Chronic Bronchitis Holistic Treatment

Dealing With Bronchitis

Dealing With Bronchitis

If you're wanting to know more about dealing with bronchitis... Then this may be the most important letter you'll ever read! You are About To Read The Most Important Information That Is Available To You Today, You Will Achieve A Better Understanding About Bronchitis! It doesn't matter if you've never had bronchitis before or never known anyone who has, This guide will tell you everything you need to know, without spending too much brainpower!

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Relieve Your Bronchitis Cure

When you begin to take the specific natural ingredients outlined in the program you will be amazed at how you will really begin to feel the Phlegm and Mucus clear up nearly immediately! Within minutes of the first step you will feel the natural ingredients in action, targeting the specific root cause of the bronchitis. These ingredients will come in direct contact with the bacteria causing your infection, and get rid of them quickly. You will discover all the secrets I have come across while I was researching how to get rid of my own Bronchitis, and how you will not only get rid of your bronchitis, but actually prevent it from ever coming back again!

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High Altitude Pharyngitis and Bronchitis

Most unacclimatized persons exercising at altitudes over 2500 m develop a dry, hacking cough. With exposure to extreme altitudes for prolonged periods of time, a purulent bronchitis and a painful pharyngitis become nearly universal. These problems may not be of an infectious nature high volumes of dry, cold air through the lungs may induce respiratory heat loss and cause purulent secretions on that basis alone. Bronchospasm may also be triggered by respiratory heat loss. Severe coughing spasms can result in cough fracture of the ribs.

Chronic Bronchitis

Definition and etiology Chronic bronchitis is defined by the presence of chronic bronchial secretions sufficient to cause expectoration occurring on most days for a minimum of 3 months for 2 consecutive years. It became recognized as a distinct disease in the late 1950s associated with the great British Smog. It develops in response to long-term irritants on the bronchial mucosa. Important irritants include cigarette smoke, dust, smoke, and fumes other causes include respiratory infection, particularly in infancy, and exposure to dampness, sudden changes in temperature, and fog. In the United Kingdom, it affects 10 of older people, and it is more common in industrial countries. Chronic bronchitis is a slowly progressive disorder unless the precipitating factors are avoided and it is treated.

Chapter References

Curr Opin Pulm Med 1 177, 1995. 4. MacKay DN Treatment of acute bronchitis in adults without underlying lung disease. J Gen Intern Med 11 557, 1996. 6. Grossman RF Guidelines for the treatment of acute exacerbations of chronic bronchitis. Chest 112(suppl) 310S, 1997. 7. Hueston WJ A comparison of albuterol and erythromycin for the treatment of acute bronchitis. J Fam Pract 33 476, 1991. 8. Hueston WJ Albuterol delivered by metered-dose inhaler to treat acute bronchitis. J Fam Pract 39 437, 1994.

Pulletgrowing Program

Given to past disease exposure in the pullet-growing house, diseases present in the region to which the pullets will be moved, and whether the pullets are being moved to a multi-age complex that has a higher degree of disease exposure (such as to Mycoplasma gallisepticum (Mg), Salmonella enteritidis (Se), variant infectious bronchitis (IB) strains, etc.). Professional advice from a competent poultry veterinarian with knowledge of the disease exposure situation, vaccines available, proper timing of vaccinations, and appropriate routes of administration should be sought. An example of a vaccination program used for pullets going to a complex with high risk of exposure to infectious laryngotracheitis (ILT), Mg, Se, fowl pox, and variant IB is given in Table 1. Vaccine company representatives and consulting veterinarians should be involved to assist the persons vaccinating the flocks with proper techniques and to review these procedures on a routine basis.

Physical Examination

Infants should be undressed completely to enable a full assessment. Vital signs are important to evaluate. For instance, tachypnea may be a clue to lower respiratory tract infection. Crying and the ease of consolability should be evaluated. Inconsolable crying, or increased irritability when handled, is frequently seen in infants with meningitis. Although fullness of the anterior fontanelle may be noted in some of these infants, other signs of meningeal irritation, such as nuchal rigidity, are most often absent. A head-to-toe evaluation should be carried out to determine whether there is a focus of infection, such as an inflamed eardrum or evidence of cellulitis.

