Disorders of the Respiratory Tract: Common Challenges in Primary Care

335 Pages·2006·2.24 MB·English

by  Nirav Patel

Disorders of the Respiratory Tract
(cid:2) (cid:2)
C C P
U R R E N T L I N I C A L R A C T I C E
N S. S , • S E
EIL KOLNIK MD ERIES DITOR
Disorders of the Respiratory Tract: Common Challenges in Primary
Care, MATTHEW L. MINTZ, 2006
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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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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
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
v
Introduction
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
vii
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........................................................................................................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
ix
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
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