PC2PULM

Bronchitis

• Bronchitis involves inflammation of the bronchial tubes
• Inflammation leads to coughing, mucus production, and potential shortness of breath
• Bronchitis can be acute (short-term) or chronic (long-term)

Inflammation of the Bronchial Tubes

• Bronchitis occurs when the bronchial tubes become inflamed and irritated
• The bronchial tubes carry air to the lungs

Causes of Bronchitis

• Acute bronchitis is often caused by viral infections like colds or flu
• Acute bronchitis can be caused by bacterial infections or irritants like smoke, dust, or fumes
• Chronic bronchitis is characterized by persistent inflammation and mucus production
• Chronic bronchitis is often linked to long-term smoking or exposure to irritants

Symptoms of Bronchitis

• Coughing that is persistent and may produce mucus (sputum)
• Mucus production results from the body trying to clear the airways
• Mucus can be thick and difficult to clear
• Shortness of breath is the result of inflammation making it harder to breathe
• Wheezing is a whistling sound when breathing, especially when exhaling
• Chest discomfort includes a feeling of tightness or pain
• Fatigue includes feeling tired and run-down
• Other symptoms include a runny nose, sore throat, headache, and low-grade fever

Types of Bronchitis

• Acute bronchitis is usually caused by a viral infection
• Acute bronchitis lasts for a few weeks
• Acute bronchitis often resolves on its own without needing antibiotics
• Chronic bronchitis is a long-term condition that can be a symptom of COPD (Chronic Obstructive Pulmonary Disease)
• Chronic bronchitis is characterized by a persistent cough that produces mucus
• The cough lasts for at least three months each year for two or more years
• There is no cure for chronic bronchitis
• Treatments can help manage symptoms and slow down the progression of chronic bronchitis

When to Seek Medical Advice for Bronchitis

• Seek medical advice when a cough is severe or persistent
• Seek medical advice when there is difficulty breathing or wheezing
• Seek medical advice when there is a fever higher than 100.4°F (38°C)
• Seek medical advice when coughing up blood
• Seek medical advice when symptoms worsen or don't improve after a few weeks
• Seek medical advice with a history of lung disease or other health conditions

Acute Bronchitis Treatment

• Rest to allow the body to heal and avoid further irritation
• Hydration by drinking plenty of fluids to thin mucus and make it easier to cough up
• Over-the-counter Medications such as cough suppressants, expectorants (e.g., guaifenesin), and pain relievers (e.g., ibuprofen) to alleviate symptoms
• Humidifier use to add moisture to the air, making it easier to breathe and loosen mucus

Chronic Bronchitis Treatment

• Bronchodilators: Inhaled medications that open up the airways and reduce wheezing
• Lifestyle changes: Quit smoking, avoid exposure to irritants, and exercise regularly
• Medications: Long-acting bronchodilators, inhaled corticosteroids, and mucolytics are often prescribed
• Oxygen therapy: May be necessary for severe cases to improve oxygen levels in the blood
• Pulmonary rehabilitation: A program that includes exercise, education, and breathing techniques to improve lung function
• Antibiotics are not typically prescribed for acute bronchitis, as it is usually caused by a virus
• Antibiotics may be used if the infection is bacterial
• Steroids, inhaled or oral corticosteroids may be prescribed in severe cases to reduce inflammation
• Surgery in rare cases, may be necessary to remove damaged airways or to reduce the size of an enlarged lung

Valley Fever

• Valley fever is a fungal infection caused by the fungus Coccidioides immitis or Coccidioides posadasii
• Cause: Inhaling spores from soil contaminated with the fungus, typically in arid regions of the southwestern United States and Central and South America
• Symptoms: Most people (60%) have no symptoms or mild flu-like symptoms, including: Fever, cough, fatigue, joint pain, and chest pain
• In severe cases, the infection can spread to other organs, such as the brain, skin, or bones
• Diagnosis: Blood test to detect antibodies against the fungus and Chest X-ray to show lung lesions
• Treatment: Most people with valley fever recover on their own without treatment
• Antifungal medications may be prescribed for severe cases or those with complications
• Mild to Moderate Cases: Fluconazole and Itraconazole, antifungal medications that inhibits fungal growth, similar to fluconazole
• Severe or Disseminated Cases: Amphotericin B, a potent antifungal medication administered intravenously
• Voriconazole, a newer antifungal medication that may be effective in cases resistant to fluconazole and itraconazole
• Posaconazole, is another newer antifungal medication similar to voriconazole