Clinical Features And Diagnosis

A history of underlying lung disease provides important clues to the underlying cause of hemoptysis. An abrupt onset of cough with bloody purulent sputum, with or without fever, may indicate acute pneumonia or bronchitis. A chronic productive cough may reflect chronic bronchitis or bronchiectasis. Although typically seen with tuberculosis, fevers, night sweats, and weight loss may represent other infections. Anorexia, weight loss, and change in cough may reflect bronchogenic carcinoma. While some tumors present with new-onset cough and hemoptysis, 80 percent of neoplastically caused hemoptysis had duration of greater than 1 week. Smoking, male gender, and age over 40 are the predominant risk factors for neoplasm. Alveolar hemorrhage syndromes from vasculitis present with dyspnea and mild hemoptysis associated with renal disease and hematuria. As noted earlier, hemoptysis is an insensitive marker for pulmonary embolism and the symptom of hemoptysis is usually overshadowed by anxiety,...

Chronic Compensated COPD

Despite the pathophysiologic segregation of chronic airflow obstruction into categories of pulmonary emphysema, chronic bronchitis, and bronchiectasis, none of these exist as a pure entity in clinical medicine. Most patients demonstrate a mixture of symptoms and signs. The hallmark symptom is exertional dyspnea. Chronic, productive cough is common, and minor hemoptysis is frequent, especially in chronic bronchitis and bronchiectasis.

High Altitude Syndromes

High altitude syndromes of primary concern are those attributed directly to the hypoxia acute hypoxia acute mountain sickness pulmonary edema cerebral edema retinopathy peripheral edema sleeping problems and a group of neurologic syndromes. The other syndromes, not necessarily related to hypoxia, include thromboembolic events (which may be attributable to dehydration, prolonged incapacitation, polycythemia, and cold), high altitude pharyngitis and bronchitis, and ultraviolet keratitis. Although the different hypoxic clinical syndromes overlap, all share a fundamental mechanism, all are seen in the same setting of rapid ascent in unacclimatized persons, and all respond to the same essential therapy descent and oxygen.

Clinical Features

The symptoms and signs may be completely nonspecific, especially with myocardial abscesses. Patients usually experience vague fevers and chills but may present with more obvious sepsis. Frequently patients are given antibiotics on an outpatient basis for some presumed bacterial infection, such as bronchitis. Patients may be suspected of having valvular endocarditis and may be admitted to the hospital for intravenous antibiotics, and yet the correct diagnosis is not made and symptoms recur after discharge. Many symptoms, including positive blood culture results, peripheral embolization, and splenomegaly, are found in both valvular and nonvalvular infections of the heart. Frequently patients have sudden fatal complications, such as myocardial rupture, tamponade, or severe peripheral embolization, diagnoses made only at autopsy.

Alternative types of exercise yoga

Two investigators have measured some aspects of dyspnea in their study of yoga exercise training. Tandon117 studied 11 males with COPD who received training in yoga breathing exercises and postures. A yoga teacher taught breathing exercises, using both abdominal and thoracic muscles and 10 yoga postures. A matched group received physiotherapy, including exercises for respiratory muscles, diaphragmatic breathing, and lower extremity exercises. Treatments for both groups were one hour three times a week for four weeks with decreasing sessions over nine months. More yoga subjects compared to the physiotherapy group stated that they had 'easier control' of their dyspnea attacks. More recently, Behera118 studied a group of 15 males with chronic bronchitis who practiced eight body postures and five breathing exercises in the laboratory 30 minutes daily for one week and then continued in the home for three weeks with weekly reinforcement. There were significant reductions in dyspnea...

Respiratory infections

These are divided into two anatomically separate categories. First, there are those of the upper respiratory tract, which extends from the nose to the vocal cords. These include the common cold (coryza), sinusitis, pharyngitis, laryngitis and epiglottitis. Secondly, there are infections of the lower respiratory tract. These may affect the large airways (bronchitis), the alveoli and parenchyma (pneumonia) or the pleura space, leading to an empyema. The source of infection is variable. Droplet inhalation is the most frequent although pathogens may be introduced to the lung by alternative routes, such as the aspiration of pharyngeal contents as seen in neurological conditions leading to bulbar palsy and defective swallowing, hematogenous spread as in miliary tuberculosis or staphylococcal septicemia, and direct extension from surrounding tissues. In patients with comorbid illness, impaired host responses or damaged respiratory tract, organisms normally regarded as nonvirulent can become...

