Asthma

vvd

A 40-year-old Hispanic homemaker is admitted with a 3-week history of high fever, chest pain, and a dry, irritating cough. Her illness began insidiously with increasing right upper chest pain that is sharp, pleuritic, and rates a 6 on a pain scale of 1 to 10. The pain is associated with temperatures of up to 38.8°C (102°F) and chills, rigors, and profuse sweating that increase in the evening. Worsening dyspnea has been accompanied by a drop in effort tolerance.

abstract: The keystone of influenza prevention is still vaccination. The 2 available types of influenza vaccine--the inactivated vaccine, which is administered intramuscularly, and the attenuated vaccine, which is delivered via nasal spray--have efficacy rates of 70% to 80%. Unfortunately, only about 65% of persons who should receive the influenza vaccine are, in fact, vaccinated. The neuraminidase inhibitors oseltamivir and zanamivir are 70% to 90% effective in preventing influenza. These antivirals also are effective in reducing the severity of influenza symptoms and the duration of illness when administered within 48 hours of the onset of clinical disease. Some patients have difficulty in self-administering zanamivir because the inhalation process is fairly complicated. Because of the resistance pattern observed in 2005, amantadine and rimantadine are not currently recommended for prophylaxis or therapy. (J Respir Dis. 2007;28(1):21-29)

The FDA has approved injectable Acetadote (acetylcysteine)from Cumberland Pharmaceuticals Incto prevent or lessen liver damage resulting from an overdoseof acetaminophen. According to the FDA, unintentionalacetaminophen overdose is responsible for 100deaths and 56,000 emergency department visits per year.

This child fell from his bicycle 3 days ago and suffered mild head trauma.He lacerated his forehead and sustained some abrasions and bruises in thesurrounding scalp. His mother now seeks medical care because the child’seyelids have become so swollen that he can hardly open his eyes.

When you are not certain about theorigin of a patient’s chronic cough,check the ears for cerumen impaction.

To determine how much medicationis left in an inhaler, drop the canisterinto a glass of water.

A 27-year-old woman with a 2-dayhistory of nausea, vomiting, andpostprandial abdominal pain is admittedto the hospital. Acute cholecystitisis suspected

A 45-year-old womanpresents with redness in the righteye, which she noticed that morning.She has not sustained trauma to theeye and reports no discomfort or lossof visual acuity. Recently, the patienthad a bout of bronchitis with a numberof severe coughing episodes. Herhistory is significant for asthma andcigarette smoking.

A 48-year-old African Americanwoman with HIV infection who hadbeen hospitalized several days earlierfor presumed Pneumocystis cariniipneumonia (PCP) is readmittedbecause of worsening dyspnea and atemperature of 38.8oC (102oF).She also complains of painful swellingand erythema on her right arm.Her symptoms have worseneddespite treatment with trimethoprimsulfamethoxazole.

The FDA has approved codeine polistirex/chlorpheniramine polistirexextended-release suspension CIII(Codeprex), from Celltech Group,for relief of cough. This drug is thefirst codeine-based cough suppressanton the market to provide 12-hour dosing.

Pandemics attributable to different influenza A virus subtypes occurredat irregular intervals throughout the 20th century. Because the timingof a pandemic cannot be predicted, we must be prepared for such an outbreak.Although influenza is generally viewed as an illness with potentiallydeadly effects primarily for elderly persons, it can lead to significant morbidityand mortality in otherwise healthy infants and toddlers and in other highriskgroups.

What is the connection between cockroach allergy and wheezing or asthmain children?

My patient is a 10-year-old boy with asthma. After an exacerbation of his asthmawas treated with albuterol and solumedrol, his blood glucose level was 250 mg/dLwith 1+ glucosuria (no ketones).

Two winters ago, the members of CONSULTANT’sEditorial Board met for 3 days with the journal’seditorial staff to brainstorm ways in whichCONSULTANT might best address the educationalneeds of primary care clinicians. One idea in particulargenerated unanimous enthusiasm: an entire issuedevoted to the health care problemsand needs of African Americans.

Q:Does theophylline still play a role in the treatment of chronicobstructive pulmonary disease (COPD), or has it been supersededby newer agents?

Q:What is the latest thinking on the use of dailyinhaled corticosteroids in the managementof chronic obstructive pulmonary disease (COPD)?

A:Theophylline remains useful in the maintenance management of COPD. It is most commonly prescribed as an adjunct to an inhaled β-agonist, ananticholinergic, or a combination of these agents.

A 45-year-old woman is admitted for evaluation of intermittentmidsternal chest pain that began 48 hours earlier.The pain is intense and radiates down both arms to theelbows; it has been accompanied by several episodes ofnausea and diaphoresis. She denies classic angina pectorisbut reports that she has experienced episodes of chestdiscomfort that is similar to her current pain-but muchless severe and without radiation-for about 3 months.She has no history of dyspnea on exertion, orthopnea, orparoxysmal nocturnal dyspnea.

Oral corticosteroids arecommonly used inambulatory patientsas short- or long-termtherapy for a numberof diseases. For example, patientswith acute exacerbations of asthmaor chronic obstructive pulmonary diseaseare routinely given 1- to 2-weekcourses of prednisone, methylprednisolone,or another oral corticosteroid.In addition, oral corticosteroidsare used as maintenance therapy inpatients with such conditions assystemic lupus erythematosus, sarcoidosis,and post-organ transplantcomplications.

Q:How can I best demonstrate to my patients who smoke theaccelerated decline in pulmonary function that occurs in smokersover time, in hopes of motivating them to quit smoking?

The patient is a 4-year-old boy who hasbeen coughing persistently for the past 2months. The mother reports that aboutthe time the coughing began, the childhad a “cold” with nasal congestion andfever. These symptoms resolved, but acough ensued. The mother tried usingover-the-counter medications, includingcough suppressants, but the cough hasnot abated. It occurs during the day andat night. It is disrupting the child’s sleep,and the teachers at his day-care centerare concerned that he may be infectingother children.

During the past 3 decades, the prevalence of asthma andallergies in children has increased steadily. Today, about 5million American children have asthma, which is the leadingcause of absence from school. The editors and authors ofthis textbook-who are recognized authorities in theirfields-discuss recent advances in the field of allergy andimmunology and tailor this new information to the specialneeds of children. Children’s immune systems are in theprocess of development; this offers special opportunities forprevention and intervention. Presented here is detailedguidance in the diagnosis and management of immunologicdiseases, upper airway allergies, asthma, food allergies, allergicskin and eye diseases, and drug allergies. Differentialdiagnoses, approaches to evaluation, environmental triggers,and both established and emerging treatments are alladdressed. The latest immune-directed therapies are discussedin depth. Photographs, graphs, tables, and figuresappear throughout the text.

Theophylline has numerouswell-documented and clinicallysignificant drug interactions.Several diseases alsoaffect theophylline clearance.Here, I provide examples of drug anddisease interactions that are most relevantto office practice.

Q:Which patients with chronic respiratory disorders are good candidatesfor pulmonary rehabilitation? When is it a better option than surgery?