Disorders of the Respiratory Tract

Transcription

1 Disorders of the Respiratory Tract

2 C URRENT C LINICAL P R ACTICE NEIL S. SKOLNIK, MD SERIES EDITOR Disorders of the Respiratory Tract: Common Challenges in Primary Care, MATTHEW L. MINTZ, 2006 The Handbook of Contraception: A Guide for Practical Management, DONNA SHOUPE AND SIRI L. KJOS, 2006 Obstetrics in Family Practice: A Practical Guide, PAUL LYONS, 2006 Psychiatric Disorders in Pregnancy and the Postpartum: Principles and Treatment, VICTORIA HENDRICK, 2006 Sexually Transmitted Diseases: A Practical Guide for Primary Care, edited by ANITA NELSON AND JOANN WOODWARD, 2006 Cardiology in Family Practice: A Practical Guide, STEVEN M. HOLLENBERG AND TRACY WALKER, 2006 Bronchial Asthma: A Guide for Practical Understanding and Treatment, Fifth Edition, edited by M. ERIC GERSHWIN AND TIMOTHY E. ALBERTSON, 2006 Dermatology Skills for Primary Care: An Illustrated Guide, DANIEL J. TROZAK, DAN J. TENNENHOUSE, AND JOHN J. RUSSELL, 2006 Thyroid Disease: A Case-Based and Practical Guide for Primary Care, EMANUEL O. BRAMS, 2005 Type 2 Diabetes, Pre-Diabetes, and the Metabolic Syndrome: The Primary Care Guide to Diagnosis and Management, RONALD A. CODARIO, 2005 Chronic Pain: A Primary Care Guide to Practical Management, DAWN A. MARCUS, 2005 Bone Densitometry in Clinical Practice: Application and Interpretation, Second Edition, SYDNEY LOU BONNICK, 2004 Cancer Screening: A Practical Guide for Physicians, edited by KHALID AZIZ AND GEORGE Y. WU, 2001 Hypertension Medicine, edited by MICHAEL A. WEBER, 2001 Allergic Diseases: Diagnosis and Treatment, Second Edition, edited by PHIL LIEBERMAN AND JOHN A. ANDERSON, 2000

3 Disorders of the Respiratory Tract Common Challenges in Primary Care By Matthew L. Mintz, MD Department of Medicine The George Washington University School of Medicine Washington, DC

4 2006 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All papers, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. This publication is printed on acid-free paper. ANSI Z (American Standards Institute) Permanence of Paper for Printed Library Materials. Cover design by Patricia F. Cleary Production Editor: Amy Thau For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: ; Fax: ; orders@humanapr.com, or visit our Website: Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $30.00 per copy is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [ /06 $30.00]. Printed in the United States of America eisbn: Library of Congress Cataloging in Publication Data Disorders of the respiratory tract : common challenges in primary care / [edited] by Matthew L. Mintz. p. ; cm. -- (Current clinical practice) Includes bibliographical references and index. ISBN (alk. paper) 1. Respiratory organs--diseases. 2. Primary care (Medicine) [DNLM: 1. Respiratory Tract Diseases. 2. Respiratory Physiology. 3. Respiratory System--anatomy & histology. WF 140 D ] I. Mintz, Matthew L. II. Series. RC731.D dc

5 Series Editor s Introduction Disorders of the Respiratory Tract: Common Challenges in Primary Care by Dr. Matthew Mintz provides a well-written, concise overview of respiratory illness that is aimed at the busy primary care physician. Dr. Mintz is director of the ambulatory care rotation for the department of Internal Medicine at George Washington University in Washington, D.C., and through his experience as a clinician and teacher, he has developed a sharp eye for the learning needs of physicians practicing primary care. Disorders of the Respiratory Tract: Common Challenges in Primary Care covers the range of knowledge needed to provide excellent care for patients with respiratory disease from the basics of pulmonary function testing to understanding and caring for common respiratory illnesses including chronic obstructive pulmonary disease, asthma, allergic rhinitis, and pneumonia, and includes discussion of some less common illnesses including sarcoidosis and lung cancer. The chapters in this volume use a casebased approach to clarify the clinical questions that need to be answered, provide clear learning objectives for each topic, and then review the respiratory condition discussed in the chapter, with attention to answering the relevant information that a primary care physician will want to know when taking care of patients. The physicians who read Disorders of the Respiratory Tract: Common Challenges in Primary Care will understand and be able to treat more than 95% of the respiratory illnesses that will present in a busy primary care practice. For this accomplishment, Dr. Mintz deserves our thanks. Neil Skolnik, MD Temple University School of Medicine Philadelphia, PA and Family Medicine Residency Program Abington Memorial Hospital Abington, PA v