Immune responses of the host

Clinically, the importance of the immune system is illustrated during its impaired function secondary to disease. Thus patients with generalized abnormalities of immunoglobulin production such as asplenic states, agammaglobulinemia, and myeloma are prone to recurrent bacterial sepsis. This particularly involves encapsulated microorganisms such as Streptococcus pneumoniae and some strains of Haemophilus influenzae, leading to repeated sinusitis, pneumonia and bronchiectasis. IgA deficiency may be asymptomatic although there can be an increase in upper and lower respiratory infections. Neutropenia increases the risk of many infections, especially those by gram-negative enteric baccilli (GNEB), such as Escherichia coli and Pseudomonas aeruginosa. An impaired T helper cell response, as associated with human immunodeficiency virus (HIV) infection, results in a greater frequency of opportunistic infections such as Pneumocystis carinii, a protozoan that

Complications of Thyroid Surgery

The general problems that occur with thyroidectomy are related to the underlying thyroid disease, the patient's associated medical condition and to the general anesthetic rather than to the procedure itself. These non procedure related problems are all relatively rare and occur in less than 1-2 of patients in large reported series of thyroidectomy. Of the cardiac complications, arrhythmias are the most common and occur in patients with hyperthyroidism or underlying cardiac disease. Pulmonary problems are surprisingly infrequent considering the amount of airway manipulation that is done during thyroidectomy. Atelectasis, bronchitis or pneumonia occur in less than 1 of patients. Urinary tract problems are extremely unusual. Postoperative nausea and or vomiting can occur in as many as 10-15 of patients but is not due to ileus or other gastrointestinal dysfunction. This troublesome problem is anesthesia related and can be substantially lessened by modern antiemetic prophylaxis.

Can Low Po2 Cause Brain Damage

Anesthetists have long known that short periods of hypoxia, unaccompanied by significant hypotension or cardiac arrest, are innocuous. But additional documentation that hypoxia does not cause brain damage comes from the arena of bronchopulmonary and ventilatory diseases, including asthma, anaphylaxis, occlusive bronchitis and bronchiolitis, pneumonia, croup, and epiglottidis. One of the most amazing well-documented cases was that of a two-and-a-half-year-old boy, who had a respiratory arrest due to bronchitis. Rapid clinical action led to tracheotomy and removal of pus with forceps - pus which had formed virtual casts of the bronchi. Although the boy remained in a coma for 14-16 days, subsequent recovery was without neurologic impairment, including school performance (Sadove et al. 1961). Another paper on pure hypoxia (Gray and Horner 1970) presents a collection of profoundly hypoxic patients without vascular disease, with arterial pO2 levels under 20 mmHg and ranging to a low of 8...

Direct Inguinal Hernia

High intra-abdominal pressure may arise due to extra-abdominal or intraabdominal pathology. Extra-abdominal pathology that results in elevated intra-abdominal pressure generally is comprised of mechanical diseases of the lungs and or pleura.8 Obstructive lung diseases, either due to excessively high lung compliance (emphysema) or elevated airways resistance (chronic bronchitis), necessitate the development of high pleural pressures during expiration in an attempt to maintain adequate expiratory airflow rates. Since the thorax and abdomen are effectively a single cavity separated by the diaphragm, contraction of the abdominal wall muscles can aid in the development of positive intrathoracic pressure. This can result in concentration of stresses at points of pre-existing structural weakness in the abdominal wall. In those patients with emphysematous characteristics, elevated lung volumes and the inferior steady-state displacement of the diaphragm confine minimally compressible abdominal...