Valley Fever Prevention & Risks

• Avoid disturbing soil in areas where the fungus is known to be present
• Wear a mask when working in dusty environments
• Get vaccinated if you are at high risk of exposure
• Risk Factors include Living or working in areas where the fungus is common (e.g., southwestern United States), having a weakened immune system, and being pregnant
• Valley fever is not contagious
• Valley fever the infection is most common in the summer months

Acute Asthma Exacerbation

• An acute asthma exacerbation is a sudden worsening of asthma symptoms
• Symptoms include wheezing, shortness of breath, chest tightness, and cough

Causes of Acute Asthma Exacerbation

• Viral or bacterial infections (e.g., common cold, flu)
• Allergens (e.g., pollen, dust mites, pet dander)
• Air pollution
• Exercise
• Stress
• Certain medications (e.g., nonsteroidal anti-inflammatory drugs)

Symptoms of Acute Asthma Exacerbation

• Wheezing
• Shortness of breath
• Chest tightness
• Cough
• Rapid breathing
• Increased heart rate
• Fatigue

Diagnosis of Acute Asthma Exacerbation

• Physical examination (e.g., wheezing, retractions)
• Lung function tests (e.g., peak flow meter)
• History of asthma and triggers

Treatment of Acute Asthma Exacerbation

• Mild exacerbations: Use of short-acting beta-agonist (SABA) inhaler (e.g., albuterol)
• Consider adding oral corticosteroids if symptoms do not improve with SABA use alone
• Moderate exacerbations: Use of long-acting beta-agonist (LABA) inhaler or nebulized corticosteroids in addition to SABA
• Hospitalization may be necessary if symptoms are severe or do not respond to treatment
• Severe exacerbations: Intravenous corticosteroids, oxygen therapy, and mechanical ventilation if needed

COVID

• Symptoms to Assess: Fever, cough, shortness of breath, fatigue, body aches, headache, loss of taste or smell, sore throat, congestion, nausea, and diarrhea

COVID 19 Assessment and Management

• PCR Test: Gold standard, highly sensitive and specific
• Antigen Test: Quick results, useful in symptomatic individuals
• Rapid At-Home Tests: Convenient but may have lower sensitivity
• Isolation Precautions: Follow CDC guidelines on duration based on symptom resolution and test results

COVID-19 Treatments

• Paxlovid is used for eligible high-risk patients within 5 days of symptom onset
• Paxlovid interacts with many common medications, including certain statins, antiarrhythmics, and immunosuppressants
• Paxlovid is contraindicated for those with severe kidney or liver disease
• Paxlovid can cause gastrointestinal symptoms, altered taste, or liver enzyme changes
• Paxlovid is generally recommended for adults and older children at high risk
• Paxlovid is not typically used during pregnancy without careful assessment
• MOLNUPIRAVIR is an alternative if Paxlovid is contraindicated
• Molnupiravir is not recommended during pregnancy due to potential risk of fetal harm
• Patients of reproductive age may be advised on contraception during treatment

Side Effects of Molnupiravir

• Potential for mild side effects like diarrhea, nausea, and dizziness
• Molnupiravir's long-term safety data is still limited

Bronchiolitis

• Bronchiolitis is an inflammation of the small airways (bronchioles) in the lungs
• Bronchiolitis is a common respiratory infection in infants and young children

Causes of Bronchiolitis

• Bronchiolitis is typically caused by viruses, most commonly respiratory syncytial virus (RSV)
• Other viruses that can cause bronchiolitis include parainfluenza virus, human metapneumovirus, and adenovirus

Symptoms of Bronchiolitis

• Symptoms usually start as a common cold
• Symptoms may include runny nose, cough, wheezing, rapid breathing, difficulty breathing, and fever

Treatment of Bronchiolitis

• Most cases resolve on their own with supportive care
• Supportive care includes rest, fluids, humidifier, and over-the-counter pain relievers (e.g., ibuprofen, acetaminophen)
• Hospitalization may be necessary for oxygen therapy, nebulized medications, or in rare cases, mechanical ventilation
• Antibiotics are not typically used to treat bronchiolitis as it is a viral infection

Prevention of Bronchiolitis

• Washing hands frequently
• Avoid contact with people who are sick
• Get vaccinated against influenza and RSV (for eligible children)
• Keep children away from secondhand smoke

Complications of Bronchiolitis

• Most cases are mild and resolve without complications
• In severe cases, complications such as pneumonia, respiratory failure, and dehydration can occur

Outlook of Bronchiolitis

• Most children recover within a few weeks
• Some children may experience a persistent cough or wheezing for several months after the initial infection

Cough

• A cough is a forceful expulsion of air from the lungs to clear the airways of irritants or mucus

