IPP: Respiratory Flashcards
(39 cards)
What is the common cold?
The common cold is a mild, self-limiting, viral, upper respiratory tract infection characterized by nasal stuffiness and discharge, sneezing, sore throat and cough. No known treatment improves time course of infection.
What is the most common cause of the cold?
Rhinovirus
How is the cold transmitted?
Either by direct contact or aerosol transmission.
People can remain infectious for several weeks
Symptoms of the cold
How long do symptoms last?
Symptom onset is sudden and peaks at 2-3 days, thereafter symptoms decreasing in intensity. Symptoms tend to last for a week (10-14 days in children) but can persist for up to 3 weeks.
Common symptoms:
- Sore throat
- Nasal congestion and discharge (rhinorrhea) – discharge becomes thicker and darker as infection proceeds
- Sneezing
- Cough
- Hoarse voice
- General malaise
Less common symptoms: fever, headache, myalgia, loss of taste and smell, eye irritability and a feeling of pressure in ears or sinuses
Management for the cold
- Reassure that although symptoms distressing, the common cold is self-limiting and complications rare.
- Symptom relief and rest most important
- Adequate fluid intake
- Healthy food recommended
- Antibiotics and antihistamines ineffective and may cause adverse effects
- Paracetamol or ibuprofen as required (if <5 only if fever and distressed)
- OTC can be used to relieve symptoms
- Arrange follow-up appointment if symptoms worsen or persist
See
Differentiating between the cold, flu, covid, hayfever and asthma
What are causes of sore throats?
Most commonly caused by viral and occasionally bacterial infections:
- Cold
- Influenza
- Streptocococcal infection
- Infectious mononucleosis
Non-infectious are uncommon: physical irritation from acid reflux, hay fever or smoking.
less common causes include HIV, gonococcal pharyngitis, and diphtheria
How long do symptoms typically last for?
Sore throat due to a viral or bacterial cause is a self-limiting condition. Symptoms resolve within 3 days in 40% of people, and within 1 week in 85% of people, irrespective of whether or not the sore throat is due to a streptococcal infection.
The symptoms of infectious mononucleosis usually resolve within 1–2 weeks although mild cases may resolve within days. However, lethargy continues for some time afterwards and in rare cases may continue for months or years.
Who do throat infections typically occur in?
Acute throat infections most commonly occur in people aged 5–24 years
Management of sore throat
Lifestyle Advice:
- Gargle warm salty water
- Plenty rest
- Eat cold or soft foods
- Suck on ice cubes/lollies
- Avoid smoking
- Regular paracetamol of ibuprofen to relieve pain and fever
- Adequate fluid intake to avoid dehydration
Additional management:
- Prescribe AB if appropriate:
- FeverPAIN Centor clinical predication scores
Arrange specialist assessment for people with recurrent tonsillitis (More than 3 episodes in one year, 5 per year for 2 years or 3 per year for 3 years). May want tonsillectomy.
Admit patient immediately if breathing difficulties, clinical dehydration or immediate life-threating condition. Refer patient if suspected life-threatening condition but not immediate.
What is allergic rhinitis?
Allergic rhinitis is an IgE-mediated inflammatory disorder of the nose which occurs when the nasal mucosa becomes exposed and sensitized to allergens. It is characterized by rhinorrhea, nasal congestion, sneezing & itching.
What are the classifications of Allergic rhinitis?
It is important obtain an accurate history as may not be seasonal but perennial. Allergic rhinitis is classed according to:
- Seasonal: symptoms occur same time every year. If caused by grass and tree pollen allergens it is aka as hay fever.*
- Perennial: Symptoms occur throughout the year. Typically due to allergens from house dust mites and animal dander.*
- Persistent: Symptoms occur more than 4 days a week and more than 4 consecutive weeks.
- Occupational: symptoms due to allergens at work e.g. flour and baker.
Complications of allergic rhinitis?
Impaired work performance, disturbed sleep, reduced concentration, possible asthma development, sinusitis and nasal polyps
Diagnosis of allergic rhinitis
Suspected if classic symptoms after exposure to known allergen and/or possible associated allergic conjunctivitis, asthma or eczema.