Vitamin A as an immune enhancer

Vitamin A, in the form of liver oils, has been used to treat various infections since antiquity. Clinical trials conducted in the 1930s showed that cod-liver oil therapy reduced mortality in children with measles and reduced morbidity in women with puerperal sepsis (the infectious complications of delivery and postpartum period). In the last decade, clinical trials have shown that periodic, high-dose vitamin A supplementation can reduce child mortality in developing countries by 20-50 . Vitamin A supplementation reduces morbidity and mortality primarily by reducing the severity of diarrheal disease but seems to have little effect upon acute lower respiratory infections. Vitamin A supplementation is now standard therapy for infants and children with acute measles. Many developing countries have adopted periodic vitamin A supplementation to reduce morbidity and mortality in preschool children. The use of vitamin A for disease-targeted therapy, i.e. HIV infection, diarrheal disease, and...

Ethical Issues in Ecogenetics

Although ecogenetics is still in its infancy as a scientific field, a number of important ethical considerations can be anticipated and should be addressed before genetic tests are used to screen individuals or populations for inherited susceptibilities to chemical or environmental agents. For example, long before the development of molecular genetics, J.B.S. Haldane suggested in Heredity and Politics (1938) that it might be reasonable to exclude persons who are susceptible to potter's bronchitis (a common problem among British potters at the time) from work in that occupation. Since workplace exclusion, stigmatization, and discrimination can result from knowledge of genetic risk factors for disease, studies of gene-environment interactions raise a number of ethical and social issues of great importance.

Common Symptomatic Lung Sounds

Signal Lung Sound Vesicular

The high-pitched whistling music type of sounds heard over large airways as well as over the chest are called wheezes. Fig. 7.4 shows a typical wheezing sound in the time and time-frequency domain. Wheezes can be caused by airway narrowing and the increased secretions. Wheezes are usually heard in congestive heart failure, asthma, pneumonia, chronic bronchitis and emphysema, bronchiectasis.

Chronic Obstructive Pulmonary Disease

Chronic bronchitis and emphysema are different pathologically but frequently co-exist as chronic obstructive pulmonary disease. A patient's condition may fall anywhere in a spectrum from solely chronic bronchitis to solely emphysema, with the majority of patients possessing symptoms and signs of both. The main feature of both diseases is generalised airflow obstruction. Chronic bronchitis is defined as daily cough with sputum production for at least three consecutive months a year for at least two consecutive years. It develops as a result of long standing irritation of the bronchial mucosa nearly always by tobacco smoke. The disease is more common in middle and later life, in smokers than in non smokers and in urban than in rural dwellers. Pathologically there is hypertrophy of mucus secreting glands and mucosal oedema, leading to irreversible airflow obstruction. Air becomes trapped' in the alveoli on expiration causing alveolar distension which may result in associated emphysema....

Effects on Particular Organs or Organ Systems

The mucociliary escalator is responsible for removing many of the particles trapped in the bronchial tubes, including infectious microorganisms. However, some toxic substances, notably tobacco smoke, paralyze it for 20 to 40 minutes. Mucus stagnates, but the irritation actually increases mucus secretion. These effects can partially or totally block smaller bronchi and exposes the habitual smoker to the possible indirect effects of lower respiratory tract infections and chronic bronchitis (inflammation of the bronchi). The inhaled irritants described above can have a similar effect.

Respiratory Zoonotic Infections

Respiratory zoonotic infections can be divided into two distinct syndromes of upper respiratory infections (pharyngitis) and lower respiratory infections (pneumonia). Recurrent culture-proven streptococcal pharyngitis in a household member can have a zoonotic source often the household pet. 34 For complete eradication of this form of streptococcal pharyngitis from a family, the family pet, in addition to family members, may require a course of antistreptococcal antimicrobial therapy. Prolonged exudative pharyngitis raises the suspicion of a zoonotic origin or atypical pharyngitis, particularly if the exudative pharyngitis includes systemic symptoms and leukocytosis, and is refractory to standard antistreptococcal therapy. In this case, it is pertinent to inquire about animal exposure. Dogs and domesticated farm animals can be the source of Streptococcus sp., Corynebacterium ulcerans, Yersinia sp., and viral vesicular stomatitis. All of these zoonoses can present as an exudative...

