As I write this foreword, I am finishing isolation from a mild COVID-19 infection. Over the past 3 years, we have seen the significant impact respiratory symptoms can have on individuals and systems. Most of us have had at least one infection, all of us have treated many patients with COVID-19, and too many have lost friends or family. We have experienced changes in practice in the form of telehealth, staffing challenges, and difficult infection control strategies. We have been affected by the destructive polarization that occurs when science and health issues are exploited for political gain. Although no current discussion of respiratory symptoms would be complete without some mention of COVID-19, this FP Essentials focuses on the many other important respiratory conditions that family physicians manage.
In a 2018 study of the top reasons patients seek primary care, respiratory issues comprised 20% (eg, upper respiratory tract infection, cough) in high-resource countries and 40% (eg, upper respiratory tract infection, pneumonia, tuberculosis, bronchitis) in lower-resource countries.1 Although many respiratory symptoms are self-limited, such symptoms can be the initial presentation of a life-threatening disease.
Evaluation and management of respiratory conditions can be quite expensive for the patient. Although cost of care can be high, sometimes the cost of not seeking and receiving treatment can be even higher in terms of lost productivity, decreased quality of life, and premature mortality. In the United States, the direct and indirect costs of asthma and chronic obstructive pulmonary disease alone are more than $100 billion a year.2
This FP Essentials reviews the evaluation and treatment of respiratory symptoms, including chronic cough, wheezing, dyspnea, and hemoptysis. The information here will prepare you to take a cost-effective and evidence-based approach to the care of the patients with respiratory symptoms you will see in the office next week.
Ryan D. Kauffman, MD, FAAFP, CCFP, Associate Medical Editor
Family Medicine and Urgent Care Physician
TMC Urgent Care, Kingsville, Ontario, Canada