Transcript Pharmaceutical guidelines of patients with pathology of breathing

Pharmaceutical
guidelines of patients
with pathology of
breathing organs.
Symptomatic treatment
of
THROAT PAIN
PHISIOLOGY of the THROAT
Breathing
 Swallowing
 Separating
(channelization)
 Speech
(articulation)
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INFLAMMATORY DISORDERS OF
THE PHARYNX
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Inflammatory disorders of the pharynx most
commonly present as throat or neck pain.
Disphagia, odynophagia, and airway obstruction
are other frequent complaints. The pharynx is a
dynamic conduit for inspired air and ingested
matter, responsible for diverting each into the
trachea or esophagus, respectively. This process
may be impaired by anything which obstructs or
restricts the mobility of the pharynx.
EVALUATION
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Key historical considerations
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Age of patient
Onset and duration
History of recent trauma (including possible foreign body)
Inflammatory symptoms - fever, pain, malaise, malodorous
breath
Status of nasal airway: congestion, obstruction, rhinorrhea,
purulent discharge, allergic history, snoring
Reflux symptoms such as heartburn or water brash
Associated ear pain
Disphagia or odynophagia
Dyspnea or stridor
Other associated symptoms
Recent exposure to infectious discharge
Cancer risk factors: smoking history
Acute Viral or Bacterial Pharyngitis
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Pharyngitis is caused by a variety of
microorganisms. Most cases are viral and include
the virus causing the common cold, flu (influenza
virus), adenovirus, mononucleosis, HIV among
various others. Bacterial causes include Group A
streptococcus which causes strep throat (15% of
cases), in addition to Corynebacterium,
Arcanobacterium, Neisseria gonorrhoeae,
Chlamydia pneumoniae and others. In up to 30%
of cases, no organism is identified.
Strep throat
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Strep often produces
white patches in the
throat and on the tonsils,
as well as red, swollen
tonsils. Pus may be seen
in the back of the throat.
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Strep throat may cause
the lymph nodes in the
neck to become swollen
and tender.
Acute Viral or Bacterial Pharyngitis
(cont’d)
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Most cases of pharyngitis occur during the
colder months -- during respiratory disease
season. Spread among household members is
common. The medical importance of
recognizing strep throat as a cause of
pharyngitis stems from the need to prevent its
complications which can include acute
rheumatic fever, kidney dysfunction and
severe disease such as bacteremia and rarely
streptococcal toxic shock syndrome.
Pharyngitis. Symptoms
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sore throat
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additional symptoms are dependent on the underlying
microorganisms
step throat may be accompanied by fever, headache, swollen
lymph nodes in the neck
viral pharyngitis may be associated with runny nose
(rhinorrhea) and postnasal discharge
severe cases of pharyngitis may be accompanied by difficulty
swallowing and rarely difficulty breathing
Signs and tests. A physical exam with attention to the
pharynx to assess whether drainage/coating (exudates) are
present, as well as skin, eyes, neck lymph nodes is frequently
done.
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Oropharyngoscopy
•Swollen,
erythematous
mucosa of the
oropharynx and
hypopharynx,
often with edema
of the uvula and
soft palate.
•Swollen cyanotic
lymphatic follicles
on the posterior
wall
•Mucous or
purulent
discharges on the
posterior wall
Complications
complications of strep throat:
 rheumatic fever,
 glomerulonephritis (kidney inflammation),
 chorea,
 bacteremia (bloodstream infection) and rarely
streptococcal shock syndrome
 in some severe forms of pharyngitis (e.g., severe
mononucleosis-pharyngitis)
 airway obstruction may occur
 peritonsillar abscess, retropharyngeal abscess
A sore throat caused by a cold virus usually resolves
in one to two weeks without treatment. On the
other hand, a sore throat caused by the
streptococcus bacterium (strep throat) should be
treated with antibiotics to prevent damage to the
heart valves (phenoxymethylpenicillin 500 mg four times a day
or cefaclor 250 mg three times daily). Generally,
streptococcus bacteria cause a more severe sore
throat and a higher fever than viral sore throats.