Airway Defense Mechanisms

Top is moved up and out of the airways. Diseases such as cystic fibrosis and chronic bronchitis can affect mucous secretion. Second, alveolar macrophages provide an additional mechanism for removing particles deposited deeper in the lungs, where the blood-gas barrier must be very thin for gas exchange. Macrophages originate in the bone marrow and circulate in the blood as monocytes before settling in the respiratory zone of the lungs, where the epithelium is not ciliated. They roam the airway surfaces by ameboid action and engulf foreign particles by phagocytosis. Most foreign substances are destroyed by lysozymes inside the macrophage. However, carbon and mineral particles may be stored in residual bodies in the macrophage, which then settles in the interstitium. The effects of mineral dusts are especially insidious, leading to a progressive destruction of lung tissue, and even lung cancer in the case of asbestosis. Normal macrophages that do not settle in the interstitium leave the...

Mycoplasma Infections

Mycoplasma pneumoniae infections are a common cause of pneumonia, upper respiratory infections, and bronchitis in children between 5 and 19 years of age. The most frequent presenting clinical findings in children and adults are fever, cough, sore throat, malaise, headache, chills, and rash. An erythematous maculopapular rash, the most frequent presentation, is located on the trunk and may be discrete or confluent. However, the most frequently reported exanthem is consistent with erythema multiforme and Stevens-Johnson syndrome, with lesions occurring primarily on the trunk, legs, and arms. The rash occurs most commonly during the febrile period. An enanthem of generalized ulcerative stomatitis or pharyngitis-tonsillitis associated with the exanthem is common. The diagnosis can be confirmed by the use of either serum cold agglutinins or several specific antibody tests.

Table 3D 1 Risk factors for pneumonia

Smoking, alcohol, COPD, cystic fibrosis, chronic bronchitis, viral infections Acute illness and antibiotic use AIDS*, diabetes, transplant, steroid use, asplenia, sickle cell disease, uremia, neoplasia, chemotherapy, extremes of age, complement deficiency Indwelling catheters, intrathoracic devices American southwest (Valley Fever), Ohio MississippiValleys (histoplasmosis, blastomycosis), Southeast Asia (tuberculosis), pigeon droppings (psittacosis), bovinesources (Q fever), buildings with contaminated water supply Dormitory, prison, barracks, nursing home

Clinical Note continued

Chronic obstructive pulmonary disease (COPD) is a general term for patients with emphysema (see Chapter 19) and chronic bronchitis. Va Q heterogeneity is the main cause of hypoxemia in this disease too, but at least two different patterns of Va Q distributions are seen that correlate roughly with the arterial PCO2. Some COPD patients maintain PaCO2 in the normal range by increasing total ventilation in the face of Va Q mismatching as described in the text. Other COPD patients hypoventilate, so their Pao2 is low and Paco2 is elevated (suggesting a problem with ventilatory control see Chapter 22). The COPD patients with normal Paco2 tend to have less chronic bronchitis and high Va Q regions in their lungs, consistent with emphysema destroying part of the alveolar capillary bed. In contrast, COPD patients with elevated PaCO2 typically have advanced chronic bronchitis and low Va Q regions in the lungs, consistent with increased airway resistance in the inflamed airways.

Confounding Effects of Infection on Laboratory Assessment

For vitamin A, severe systemic infections (e.g., pneumonia, bronchitis, diarrhoea, septicaemia, rheumatic and scarlet fever, malaria, and measles) cause a marked decrease in serum retinol level. This decrease may be due to various factors (e.g., increased retinol excretion in urine and reduced liver release of retinol and RBP to plasma). A reduction of vitamin A liver reserves assessed by the RDR test has been observed in children with chickenpox.

Chronic Obstructive Pulmonary Disease COPD

The generation of oxygen free radicals by activated inflammatory cells produces many of the pathophys-iological changes associated with COPD. Common examples of COPD are asthma and bronchitis, each of which affects large numbers of children and adults. Antioxidant nutrients have therefore been suggested to play a role in the prevention and treatment of these conditions. A number of studies have demonstrated a beneficial effect of fruit and vegetable intake on lung function. For example, regular consumption of fresh fruit rich in vitamin C (citrus fruits and kiwi) has been found to have a beneficial effect on reducing wheezing and coughs in children. Vitamin C is the major antioxidant present in extracellular fluid lining the lung, and intake in the general population has been inversely correlated with the incidence of asthma, bronchitis, and wheezing and with pulmonary problems. Although some trials have shown high-dose supplementation (1-2g day) to improve symptoms of asthma in Other...

