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Archive for the ‘Bronchitis’ Category

There are many misperceptions about the appropriate use of antibiotics for the treatment of upper-respiratory infections.

As we come to the end of another year and find ourselves in the midst of the cold and flu season, I want to talk about the diagnosis and treatment of the common upper-respiratory infections. These infections include sinus infections (sinusitis), sore throats (pharyngitis), ear infections (otitis) and coughs (bronchitis).

These are the most common illnesses seen in my practice in urgent care, as well as in most acute-care practices. We physicians are constantly receiving information from current medical literature indicating that almost all of these infections are caused by viruses, which are completely unaffected by the use of antibiotics. These viral infections will usually improve with time. The big question here is how much time.

At what point does the simple viral infection become a secondary bacterial infection that can be cured with an antibiotic? That is the critical issue, and one that I’m sorry to say is difficult to determine.

We physicians have various means to confidently diagnosis such problems as appendicitis, heart attacks, ulcer disease, diabetes and others. But we have no easy, fast, or accurate method of determining at what point in time the upper-respiratory infection changes from a viral infection to a bacterial infection.

I want to say emphatically that antibiotics will not shorten the duration of an upper-respiratory infection.

Why not just give an antibiotic and hope for the best?

Simply put, antibiotics can cause problems from annoying to life-threatening allergic reactions, diarrhea and yeast infections. Just recently, overuse of antibiotics has been linked to obesity by Dr. Martin Blaser, a professor of microbiology at New York University Langone Medical Center. Antibiotics are also very costly and drive up the cost of health care when prescribed needlessly.

The most important issue is that the inappropriate use of antibiotics causes the development of “super germs” that resist treatment by almost all antibiotics. Unfortunately, unlike in past years, very few new antibiotics are being developed. The situation worries me.

What I would ask of patients with symptoms of the abovementioned respiratory illnesses is to give as much time as possible for the illness to run its course. If you have a fever or increasing pain, if you feel so sick that you can’t perform your usual routine or if you develop any other symptom that worries you, an immediate trip to your physician is justified.

Once you decide to see your doctor, you should expect the doctor to listen to your explanation of symptoms, examine you, give you a diagnosis and offer an estimate as to when you should feel better. Then let him or her advise you of the proper treatment to help you feel better.

When it comes to the common upper-respiratory infection, let us do for you what will ultimately help you, in the safest and best way, feel better.

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Acute bronchitis, an infection causing inflammations of the lung’s airways, is one of the most common of human ailments.

It usually begins with head cold symptoms, such as a runny nose, sinus congestion or a sore throat. It is almost always caused by a virus and rarely by bacteria. If a cough is not caused by pneumonia, influenza or asthma, it is most likely a symptom of bronchitis.

Most people actually feel fairly well with bronchitis, except for having a persistent cough. Fever is rare with bronchitis, and mucus production may or may not be present.

A very common misperception is that colored mucus, especially green, indicates a bacterial infection and therefore the need for antibiotics. Recent scientific evidence overwhelmingly supports that virus infections also produce green mucus, and viruses are treated not with antibiotics, but rather by one’s own immune system.

Those who smoke are much more susceptible to bronchitis, because of the damage done by the smoke to the lining of the breathing tubes; therefore, germs can enter the lungs more easily, causing an infection.

Many patients request antibiotics in hopes of quickly ridding themselves of the cough and therefore visit their doctor as soon as symptoms begin so that they may “nip it in the bud.” Some think that antibiotics helped them on previous occasions, but there is no proven benefit for these drugs in the treatment of bronchitis. Inappropriate antibiotic use can cause unnecessary side effects, increase the cost of medical care and lead to the development of resistant germs.

Treatment for bronchitis should be directed toward relieving the symptoms.

For the head cold symptoms that go with bronchitis, Tylenol (acetaminophen) or Advil (ibuprofen) can be used for the relief of aches and pains. An oral decongestant pill, such as Sudafed (pseudoephrine), as well as a decongestant nasal spray, such as Afrin (oxymetazoline hydrochloride), can be used to combat nasal and sinus congestion. Afrin spray is usually very effective, but it should not be used for more than a week to avoid rebound (worsening) congestion.

Drinking plenty of liquids has proven to be very effective to keep the mucus loose. For cough symptoms, over-the-counter cough medicines with dextromethorphan, such as Robitussin DM or Vicks 44, may be helpful.

If one ends up at the doctor’s office, a prescription cough medication may be prescribed. A cough suppressant, especially if taken at bedtime, will not interfere with the healing process. Also, for a cough associated with wheezing, a doctor may prescribe a brief course of an inhaled medication commonly used for asthmatics.

In summary:

**Bronchitis is caused by a virus, and antibiotics are almost never necessary

**The cough of bronchitis often lasts 10 to 20 days.

**For aches and pains, Tylenol or Advil

**For nasal or sinus congestion, Sudafed or Afrin nasal spray

**For cough relief, Robitussin DM or Vicks 44

See your doctor if you have any significant worries regarding your symptoms, but especially if your cough is associated with a fever of greater than 38 degrees Celsius or 100½ degrees Fahrenheit, or if you have chest pain or trouble breathing.

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Doctors are seeing an increased number of patients with symptoms of respiratory infections such as common colds, bronchitis, sinusitis, ear infections and sore throats. I would like to review some important points regarding these common infections, along with their recommended treatments.

Everyone has, at one time or another, experienced a common cold that carried symptoms such as nasal and sinus congestion, a runny nose, a mild sore throat and cough. This common infection may last from a few days to one to two weeks. It is always caused by a virus — therefore patience, not antibiotics, is the main treatment.