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In some cases, strep may cause
nausea, a lack of appetite,
or pain in the head and abdomen.
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A less common sign of strep infection is a rash
that appears on the neck and chest, eventually
spreading to the rest of the body. When this
rough, sandpaper-like rash develops, the
infection is known as scarlet fever. Although the
full body rash may be alarming, it will start to
fade after a few days
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Sneezing, runny nose, and cough more
frequently accompany sore throats due to a
cold virus, rather than streptococcus
infections. Sometimes, a throat culture is
necessary to establish the cause of the sore
throat.
Antibiotic treatment may
lessen symptoms
and duration of illness
and decrease
the chance for complications
Acute Tonsillitis
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The most common organism is beta hemolytic
streptococcus, but viral organisms can also cause
exudative tonsillitis. Other causative organisms
include staphylococcus aureus, streptococcus
viridans, and various hemophilus species.
General Symptoms
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Rapid onset of throat pain with pain on
swallowing associated with
Fever, often 38°-39° C
Malaise
fatigue
Chill
Pain in extremities, muscles and joints
Catharal and Follicular Tonsilitis
•The tonsils are
red, enlarged and
painfulness
with an exudate or
studded with white
follicles.
•Tender, firm
cervical
adenopathy is
often present
Tonsillar hypertrophy
Treatment
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Taking antibiotics
unnecessarily can
contribute to the
growing problem of
microbial resistance.
When bacteria are
frequently exposed to
antibiotics, they may
become "superbugs" that
can't be treated with
standard medications.
Treatment
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Since fever and painful
swallowing can lead to
dehydration, it's
important to increase
intake of fluids to
combat it. Water and
ginger ale are good
choices. A patient should
avoid citrus drinks which
can irritate an inflamed
throat.
Treatment
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Medications that are available OTC for the
temporary relief of sore throat due to the
common cold usually contain anesthetics
such as benzocaine and dyclonine or
menthol and come in the form of
lozenges,
gargles,
sprays.
Treatment
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Pain Relievers
Over-the-counter pain
relievers, like
acetaminophen,
ibuprofen, or naproxen,
can temporarily dull the
pain of a sore throat.
(Do not give aspirin to
children and teenagers
because of the risk of
the rare but potentially
fatal Reye's syndrome.)
Use a decongestant
Decongestants make breathing easier by
shrinking swollen mucous membranes in the
nose, allowing air to pass through. They also
help relieve a runny nose and postnasal drip,
which can cause a sore throat.
 Decongestants can be taken orally or used as
decongestant nasal sprays. Oral decongestants
(pills) are probably more effective and provide
longer relief but may cause more side effects.
 These medicines may not be safe for young
children or for people who have certain health
problems.
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Threatning symptoms
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Any sore throat that has a rapid onset and is
associated with a fever or tenderness of the front
of the neck may be serious and should be seen
by a health care professional.
Any sore throat that causes a patient to have
difficulty swallowing (not just pain with
swallowing) or breathing should be seen by a
health care professional.
Any sore throat that lasts for more than a week
should be evaluated by a health care
professional.
Persistent Sore Throat
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If a sore throat lasts over a week or gets
worse, this is the indication for doctor visiting,
even if an initial strep test came back negative. A
persistent sore throat could be a sign of acid
reflux, mononucleosis, or another condition. In
rare cases, a sexually transmitted disease may be
to blame (pharyngeal gonorrhea).
Noninfectious sore throat
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Not all sore throats are caused by infection. Postnasal
drip can irritate the throat and make it sore. It can be
caused by hay fever and other allergies that irritate the
sinuses. Environmental and other conditions, such as
heavy smoking or breathing secondhand smoke, heavy
alcohol consumption, breathing polluted air or
chemical fumes, or swallowing substances that burn or
scratch the throat can also cause pharyngitis. Dry air,
like that in airplanes or from forced hot air furnaces,
can make the throat sore. People who breathe through
their mouths at night because of nasal congestion often
get sore throats that improve as the day progresses.
Sore throat caused by environmental conditions is not
contagious.