6 Introduction I am pleased that you have chosen to read Disorders of the Respiratory Tract: Common Challenges in Primary Care. I am hopeful that this will be a worthwhile experience, and that you will not only use this book to improve your knowledge of respiratory disorders, but will also use it as a reference should patients with respiratory symptoms present to your clinic. Disorders of the Respiratory Tract: Common Challenges in Primary Care was written exclusively for primary care practitioners. Respiratory symptoms are one of the most common presentations to a primary care setting. Although complex respiratory cases can be challenging for the primary care provider, even common diseases such as asthma and allergic rhinitis can prove difficult. What are the best approaches to these common disorders? How and to what degree do you need to work up a patient for a more severe condition? Unfortunately, many of the most up-to-date treatments and guidelines are published in multiple subspecialty journals, to which primary care providers rarely have access. Hopefully, Disorders of the Respiratory Tract: Common Challenges in Primary Care will provide primary care providers with answers to these and many other questions. Disorders of the Respiratory Tract: Common Challenges in Primary Care begins with a section containing the basic approach to a patient with respiratory disorders ( The Basics ), reviews the anatomy and physiology of the respiratory tract, and offers a review of pulmonary function testing. The remainder of the book is divided into three sections: Disorders of the Upper Airway, Disorders of the Lower Airway, and Non-Airway Disorders That Present With Respiratory Symptoms, respectively. Each chapter follows an almost identical format, beginning with a clinical case that a primary care physician would typically see. Next, several key clinical questions that a primary care provider might ask are presented. Prior to the discussion of the topic, the learning objectives of the chapter are reviewed so that readers can orient themselves to the material. The chapter then sequentially reviews the epidemiology of the disease, the pathophysiology, and the diagnosis, differential diagnosis, and treatment of the disorder. Finally, because texts are usually out of date once they are printed, most chapters end with a section on future directions so that the primary care provider can be aware of the most up-to-date advances. Please also keep in mind that this book is available as a personal digital assistant (PDA) product for easy and efficient clinical use. To obtain the PDA, please contact the publisher, Humana Press (ISBN: ; I want to personally thank all of my coauthors who worked so hard to bring the most up-to-date reviews of common topics in respiratory medicine to Disorders of the Respiratory Tract: Common Challenges in Primary Care. vii Matthew L. Mintz, MD

7 Contents Series Editor s Introduction... v Introduction...vii Contributors... xi Part I. The Basics 1. Approach to the Patient With a Respiratory Disorder...3 Nirav Patel and Matthew L. Mintz 2. Anatomy and Physiology of the Respiratory Tract...11 Anna Person and Matthew L. Mintz 3. Pulmonary Function Testing...17 Shyam Parkhie and Matthew L. Mintz Part II. Disorders of the Upper Airway 4. Allergic Rhinitis...31 Holly Bergman Sobota, Trissana Emdadi, and Matthew L. Mintz 5. Non-Allergic Rhinitis...47 Cardin Bell and Matthew L. Mintz 6. Sinusitis...65 Neelam Gor and Matthew L. Mintz 7. Pharyngitis...77 David Jager and Matthew L. Mintz 8. Laryngitis and Hoarseness...89 Matthew Chandler and Matthew L. Mintz Part III. Disorders of the Lower Airway 9. Croup Jeremy Spencer and Matthew L. Mintz 10. Pediatric Asthma Katrina Dafnis and Matthew L. Mintz 11. Adult Asthma Dharti Patel and Matthew L. Mintz 12. Exercise-Induced Bronchospasm Khalid Jaboori and Matthew L. Mintz ix

8 x Contents 13. Acute Cough Karen J. Scheer and Matthew L. Mintz 14. Chronic Cough Clara Peck and Matthew L. Mintz 15. Chronic Obstructive Pulmonary Disease Anna Person and Matthew L. Mintz 16. Lung Cancer Mohammad A. Raza and Matthew L. Mintz 17. Sarcoidosis Danielle Davidson and Matthew L. Mintz 18. Pneumonia Mohamed Al-Darei and Matthew L. Mintz 19. Bronchiolitis Elizabeth A. Valois Asser, Alexander S. Asser, and Matthew L. Mintz Part IV. Non-Airway Disorders That Present With Respiratory Symptoms 20. Obstructive Sleep Apnea Vikram Bakhru and Matthew L. Mintz 21. Obesity Rebecca Chatterjee and Matthew L. Mintz 22. Vocal Cord Dysfunction Amy Humfeld and Matthew L. Mintz 23. Pulmonary Embolism Eric Wollins and Matthew L. Mintz 24. Hemoptysis Samantha McIntosh and Matthew L. Mintz 25. Gastroesophageal Reflux Disease, Cough, and Asthma Niral Shah and Matthew L. Mintz Index

9 Contributors Following is a list of the contributing authors for this volume, all of whom are from The George Washington University School of Medicine in Washington, DC. MOHAMED AL-DAREI ALEXANDER S. ASSER, MD CARDIN BELL VIKRAM BAKHRU, MD MATTHEW CHANDLER, MD REBECCA CHATTERJEE, MD KATRINA DAFNIS, MD DANIELLE DAVIDSON, MD TRISSANA EMDADI, MD NEELAM GOR, MD AMY HUMFELD, MD KHALID JABOORI DAVID JAGER, MD SAMANTHA MCINTOSH, MD MATTHEW L. MINTZ, MD SHYAM PARKHIE, MD DHARTI PATEL, MD NIRAV PATEL, MD CLARA PECK, MD ANNA PERSON, MD MOHAMMAD A. RAZA KAREN J. SCHEER, MD, RSM NIRAL SHAH, MD HOLLY BERGMAN SOBOTA, MD JEREMY SPENCER, MD ELIZABETH A. VALOIS ASSER, MD ERIC WOLLINS, MD xi