Tobacco a risk factor for coronary heart disease

The evidence from these two studies on the disease-specific risks associated with smoking are similar.8 Current smokers have about a 20-fold higher death rate from lung cancer than never smokers, among whom lung cancer death rates have remained low and constant. There is epidemio-logic evidence to suggest that this is also the case in other populations. For example, based on the two American Cancer Society studies with follow up to 1959-65 and 1982-86 respectively, lung cancer death rates among lifelong non-smokers were remarkably constant at 15-4 and 14-7 per 100000 (age-standardized) for men, and 9-6 and 12-0 for women the rates for current smokers were 187-1 and 341-3 for men, and 26-1 and 154-6 for women.9 Smokers also incur a 10-20-fold excess mortality from chronic obstructive lung disease (primarily chronic bronchitis and emphysema), and a risk of death from major vascular diseases that is about twice that of non-smokers.

Pulmonary Disease

An accurate preoperative prediction of pulmonary risk associated with abdominal surgery is not well-defined. Clinical factors that have been shown to be useful in the prediction of postoperative pulmonary complications include a history of smoking, chronic bronchitis, airflow obstructions, obesity, and prolonged preoperative hospital stay. The presence of colonizing bacteria in the stomach and the use of nasogastric intubation increase the specific risk of postoperative pneumonia. Smaller incisions and the use of laparoscopic techniques reduce the incidence of pulmonary complications due to decreased postoperative pain and early ambulation. The most important predictive factors appear to be the overall condition of the patient (based on the ASA classification) and patient age. Patients with controlled cough or wheeze and asthma well controlled on inhalers belong to ASA Class 2, and those with breathlessness on minor exertion, and poorly controlled asthma that limits lifestyle are...

Pathology

Vaccines effective against other diseases of chicks exist Newcastle disease (caused by an influenza-like virus), fowl pox and cholera, infectious bronchitis, avian encephalomyelitis, egg drop syndrome and coccidiosis, which is caused by a gut parasite. There is considerable interest in defining coccidial antigens which render birds immune after a single coccidial infection, since the current attenuated vaccine needs more care in storage and delivery than would a sub-unit-based vaccine. T cell clones with specificity for coccidial antigens have been cloned and in some cases shown to have helper activity in vitro. Defining the mechanisms of resistance to this and other avian diseases is currently an important task.

Specific Issues

Inflammation of large and small airways, bronchial wall distortion, and bullae formation are pulmonary changes affecting patients who have COPD. The lower respiratory tract, which is ordinarily sterile in healthy nonsmokers, in COPD becomes colonized with potentially pathogenic bacteria, and it is assumed that these organisms may cause pneumonia. The risk factors for gram-negative colonization in COPD include advanced age, serious underlying illness, cigarette smoking, recent antibiotic use, endotracheal intubation, malnutrition, viral tracheobronchitis, corticosteroid use, prolonged hospitalization, and advanced pulmonary disease. Patients with stable chronic bronchitis are predominantly colonized with S. pneumoniae and nontypeable H. influenzae. Although pneumococcal pneumonia occurs more commonly in COPD than in other outpatient groups, its relative frequency appears to be declining. The incidence of pseudomonal pneumonia is low, but certain therapies such as frequent use of...

Late Complications

OBLITERATIVE BRONCHIOLITIS The most frequent cause of death after the second posttransplant year is obliterative bronchiolitis (OB), characterized by chronic allograft dysfunction and airflow limitation. Current evidence suggests that chronic rejection plays the most important role in the development of OB, but other factors such as CMV infection, toxic fume inhalation, and chronic foreign-body exposure caused by abnormal mucociliary clearance may contribute as well. Diagnostically, the yield from bronchoscopy and biopsy is low. Therefore, diagnosis rests on clinical criteria (i.e., > 20 percent fall in FEV without any other identifiable cause). Since the large airways become bronchiectatic as the small airways are obliterated, episodes of bacterial bronchitis are common. Typically the chest radiograph is clear of infiltrates. Current treatment is augmentation of immunosuppression and high-dose steroids. The prevalence of OB syndrome in long-term survivors is 20 to 50 percent. The...