Assessment of a person with suspected allergic rhinitis should include:
- The type, frequency, persistence, and location of symptoms.
- The severity and impact of symptoms.
- Housing conditions, pets, and occupation.
- Any drugs that may cause or aggravate symptoms.
- Any family history of atopy.
- Examination for signs and underlying causes of rhinitis, and/or associated conditions.
Management of allergic rhinitis
Initial management:
- Support and information sources
- Possible use of nasal irrigation with saline
- Allergen avoidance techniques
- As required intranasal antihistamine or non-sedating oral AH or intranasal chromone
- Regular intranasal CCS during periods of allergen exposure for moderate-severe persistent symptoms or if initial treatment ineffective.
- Arrange review 2-4 weeks if symptoms persist as management may need stepped up.
Management of refractory allergic rhinitis:
Possible add-on treatments, such as an intranasal decongestant, intranasal anticholinergic, combination intranasal antihistamine and corticosteroid, or leukotriene receptor antagonist, depending on the nature of symptoms, the person’s age, and personal preferences.
A short course of oral corticosteroid for severe, uncontrolled symptoms that are significantly affecting quality of life.
Referral to an allergy or ear, nose, and throat specialist should be arranged if:
- There are red flag features suggesting an alternative or serious diagnosis.
- There are persistent symptoms despite optimal management in primary care.
- Allergen avoidance techniques such as house dust mite or animal dander avoidance are being considered, as allergy testing may be needed.
- The diagnosis is uncertain, as allergy testing may be needed.
What is Croup?
Croup is a viral condition that can present in children from ages of 3 months to 6 years. Although most common in the second year of life.
What are symptoms of croup?
Characterized by the sudden onset of a seal-like barking cough usually accompanied by stridor (predominantly inspiratory), hoarse voice and respiratory distress due to upper-airway obstruction.
Symptoms worsen at night and there may be a fever.
There is often a preceding 12-48 hour history of a non-specific cough, rhinorrhea and fever.
What symptoms are present in:
A) mild
B) Moderate
C) Severe
Croup?
Some symptoms presented under ‘coup’. The symptoms can be divided into the following:
Mild: seal-like barking cough with no stridor or sternal/intercostal recession at rest.
Moderate: seal-like barking cough with stridor and sternal recession at rest; no agitation or lethargy.
Severe: seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
What are symptoms of an imending respiratory failure?
Symptoms of impending respiratory failure include increasing upper airway obstruction, sternal/intercostal recession, asynchronous chest wall and abdominal movement, fatigue, pallor or cyanosis, decreased level of consciousness. The degree of chest wall recession may diminish with the onset of respiratory failure as the child tires.
When should a child be admitted with croup?
A child should be immediately admitted when presenting with moderate or severe croup, or impending respiratory failure.
What is the management for croup?
All states of croup are treated with single oral dose of dexamethasone (0.15mg/kg). If child too unwell either inhaled budesonide (2mg nebulized as single dose) or IM dexamethasone (0.6mg/kg as single dose) are possible alternatives.
Croup is usually self-limiting and symptoms resolve in 48hr. If being managed from home paracetamol or ibuprofen can be used for fever & pain. If any deterioration seek urgent medical advice.
Mild croup can typically be managed from home
Mild croup can usually be managed form home. When should a parent think about admitting their child?
Mild croup can usually be managed at home. However, reasons for admission include: chronic lung disease, congenital heart disease, neuromuscular disorders, immunodeficiency, age under three months, inadequate fluid intake, factors that might affect a carer’s ability to look after a child with croup, and longer distance to healthcare, in case of deterioration.
What is influenza?
How can this be distiguished from the cold?
Influenza(flu) is a viral infection that produces respiratory symptoms which are accompanied by systemic symptoms e.g. malaise, myalgia, fever. These systemic symptoms do not normally occur with just a common cold and therefore their presence is a good way of discriminating between the common cold and influenza.
How is diagnosis of influenza made?
Diagnosis can only be confirmed by lab testing – but suspected if influenza circulating and person has high fever.
Rapid influenza testing should be done for patients with complicated influenza (start antiviral treatment immediately) and testing should also be done if a patient develops symptoms despite prophylaxis or persistent infection while on antiviral treatment to identify potential antiviral resistance.