Common Causes of Cough

• Common cold
• Flu
• Allergies
• Asthma
• Sinusitis
• Postnasal drip

Less Common Causes of Cough

• Lung infections (e.g., pneumonia)
• Heart failure
• Gastroesophageal reflux disease (GERD)
• Irritants (e.g., smoke, dust)

Types of Cough

• Acute cough: Lasts less than three weeks
• Subacute cough: Lasts between three and eight weeks
• Chronic cough: Lasts more than eight weeks
• Dry cough: Produces no mucus
• Wet cough: Produces mucus

Symptoms of Cough

• Forceful expulsion of air
• May produce mucus
• Can be accompanied by other symptoms, such as a runny nose, sore throat, fever, or shortness of breath

Diagnosis of Cough

• Physical exam
• Medical history
• Chest X-ray or CT scan in some cases

Treatment of Cough

• Home remedies: Rest, drink plenty of fluids, use a humidifier, and Use over-the-counter cough suppressants or expectorants
• Medications: Antibiotics for bacterial infections, Antihistamines or corticosteroids for allergies, Inhalers for asthma, and Proton pump inhibitors for GERD

When to See a Doctor for Cough

• If the cough lasts for more than three weeks
• If it is accompanied by high fever, difficulty breathing, or chest pain
• If it produces bloody or discolored mucus
• If it is associated with chronic conditions, such as asthma or COPD

Upper Respiratory Infections (URIs)

• Infections that affect the upper respiratory tract, including the nose, sinuses, throat, and larynx

Causes of URIs

• Primarily caused by viruses, such as the common cold virus (rhinovirus) and influenza virus
• Can also be caused by bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae

Symptoms of URIs

• Runny or stuffy nose
• Sore throat
• Cough
• Nasal congestion
• Sneezing
• Headache
• Fatigue
• Fever (in some cases)

Diagnosis of URIs

• Usually diagnosed based on symptoms
• Physical exam and medical history are sufficient in most cases
• A swab of the nose or throat may be taken for laboratory testing to identify the specific virus or bacterium causing the infection

Treatment of URIs

• Most URIs are self-limiting and resolve within 7-10 days
• Treatment typically involves rest, staying hydrated, over-the-counter pain relievers (e.g., ibuprofen, acetaminophen), decongestants (for nasal congestion), and antihistamines (for sneezing and runny nose)
• Antibiotics are used if the infection is bacterial

Prevention of URIs

• Washing hands frequently
• Avoiding contact with sick people
• Getting vaccinated against influenza
• Managing stress levels
• Improving the immune system through a healthy diet and regular exercise

Complications of URIs

• Most cases are mild and resolve without complications
• Can lead to more serious complications, such as sinusitis, tonsillitis, laryngitis, and pneumonia

Respiratory Syncytial Virus (RSV)

• A common, contagious respiratory virus that typically causes mild, cold-like symptoms
• Can be serious, especially in infants and older adults, potentially leading to conditions like bronchiolitis or pneumonia

How RSV Spreads

• Through respiratory droplets (coughing, sneezing) and contact with contaminated surfaces

Symptoms of RSV

• In many cases, RSV causes mild, cold-like symptoms like runny nose, cough, and fever
• In some individuals, especially infants, it can lead to more serious conditions like bronchiolitis (inflammation of the small airways in the lungs) or pneumonia

Who is At Risk from RSV

• RSV can be particularly dangerous for infants, young children, older adults, and people with underlying health conditions

Treatment of RSV

• There's no specific antiviral treatment and most cases resolve on their own within a week or two
• Treatment focuses on supportive care, such as providing fluids and oxygen

RSV Prevention

• Good hygiene practices, like frequent handwashing, can help prevent the spread

RSV Drugs

• Nirsevimab is a long-acting antibody available for infants and vulnerable young children to prevent RSV
• Palivizumab is another long-acting antibody also available for passive prophylaxis of selected pre-term infants
• Vaccination is available for older adults and pregnant women

Seasonal outbreaks of RSV

• RSV typically circulates during the fall and winter months

Influenza

• Cause: Influenza A and B viruses
• Transmission: Airborne respiratory droplets
• Incubation period: 1-4 days
• Seasonality: Peaks in winter months

Common Symptoms of Influenza

• Fever
• Chills
• Muscle aches
• Headache
• Sore throat
• Cough
• Nasal congestion
• Fatigue
• Malaise

Findings History and Physical Exam for Influenzas

• Recent exposure
• Rapid symptom onset
• Physical Exam: Fever, pharyngitis, mild lung exam abnormalities

