Disorders of the Respiratory Tract
CU R R E N T 䉫 C L I N I C A L 䉫 P R A C T I C E
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
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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
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
© 2006 Humana Press Inc.
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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 regu- lations, 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 recom- mended 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.
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Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 eISBN: 1-59745-041-3
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 1-58829-556-7 (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 D6126 2006] I.
Mintz, Matthew L. II. Series.
RC731.D58 2006 616.2--dc22
2005029431
Series Editor‘s Introduction
v
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 devel- oped a sharp eye for the learning needs of physicians practicing primary care. Disor- ders 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 com- mon respiratory illnesses including chronic obstructive pulmonary disease, asthma, allergic rhinitis, and pneumonia, and includes discussion of some less common ill- nesses including sarcoidosis and lung cancer. The chapters in this volume use a case- based 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 under- stand 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
Introduction
vii
I am pleased that you have chosen to read Disorders of the Respiratory Tract: Com- mon Challenges in Primary Care. I am hopeful that this will be a worthwhile experi- ence, 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 writ- ten 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 pro- viders 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 them- selves 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: 1-58829-919-8;
www.humanapress.com).
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.
Matthew L. Mintz, MD
Contents
ix
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 ... 103 Jeremy Spencer and Matthew L. Mintz
10. Pediatric Asthma ... 115 Katrina Dafnis and Matthew L. Mintz
11. Adult Asthma ... 131 Dharti Patel and Matthew L. Mintz
12. Exercise-Induced Bronchospasm ... 147 Khalid Jaboori and Matthew L. Mintz
x Contents 13. Acute Cough ... 159
Karen J. Scheer and Matthew L. Mintz
14. Chronic Cough ... 173 Clara Peck and Matthew L. Mintz
15. Chronic Obstructive Pulmonary Disease ... 189 Anna Person and Matthew L. Mintz
16. Lung Cancer ... 205 Mohammad A. Raza and Matthew L. Mintz
17. Sarcoidosis ... 221 Danielle Davidson and Matthew L. Mintz
18. Pneumonia ... 235 Mohamed Al-Darei and Matthew L. Mintz
19. Bronchiolitis ... 249 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 ... 263 Vikram Bakhru and Matthew L. Mintz
21. Obesity ... 273 Rebecca Chatterjee and Matthew L. Mintz
22. Vocal Cord Dysfunction ... 279 Amy Humfeld and Matthew L. Mintz
23. Pulmonary Embolism ... 289 Eric Wollins and Matthew L. Mintz
24. Hemoptysis ... 307 Samantha McIntosh and Matthew L. Mintz
25. Gastroesophageal Reflux Disease, Cough, and Asthma ... 317 Niral Shah and Matthew L. Mintz
Index ... 325
Contributors
xi
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
