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Disorders of the Respiratory Tract


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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


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.


Bronchial Asthma: A Guide for Practical Understanding

and Treatment, Fifth Edition, edited by M. ERIC GERSHWIN AND


Dermatology Skills for Primary Care: An Illustrated Guide, DANIEL J.


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.


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


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


Matthew L. Mintz, MD

Department of Medicine

The George Washington University School of Medicine Washington, DC


© 2006 Humana Press Inc.

999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 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 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.

This publication is printed on acid-free paper.

ANSI Z39.48-1984 (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.: 973-256-1699; Fax: 973-256-8314; E-mail:

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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



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 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




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,”


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;


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




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




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.





























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