Influenza Testing

• Rapid Influenza Diagnostic Tests (RIDTs) give results in 15 minutes but can have false negatives
• RT-PCR has high sensitivity, but longer turnaround time, preferred in cases of high clinical suspicion with negative RIDT
• Clinical Diagnosis can be made without testing during peak flu season

Influenza Treatments

• Oseltamivir (Tamiflu): Oral, effective within 48 hours of symptom onset
• Zanamivir (Relenza): Inhaled, alternative for Tamiflu intolerance
• Baloxavir (Xofluza): Single-dose oral medication

Dyspnea Definition

• Dyspnea is a medical term that refers to shortness of breath or difficulty breathing
• It is a subjective symptom that can be described as a feeling of not getting enough air or having to work hard to breathe

Causes of Dyspnea

• Respiratory diseases (e.g., asthma, COPD, pneumonia)
• Heart conditions (e.g., heart failure, heart attack)
• Anemia
• Anxiety disorders
• Pulmonary embolism (blood clot in the lung)
• Certain medications (e.g., beta-blockers)

Symptoms of Dyspnea

• In addition to shortness of breath, other symptoms that may accompany dyspnea include wheezing, coughing, chest pain or tightness, rapid breathing, and fatigue

Diagnosis of Dyspnea

• A doctor will typically perform a physical exam, ask about medical history, and may order tests such as X-rays, CT scans, pulmonary function tests, and electrocardiogram (ECG)

Treatment for Dyspnea

• Treatment depends on the underlying cause
• treatment may include medications (e.g., bronchodilators, corticosteroids, diuretics)
• treatment may include oxygen therapy and surgery (e.g., for lung cancer, pulmonary embolism)
• treatment may include lifestyle changes (e.g., smoking cessation, weight loss)

Prognosis of Dyspnea

• The prognosis depends on the underlying cause
• Some conditions, such as asthma, can be well-managed with treatment
• Others, such as advanced heart failure, may have a poorer prognosis

Community-Acquired Pneumonia (CAP) Diagonsis

• Acute onset of cough, fever, dyspnea, and pleuritic chest pain
• Fatigue, myalgias, or sputum production may also be present

Community-acquired pneumonia (CAP) Physical Exam Findings

• Crackles or rales upon lung auscultation
• Dullness on percussion and decreased breath sounds (consolidation)

Community-acquired pneumonia (CAP) Diagnostic Tests

• Chest X-ray confirms diagnosis and identifies lobar consolidation
• Pulse Oximetry assesses oxygen saturation
• Sputum Culture (if available) identifies causative pathogen
• Consider the possibility in older adults (≥65 years), infants and young children (<2 years)

Community-acquired pneumonia (CAP) Risk factors for Consideration

• Chronic obstructive pulmonary disease (COPD), asthma, or other chronic lung diseases, heart disease (e.g., congestive heart failure)Diabetes mellitus, chronic kidney disease or liver disease
• Immunosuppression, HIV/AIDS, immunosuppressive therapy (e.g., corticosteroids, chemotherapy)Organ transplant recipients
• Lifestyle Factors: Smoking, excessive alcohol use, poor nutrition
• Environmental Exposure: Recent exposure to respiratory pathogens (e.g., influenza), living in crowded settings (e.g., nursing homes, shelters)
• Recent Illness: Recent viral infection (e.g., influenza) that can predispose to bacterial pneumonia, recent hospitalization or antibiotic use
• Functional Status: Impaired airway, difficulty swallowing or impaired gag reflex, leading to aspiration, bedridden or reduced mobility

Community-acquired pneumonia (CAP) Outpatient Treatment

• Amoxicillin: High dose (1g TID) for 5-7 days
• Doxycycline: 100 mg BID for 5-7 days
• Macrolides (e.g., Azithromycin): 500 mg day 1, then 250 mg daily for 4 days
• Use outpatient if there are comorbidities
• Beta-Lactam (e.g., Amoxicillin-Clavulanate) + Macrolide or Doxycycline OR Respiratory Fluoroquinolones (e.g., Levofloxacin 750 mg daily for 5 days)

Evaluating pneumonia severity

• CURB-65 is used to guide decisions about hospitalization for patients with community-acquired pneumonia (CAP)

CURB-65 Criteria

• Confusion (new-onset or worsening)
• Urea level >7 mmol/L (19 mg/dL)
• Respiratory rate ≥30 breaths per minute
• Blood pressure: Systolic <90 mmHg or diastolic ≤60 mmHg
• Age ≥65 years

CURB-65 Scoring

• 0-1 points: Low risk (consider outpatient treatment)
• 2 points: Moderate risk (consider short hospital stay or close outpatient monitoring)
• 3-5 points: High risk (consider hospitalization and possibly ICU care)