Respiratory

diseases for GPs

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1) Asthma :
--bronchodilators :
1- short acting 2 agonists : e.g. salbutamol, terbutaline
Action 3-5 hrs , used mainly for acute attacks , not effective in
longterm control of ashma
R/ salbovent syrup/tab/amp
R/ farcolin syrup/tab/amp + nebulizer solu.
R/ ventolin becotide inhalers
2- long acting 2 agonists : e.g. salmeterol, formeterol
Action 12 hrs , used mainly for night time asthma , not used in acute
attacks
R/ foradil diskus
3- steroids :
R/ flixotide diskus 50/100/150
R/ beclo spray
**salmeterol + budesonide ( long 2 + cortisone) R/ serotide diskus
4- aminophylline : 20mg/kg/d
R/ etaphylline 100-500 supp/ 120 syrup / 500 tab / 300-500 amp
R/ quibron-t sr 500 tab
R/ minophylline
as etaphylline
--Asthma in adults :
Sympt. : cough, dyspnea, wheezes, in recurrent attacks more at night and
early morning
Signs : none if not in attack
Bil. Diffuse wheezes mainly expiratory
Acute severe attack : tachypnea, tachycardia, unable to complete
asentence, working accessory muscles of respiration


Life threatening signs : bradycardia, hypotention, central cyanosis, silent
chest
Management :
1- Ttt of chronic asthma :
--no smoking, light diet, small frequent meals, wt reduction if obese,
avoidance of allergens


)
)
--Drugs :
) 1- mild intermittent: (1 drug)R/ ventolin inhaler
)
4-3 2- regular preventive therapy :(1 drug) R/ beclo spray
3- add-on therapy :(2-3 drugs) foradil + miflonide +/- etaphylline 500 supp
4- poor control :(4 drugs) foradil + miflonide + etaphylline or quibron +
montekal 10 tab

1-
R/ ventolin inhaler
)cm farcolin + 2cm saline )Or R/ farcolin nebulizer 1
2 2-
R/ quibron-t sr tab
+ R/ etaphylline 500 supp
3 + R/ allvent syrup
4-3 3-
R/ foradil diskus + miflonide diskus
Or R/ serotide diskus
+ R/ etaphylline 500 supp
+ R/ montekal 10 tab
**
asthma **
If asthmatic bronchitis add proper AB e.g. R/larivex 500 tab
Or R/ cefotax 1gm vial

+ mucolytic e.g. R/ muco tab
Or R/ farcosolvin syrup 3
+ paracetamol e.g. R/ cetal 500 tab 1*2 or
1*3
2- Ttt of acute attack of asthma :
-/+ Acute mild attack :
+ solucortef vial IM + Acute moderate attack :
Acute severe attack : saline of ringer + solucortef or dexa amp +
minophylline 500 amp + avil vial +
2) Pneumonia :
Diagnosis : high fever 38.5, FAHM , cough, purulent sputum,+/- chest pain
on breathing stops on stopping breathing (pleurisy) .
Decreased air entry on affected side, crackles +/- consolidation signs

Chest XR pneumonia
Management : according to CURB-65 classification
C : confusion
U : 24 hrs urinary urea 7 mol/dl ( 126 gm/dl ) n.= 120 gm/dl
R : RR 30 breathe/min.
B : BP 90/60
65 : age 65 years
--each letter resembles number so we have 5 numbers
0/1/2 ttt at home
4/5 hospitalization
3 according to your estimation ( in Egypt always refer to hospital )
--ttt at home :
1- complete rest in bed , stop smoking, drink plenty of fluids especially warm
2- AB : 3rd g cephalosporins then strong broad spectrum
3- analgesics antipyretics : amp is the best
4- cough medic : if productive cough give mucolytic expectorant
If dry cough give antitussive
5- if BP low give IV fluids
6- F/U within 48 hrs and reestimation
e.g.
R/ ringer 500 ml solu + cefotax 1gm vial + declophen amp
R/ glucose 5% 500ml + cefotax + declophen
Then R/ hibiotic 1gm tab
R/ olfen amp 12
R/ allvent syrup 2 3
Other effective Abs : clarithro, klacid, augmentin, emoxclave, larivex,
gemique


((acute bronchitis))
diagnosis: dry irritating cough more at night+ low or no fever + bone aches
allover the body



general ex : you may see red eyes cause of cough nothing more
chest sounds normal no wheezes or crepitations
may be ribs pain due to cough
ttt
the best AB for bronchitis is azithromycin + antiinflammatory +
bronchodilator and cough med.
ex:

 R/ azrolid 500 tab

R/ olfen amp 4
2 3 R/ allvent syrup
ex 2 :
R/ zisrocin 500 tab 1*1*3
R/ dolphin-k supp 1*2
R/ allvent syrup 2*3
:
azithromycin
allvent
6-5 -

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