October 2000 • Post-Assembly Edition • Dallas
Experts examine common respiratory problems, solutions
BY DENNIS CONNAUGHTON
You deal with respiratory problems almost every day in your practice. Some of the most common ones came under scrutiny in a course at this year's Assembly.
Asthma
"I hope that by the time you leave today, I can convince you that nebulizers are an obsolete way of treating children with asthma," said Leslie Hendeles, Pharm.D., professor of pharmacy and pediatrics at the University of Florida in Gainesville.
He recommended, instead, the use of albuterol delivered through a valved holding chamber device. "You can get the same clinical effect using a spacer with albuterol that you get with a conventional nebulizer system," Hendeles maintained.
When using albuterol, be sure to select an albuterol nebulizer product that does not contain a bronchoconstricting preservative, such as benzalkonium, he advised. Using levalbuterol, an active stereo-isomer of albuterol, for acute asthma in children is no more effective but much more costly than using albuterol, he said.
Otitis media and sinusitis
Rick Ricer, M.D., professor and predoctoral director of family practice at the University of Cincinnati, described the latest treatment options for otitis media and sinusitis. "Otitis media and sinusitis are very similar disease processes," Ricer said. "Many of the same things trigger each response. The bacterial causes are identical, and the antibiotics used are the same."
He said the first-line drug therapy for both conditions is amoxicillin -- 80 to 90 mg per kilogram per day for acute otitis media, except in very low-risk patients, and 40 to 90 mg per kilogram per day for sinusitis.
"Nebulizers are an obsolete way of treating children with asthma." Up to 80 percent of acute otitis media cases may resolve spontaneously, Ricer said. Nonetheless, he recommended the use of antibiotics, saying they shorten the course of the illness, decrease otalgia, speed perforation healing and decrease the incidence of subsequent mastoiditis.
Not all cases of acute sinusitis need antibiotic therapy, Ricer said, but all cases need some type of drainage with decongestants or other options. Decreased use of antibiotics for colds masquerading as acute sinusitis may help thwart the problem of drug resistance, he contended.
Sore throat
For patients with pharyngitis, physicians should do a rapid strep test, said Louis Kuritzky, M.D., clinical assistant professor of family medicine at the University of Florida in Gainesville. If the test is positive, treat the patient with penicillin for 10 days or with similar antibiotics, such as erythromycin.
If the strep test is negative, consider false-negative streptococcal infection or other infections, such as those caused by Chlamydia, Mycoplasma, non-group A Streptococcus or Clostridium hemolyticum. Also ask the patient about his or her sexual practices because sexually transmitted diseases can cause a sore throat, Kuritzky said.
Community-acquired pneumonia
For community-acquired pneumonia, Kuritzky recommended outpatient care for patients at low risk of mortality, based on a risk stratification scale developed by the Pneumonia Observation Results Team. High-risk patients require traditional inpatient care.
AECB
Patients with acute exacerbation of chronic bronchitis should be managed with maximum bronchodilator therapy and postural drainage, Kuritzky said. Do not give them cough suppressants or sedatives, and advise them to stop smoking. Antibiotic treatment may have a small but beneficial effect.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
FP Report | Headlines |AAFP Home | Search