Respiratory Diseases

Confirming the presence of the H1N1 influenza virus in patients with suspected infection is critical to public health efforts to track, study, and contain the disease-and to the ability of clinicians to provide optimal management. Appropriate diagnostic testing is key to this process.

Not all patients in whom infection with the H1N1 influenza virus is suspected or confirmed need to be treated. Many patients with mild disease can forgo pharmacotherapy. In fact, in many cases, it may even be prudent to discourage such patients from coming into their health care provider's office, in the interest of infection control. However, all patients with severe disease and those considered at high risk for complications from seasonal influenza should be offered therapy with antiviral agents.

Before considering the infection control strategies recommended during the current H1N1 influenza pandemic, it is useful to review the transmission characteristics of influenza viruses-including H1N1-that form the basis for these strategies:

The ability to recognize cases of the new H1N1 flu and distinguish these from seasonal influenza and other respiratory illnesses is perhaps the overriding concern of primary care practitioners. Prompt and accurate identification of this entity is the key to both effective management of individual illness and effective public health measures.

On Sept 15, 2009, the FDA approved 4 vaccines against the H1N1 influenza virus. Distribution of the vaccine to about 90,000 sites across the United States will begin in mid October.

When you encounter unexplained seizures or mental status changes in children who have influenza-like illness, send respiratory specimens for diagnostic testing and promptly start empirical antiviral therapy, especially in hospitalized patients.

Reserve antivirals for adults and children over age 1 who have severe novel H1N1 influenza or who are at high risk for complications.

When you encounter unexplained seizures or mental status changes in children who have influenza-like illness, send respiratory specimens for diagnostic testing and promptly start empirical antiviral therapy, especially in hospitalized patients.

Federal health officials stressed the need to start planning now for the fall influenza season when they met with state delegates at the H1N1 Influenza Preparedness Summit. "Over the course of coming weeks and months, we will move aggressively to prepare the nation for the possibility of a more severe outbreak of the H1N1 virus," said Secretary of Health and Human Services Kathleen Sebelius.

Chronic obstructive pulmonary disease (COPD) is recognized as a common condition in older adults, but asthma is often considered something that most patients outgrow long before they retire and qualify for Medicare.

More than 1 million persons in the United States may have been infected with novel H1N1 (swine) influenza virus, according to US health officials. In a recent media briefing, Dr Anne Schuchat, Director of the National Center for Immunization and Respiratory Diseases, CDC, noted that the infection is continuing to spread well past the typical influenza season in the Northern Hemisphere.

The World Health Organization (WHO) today declared the influenza A (H1N1) outbreak to be a pandemic. The agency decided to raise the pandemic alert level from Phase 5 to 6 based on the rising number of cases seen in Australia and Asia.

If Shakespeare were alive, he would urge caution regarding the “Ides of Influenza.” Recent publicity about global influenza, a result of both potential and real avian and swine flu epidemics, has led to a plethora of theories as well as alarm. How can the primary care practitioner answer questions, educate, prepare, and alleviate anxiety?

If Shakespeare were alive, he would urge caution regarding the “Ides of Influenza.” Recent publicity about global influenza, a result of both potential and real avian and swine flu epidemics, has led to a plethora of theories as well as alarm.

For 3 months, a 63-year-old man had experienced progressively worsening dyspnea. He denied fever, weight loss, and hemoptysis. Eight months earlier, he had had a right thoracotomy to drain a right empyema. Comorbidities included morbid obesity, type 2 diabetes mellitus, hypertension, and obstructive sleep apnea. However, he did not have any intrinsic lung disease.

Here we provide a list of questions with links that can help you respond to patients who may be asking you about H1N1 virus infection (swine flu). Topics include travel restrictions and recommendations for persons with chronic disorders.

A 50-year-old woman presents to the emergency department with severe dizziness, weakness, and dyspnea of 1 week’s duration. Ten days earlier, an upper respiratory tract infection (URTI) was diagnosed; over-the-counter cough syrup and acetaminophen were prescribed. However, the patient’s condition has steadily deteriorated since then. In addition, her urine has darkened over the past few days.

A 24-year-old man presented to the emergency department with worsening dyspnea and fever of 1 day’s duration. About 3 years earlier, he had been treated for testicular cancer (leiomyosarcoma) with orchidectomy, chemotherapy, and radiation. He had no significant social or family history. Temperature was 38.6°C (101.4°F); blood pressure, 119/80 mm Hg; heart rate, 121 beats per minute; and respiration rate, 20 breaths per minute. Oxygen saturation measured with pulse oximetry was 98% with a nonrebreather mask and about 80% without a nonrebreather mask. Breath sounds were decreased bilaterally. The abdomen was soft. Extremities were nonedematous. Neurological findings were intact with no focal deficits.

During the evaluation of a 61-year-old man who had sustained mild head and upper trunk injuries in a car accident, a right lower lobe consolidation was noted on the chest radiograph. There was no evidence of rib fracture. A chest CT scan with contrast showed a hilar mass that obstructed the lateral segmental bronchi of the right lower lobe. Atelectasis of the posteromedial segments of the right lower lobe and ipsilateral subcarinal adenopathy were also noted.

For 3 days, a 45-year-old woman with HIV infection who was noncompliant with her antiretroviral medications had cough, yellowish sputum, fever, and dyspnea. She denied hemoptysis, weight loss, or recent hospitalization. She had a long history of heavy smoking and alcohol and intravenous drug abuse.

An 18-year-old woman with a history of allergic rhinitis and moderate persistent asthma presented with right-sided nasal congestion of 6 months’ duration. Her symptoms persisted despite her usual allergy medications, allergen immunotherapy, and 2 courses of antibiotics. A sinus CT scan showed complete opacification of the right maxillary sinus with increased attenuation of the mucin. Allergic fungal rhinosinusitis was suspected, and an otolaryngologist was contacted.

One way to determine whether a patient's asthma is well controlled is to inquire about the frequency of rescue treatments with an albuterol metered-dose inhaler.

Parents of young children know that colds are extremely common, especially from fall until spring. Colds account for a large number of pediatric office visits and telephone calls-particularly during "cold season."

New guidelines for community-acquired pneumonia (CAP) issued jointly by the Infectious Diseases Society of America and the American Thoracic Society emphasize the need for communities to adapt the recommendations to local conditions.

In the vast majority of nonsmokers who are not receiving angiotensin converting-enzyme inhibitors and who have no evidence of active disease on chest radiographs, chronic cough is caused by postnasal drip syndrome (recently renamed upper airway cough syndrome [UACS]), asthma, non-asthmatic eosinophilic bronchitis, or gastroesophageal reflux disease (GERD), alone or in combination.

Given the dramatic advances in antimicrobials since penicillin was introduced, why has the mortality rate associated with community-acquired pneumonia (CAP) remained essentially unchanged?

Take this MedPage Today poll on the accessibility of influenza vaccine.

MINNEAPOLIS -- Influenza vaccination reduces older adults' risk of hospitalization and mortality, researchers affirmed, despite lingering questions.

ROCKVILLE, Md. -- Afluria was approved today by the FDA as the sixth seasonal influenza vaccine on the U.S. market. Manufactured by Australia's CSL Limited, the company will produce about two million doses for this year's flu season.

WASHINGTON -- Influenza vaccination may save many fewer older patients' lives than generally claimed, according to researchers here.