihistamine.

A 92-year-old woman presented with signs and symptoms of heart failure, including marked bilateral lower extremity edema, jugular vein distention, and difficulty in breathing at rest. Her medical history was significant for hyperthyroidism, chronic asthmatic bronchitis, and senile dementia. Medications included oral methimazole, 10 mg/d, and oral theophylline, 200 mg/d.

Doctors, especially primary care doctors, love stories. We love hearing them from patients and telling them to one another. “Anecdotal learning” it’s called by some (somewhat derisively because it’s not science).

In 2010, CONSULTANT marks its 50th year of service to primary careclinicians. On our golden anniversary, it seems appropriate to reflect onthe challenges, rewards, and frustrations of current medical practice.

To improve adherence in patients whose drug regimen calls for twice-daily dosing, I encourage them to keep the medication near their toothbrush. The habit of brushing their teeth twice a day reminds them to take their medication. This works especially well for young children who take asthma medication.

Tell patients who are clamoring for the H1N1 influenza vaccine that more doses will soon be available. At a recent press conference, Thomas Frieden, MD, Director of the CDC, had this message for health care providers: “Don’t reserve available vaccine; give it out as soon as it comes in, because more is on the way.”

Lung disease was the most common underlying condition in a British study of 192 patients who had been admitted to the hospital because of complications related to H1N1 influenza.

Allergic rhinitis is highly prevalent; about 20% of adults in the United States and 25% of children worldwide are affected. It is a major societal expense, with direct costs, attributable to physician visits and medications, of up to $5 billion per year, and indirect costs, mainly stemming from lost productivity, of up to $9.7 billion per year. In the United States, allergic rhinitis results in 3.5 million lost workdays and 2 million lost schooldays each year.

The ability to recognize cases of the new H1N1 flu and distinguish these from seasonal influenza and other respiratory illnesses is perhaps the overriding concern of primary care practitioners. Prompt and accurate identification of this entity is the key to both effective management of individual illness and effective public health measures.

In 2000, the World Allergy Organization (WAO) published a consensus definition of anaphylaxis as a severe, life-threatening generalized or systemic hypersensitivity reaction. The reaction is caused by the release of bioactive mediators from mast cells and basophils.

Chronic obstructive pulmonary disease (COPD) is recognized as a common condition in older adults, but asthma is often considered something that most patients outgrow long before they retire and qualify for Medicare.

More than 1 million persons in the United States may have been infected with novel H1N1 (swine) influenza virus, according to US health officials. In a recent media briefing, Dr Anne Schuchat, Director of the National Center for Immunization and Respiratory Diseases, CDC, noted that the infection is continuing to spread well past the typical influenza season in the Northern Hemisphere.

Inhaled medications are the cornerstoneof therapy for most of themore than 30 million Americanswho have asthma or chronic obstructivepulmonary disease(COPD). Unfortunately, many ofthese patients use aerosol deliverydevices incorrectly.

About 50% of pregnanciesin the United States areunplanned.

About 50% of pregnancies in the United States are unplanned.1 Thus, an awareness of which medications are safe and which are contraindicated in pregnancy is essential for good primary care-even in practices that do not include obstetrics.

My patient is a 45-year-old woman who has a severe reaction to wine; however, she can drink “hard” liquor with no problems. Her reactions are mainly dermatological, such as itching, rash, and urticaria. Is there any treatment?

This 43-year-old woman presents with a painful eruption of sudden onset; it is confined to her trunk. She is otherwise healthy.What is your clinical impression?

The term “anaphylaxis” (without protection) was first coined by Richet and Portier in 1902 to describe a “supersensitivity” reaction they observed while attempting to produce tolerance to sea anemone venom in dogs. During their experiments, an unforeseen event occurred.

An 18-year-old woman with a history of allergic rhinitis and moderate persistent asthma presented with right-sided nasal congestion of 6 months’ duration. Her symptoms persisted despite her usual allergy medications, allergen immunotherapy, and 2 courses of antibiotics. A sinus CT scan showed complete opacification of the right maxillary sinus with increased attenuation of the mucin. Allergic fungal rhinosinusitis was suspected, and an otolaryngologist was contacted.

Swelling of the wrists and ankles of 3 months' duration prompted a 33-year-old man to seek medical attention. The swelling was highly migratory, with periods of regression that lasted several days at a time. The patient also had a 3-year history of "breaking out" after contact with water. He had no personal or family history of asthma, allergies, or other atopic disorders. He was not taking any medications.

One way to determine whether a patient's asthma is well controlled is to inquire about the frequency of rescue treatments with an albuterol metered-dose inhaler.

A 14-year-old boy presents with frequent severe headaches characterized by sharp, throbbing pain behind his left eye and left temple.

Parents of young children know that colds are extremely common, especially from fall until spring. Colds account for a large number of pediatric office visits and telephone calls-particularly during "cold season."