Summary

The treatment of a broad range of complaints. The salutary effects of breathing retraining can be found in the treatment of noncardiac chest pain, as an adjunctive procedure in stress management programs and cardiac rehabilitation programs, and in the reduction of intensity of symptoms of chronic lung disease (asthma, bronchitis, and emphysema).

History

It can be helpful in establishing a diagnosis to inquire as to when dyspnea occurs and in which position.3 Orthopnea, difficulty breathing while lying flat, is very common with symptomatic congestive heart failure, mitral valvular disease and superior vena cava syndrome, but rare in people with emphysema, severe asthma, chronic bronchitis and neurological diseases. Platypnea, difficulty breathing while sitting up and relieved by lying flat, is rare but occurs status post-pneumonectomy, cirrhosis, hypovolemia and with some neurological diseases. Trepopnea, when patients are more comfortable breathing while lying on one side, occurs in people with congestive heart failure or with a large pleural effusion.3 Studies have shown that patients universally respond to breathlessness by decreasing their activity to whatever degree necessary. It is therefore helpful to ask about shortness of breath in relation to activities such as 'walking at the same speed as someone of your age', 'stopping to...

Pneumococcus

As a result of these considerations, it is not unexpected that individuals who have impaired capacity to produce immunoglobulin are especially susceptible to pneumococcal pneumonia. Included are those with congenital or acquired hypogammaglobulinemia, acquired immune deficiency syndrome, multiple myeloma, lymphoma, chronic renal insufficiency or chronic liver disease. Probably the greatest increase in pneumococcal pneumonia is seen in persons infected with the human immunodeficiency virus. Pneumococcal pneumonia occurs with greatly increased incidence in individuals who have preexisting bronchopulmonary disease, either acute such as influenza, or chronic such as bronchitis or emphysema, because local factors that might allow clearance of inhaled pneumococci are not operating normally. Individuals who lack a normal spleen are at risk of overwhelming sepsis once pneumococcal infection occurs.

Clavulanic Acid

The combination with amoxycillin (co-amoxiclav) has been particularly successful. Pharmacokinetically the combination closely mimics that of amoxycillin alone. In addition to the side effects of amoxycillin, there is a small risk of cholestatic jaundice. Co-amoxiclav is used in the treatment of soft tissue infections, surgical prophylaxis, lower respiratory infections and urinary tract infections.

Tracheostomy Tubes

Tracheoinnominate Fistula Imaging

All indwelling tracheostomy tubes are contaminated with normal and sometimes pathogenic flora. Stomal skin infection, tracheitis, and bronchitis can be a recurring problem.6 Staphylococcus aureus, Pseudomonas, and Candida are often identified.6 Broad-spectrum antibiotics are indicated in the setting of clinical disease.

Demographics

Although small, round metal objects typically do not cause tissue reactions, this is not the case with vegetable matter. Aspirated vegetable matter commonly causes an intense pneumonitis and subsequent pneumonia and or suppurative bronchitis. Aspirated vegetable matter is commonly difficult to remove if not found early, as it swells with the absorption of moisture from the surrounding lung and, if left long enough, may even sprout.

Infections

There are possible epidemiologic associations between diabetes and urinary tract infections, candidal vulvovaginits, cystitis, and balanitis, pneumonia, influenza, chronic bronchitis, bacteremia, primary and reactivation tuberculosis, mucormycosis, malignant otitis externa, lower extremity skin and soft tissue structure infections, surgical wound infections, and Fournier gangrene. 23 However, only a few of these conditions have been shown to be more frequent in diabetics than in a nondiabetic control group in controlled studies.

Monitoring

Serology testing on a routine basis is used to determine the effectiveness of vaccinations at the point-of-lay, to determine exposure for diseases not included in the vaccination program (avian influenza or Mg in an Mg-negative unit), and to follow changes in titers during lay for such diseases as Mg in a positive unit, Newcastle disease (ND), and infectious bronchitis (IB). cND IB Newcastle Infectious bronchitis. mND IB SE Newcastle Infectious bronchitis Salmonella enteritidis. nIM Intramuscularly. cND IB Newcastle Infectious bronchitis. mND IB SE Newcastle Infectious bronchitis Salmonella enteritidis. nIM Intramuscularly.