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When will you consider trial of treatment, Discontinue medication,…
When will you consider trial of treatment
COPD
Purulent sputum
Spirometry is diagnostic : :
Asthma
Shortness of breath, wheezing, chest tightness,
Spirometry/ Bronchial challenge
Treatment: Inhaled bronchodilator, inhaled high dose corticosteroid, leukotriene receptor antagonist Montelucat, resolution in 1-2 weeks, if refractory or severe follow 5-10 day course of Prednisone 40-60 mg or equiv : oral corticosteroid
Decongestant with antihistamine, intranasal corticosteroid, saline nasal rinses, nasal anticholinergics. Improvement in days to weeks to 2 months. If chronic rhinosinusitis suspected flexible nasolaryngoscopy or sinus CT
Non-asthmatic Eosinophilic bronchitis:
Treatment: Inhaled corticosteroid, eliminate occupational/ inhaled allergens
Aitflow obstruction, normal response on methacholine test, : sputum eosinophilia
GERD:/larygopharyngeal reflux disease:
Proton pump inhibitors, for 8 weeks,lifestyle/ dietary changes, weight loss, histamine H2 receptor antagonist and/ or Backofen (Lioresal 20 mg/ day)
Heartburn, regurgitation, sour taste, hoarseness, Globus sensation
UACS
ACE I
)
Malignancy : HRCT , biopsy, refer
Suppurative Pneumonia, X-ray, antibiotics
Discontinue medication
Tuberculosis low grade fever, hemoptysis, loss of weight, sputum culture/ AFB, biopsy 9 month course
Treatment: Inhaled bronchodilator, inhaled corticosteroids, inhaled anticholinergic & 1-2 week course oral corticosteroids with or W/o antibiotics
References: Evaluation of patient with chronic cough JOSEPH J. BENICH III, MD, and PETER J. CAREK, MD, MS, Medical University of South Carolina, Charleston, South Carolina American Family Physician, Volume 84, Number 8, October 15, 2011
UACS: : Rhinorrhoea, nasal stuffiness, , sneezing , itching, post nasal drainage. Absence of s/s does not rule out diagnosis. Signs: swollen turbinates, direct visualisation of post nasal drip, cobblestoning of posterior pharynx.
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Submitted by Asiya Shahab on account of Group 4