Bronchitis can be thought of as any cough that is not caused by pneumonia or asthma. The main symptom of bronchitis is a cough without a fever. People with bronchitis usually just have a cough and do not feel particularly sick and are able to continue their normal daily activities. One can expect coughing from bronchitis to last from one to three weeks.

Again, this is a viral infection, and antibiotics are not necessary. If a cough lasts more than several weeks or is associated with fever, it would be wise to visit your doctor.

Sinusitis is an infection of the sinuses, which are air-filled pockets around the nose in the skull. This infection is usually preceded by a common cold. It, too, is usually caused by a virus, but after lingering for one to two weeks can turn into a bacterial infection.

One of the key factors in determining the proper treatment for a sinus infection is the duration of the symptoms. If you’ve had a cold for one to two weeks and are experiencing pain or pressure in your sinuses along with yellow or green nasal mucus and perhaps a fever, then antibiotics may be helpful.

A sore throat is often a symptom of a cold, but can sometimes be a bacterial strep throat infection. A good rule of thumb is that if a sore throat is associated with a bad head cold, and especially with a cough, it is usually caused by a virus and needs no prescribed treatment.

If, however, one has a sore throat without cold symptoms or cough but with a fever and a past history of strep infections, then the most likely culprit is the strep germ, which needs to be treated with antibiotics. Strep is much more common in children than in adults. Many people go through life without a single strep infection.

Over-the-counter medications for adults can be helpful in alleviating the miserable symptoms of respiratory infections. The following are the basic ingredients of all the myriad combinations of cold and flu drugs found on pharmacy shelves:

  • Acetaminophen (Tylenol) or ibuprofen (Advil) may be used to reduce fever and to ease aches and pains.
  • Pseudoephridine (Sudafed) is a decongestant to help relieve nasal and ear congestion.
  • Guaifenesin (Robitussin or Mucinex) is an expectorant to help loosen mucus. (Dinking lots of liquids may work just as well.)
  • Dextromethorphan is a cough suppressant, which might help ease a persistent cough.
  • One may purchase a sinus rinsing system called Neil Med, which can be found at all pharmacies. This is a natural treatment using a salt-based solution to flush out the sinuses, helping clear out mucus. I have found this to be one of the very best treatments for bad colds and sinus infections.

See your doctor if you have a fever for more than three or four days, or if your fever is 103 degrees Fahrenheit or higher. Your doctor will determine whether antibiotics are necessary to treat you. At the very least, your doctor may prescribe medication that will help treat your symptoms and make you feel more comfortable.

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Acute bronchitis is an infection causing inflammations of the lungs’ airways and is one of the most common of human ailments. It usually begins with head-cold symptoms — a runny nose, sinus congestion or a sore throat.

Bronchitis is almost always caused by a virus but is also (rarely) caused by bacteria. If a cough is not caused by pneumonia, influenza or asthma, it is most likely a symptom of bronchitis. Most people actually feel fairly well with bronchitis, except for having a persistent cough. Fever is rare with bronchitis and mucus production may or may not be present.

A very common misperception is that colored mucus, especially green, indicates a bacterial infection and therefore the need for antibiotics. Recent scientific evidence overwhelmingly indicates that viruses also produce green mucus. Viruses are not treated with antibiotics, but rather by one’s own immune system.

Those who smoke are much more susceptible to bronchitis because of the damage done by the smoke to the lining of the breathing tubes; germs can therefore enter the lungs more easily, causing an infection.

Many patients request antibiotics in hopes of quickly ridding themselves of the cough. They visit their doctor as soon as symptoms begin so that they may “nip it in the bud.” Some think that antibiotics helped them on previous occasions, but there is no proven benefit for these drugs in the treatment of bronchitis.

Inappropriate antibiotic use can cause unnecessary side effects, increase the cost of medical care and lead to the development of resistant germs, such as the resistant staph germ I wrote about last month.

Treatment for bronchitis is directed toward relieving its symptoms.

For the head cold symptoms that come with bronchitis, Tylenol (acetaminophen) or Advil (ibuprofen) can be used for the relief of aches and pains. An oral decongestant pill such as Sudafed (pseudoephrine) as well as a decongestant nasal spray, such as Afrin (oxymetazoline hydrochloride,) can be used to combat nasal and sinus congestion. Afrin spray is usually very effective but should not be used for more than one week to avoid rebound (worsening) congestion.

Drinking plenty of liquids has proven to be just as effective as an expectorant medication to keep the mucus loose. For cough symptoms, over the counter cough medicines with dextromethorphan, such as Robitussin DM or Vicks 44, may be helpful.

If one ends up at the doctor’s office, a prescription cough medication may be given. A cough suppressant, especially if taken at bedtime, will not interfere with the healing process. Also, for a persistent bothersome cough of one to two weeks duration, a doctor may prescribe a brief course of an inhaled medication commonly used for asthmatics.

In summary:

  • Bronchitis is caused by a virus and antibiotics are almost never necessary.
  • The cough caused by bronchitis often lasts 10 to 20 days.
  • For aches and pains, take Tylenol or Advil.
  • For nasal or sinus congestion, take Sudafed or Afrin nasal spray.
  • For cough relief, take Robitussin DM or Vicks 44.

See your doctor if you have concerns regarding your symptoms, but especially if your cough is associated with a fever of greater than 38 degrees C or 100.5 F, or if you have chest pain or trouble breathing.

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