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COLDS. The COMMON Cold #1 REASON for visits to physicians, #3 for internists 27 million physician visits per year 23 million days of work missed Average.

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Presentation on theme: "COLDS. The COMMON Cold #1 REASON for visits to physicians, #3 for internists 27 million physician visits per year 23 million days of work missed Average."— Presentation transcript:

1 COLDS

2 The COMMON Cold #1 REASON for visits to physicians, #3 for internists 27 million physician visits per year 23 million days of work missed Average adult has 2-4 colds per year $3 billion spent per year on OTC remedies

3 Epidemiology September through May Spread by hand-to-hand contact and aerosols

4 Microbiology _____________________________________ Virus % of cases Rhinovirus30-40 Coronavirus10-15 RSV Influenza Parainfluenza Adenovirus Unkown25-40

5 Pathogenesis ICAM Rhinosinusitis Histology of Nasal Epithelium is Normal Increased vascular permeability and secretions Components of Snot Role of PMNs, Histamine, Kinins, IL

6 Approach to the common cold ____________________________________ ____________________________________ H & P Diagnosis - consider complications, flu allergy, strep Ascertain Expectations Reassure (but don’t minimize) Express sympathy Educate Offer symptomatic relief

7 H & P SymptomFrequency Day Nasal 45 to 75% Discharge Sneezing Obstruction Pharyngeal 35 to 50% Sore Throat Scratch Throat Cough 40 to 80% Hoarse 15 to 30% Constitutional Feverish Myalgia Headache

8 Consider Complications Bronchitis Sinusitis Otitis Media Pneumonia Bronchospasm

9 THE TRUE BLUE FLU Epidemiology Usually peaks in January or later 20,000 deaths in a typical epidemic season 110,000 hospitalizations 10%-20% of population infected during typical season When flu epidemic in region, high percentage of those with ILI have flu

10 THE TRUE BLUE FLU Clinical Presentation Classic Flu - sudden onset prostration, high fever, nasal stuffiness, sore throat, myalgia, cough and headache Study Flu - usually fever + 2 symptoms Illness resolves over four to five days Cough, fatigue, malaise can linger 2-3 weeks Complications - bacterial tracheobronchitis, sinsusitis, pneumonia

11 DIAGNOSIS OF INFLUENZA Are there pathognomonic symptoms? Proportion of patients with symptom Symptom Fever (> 37.8) Feverishness Cough Nasal congestion Weakness Loss of Appetite Sore Throat Headache Myalgia With flu Without flu

12 DIAGNOSIS OF INFLUENZA Are there pathognomonic symptoms? USE OF A CASE DEFINITION AS A DIAGNOSTIC TOOL 100 patients with a flu-like illness: T > 37.8 plus 2 of 4: cough, myalgia, sore throat, headache Case Definition: T > 38 + cough during flu season Positive Predictive Value86.8% Negative Predictive Value39.3% Sensitivity77.6% Specificity55.0% __________________________

13 DIAGNOSIS OF INFLUENZA INFLUENZA SURVEILLANCE WHO - worldwide tracking of drift and shift CDC, Influenza Branch –National Respiratory and Enteric Virus Surveillance System –122 Cities Mortality Reporting System –State and Territorial Epidemiologists Reports –US Influenza Sentinel Physicians Surveillance Network

14 DIAGNOSIS OF INFLUENZA RAPID FLU TESTS

15 INFLUENZA Treatment DrugTrade NameFlu TypeCostCaveat ____________________________________________________ AmantidineSymmetrelA9.83 Resistance Generic1.72 CNS RimantidineFlumadineA18.87 Resistance ZanamivirRelenzaA and B44.40 Bronchospasm OseltamivirTamifluA and B53.00 GI

16 INFLUENZA Prophylaxis VACCINATE EXPOSURES LONGTERM CARE FACILITIES

17 Approach to the common cold ____________________________________ ____________________________________ H & P Diagnosis - consider flu, bacterial complications, allergy, strep Ascertain Expectations Reassure (but don’t minimize) Express sympathy Educate Offer symptomatic relief

18

19 Patients’ Understanding of the Common Cold *87% of people do not seek care for their colds *In a survey of young adults 94% said it was not necessary to go to a doctor for a cold. On the other hand *Of patients in a clinic for other reasons, 61% said they would seek care for 5days rhinorrhea, cough, sore throat; if the discharge were discolored, 79% would seek care. *87% of a sample in England thought antibiotics were beneficial for a cold. a

20 Patients’ Understanding of the Common Cold What Causes a Cold? Virus43.5% Virus and Bacteria41.9% Bacteria 7.9% Don’t Know 6.7% Antibiotics are helpful for colds Strongly Agree18.2% Agree26.1% Disagree17.2% Strongly Disagree31.4% Don’t know 7.1% aa

21 Factors Correlating with a Desire for Antibiotics Previous Rx for Antibiotic for URI Belief they work Purulent secretions Medicaid From a country where abx are OTC

22 Why not give antibiotics? Biggest Risk Factor for developing resistant S.pneumonia is previous exposure to abx Good studies show that when overall antibiotic prescribing is reduced, the prevalence of resistant strains drops. About 30% of all the antibiotics prescribed in the US are for outpatient colds. In many studies, patients with clear cut colds are Rxed abx 50-60% of the time. They don’t work a

23 A Multidimensional Intervention to Reducing Rxs For Antibiotics For “Bronchitis” Preliminary study found that clinicians code according to Rx given, not symptoms. The dx of “chest cold” rather than “bronchitis” lowered expectations for abx Patient and clinician education Reduced Rxs for bronchitis from 74% to 48%

24 Symptomatic Treatment SymptomTreatments CongestionTopical Decongestant Oral Decongestant RhinorrheaAnticholinergic SneezingAntihistamine CoughSuppressant Tx for Rhinorrhea ConstitutionalAcetaminophen ASA, NSAID Sore ThroatGargles, Lozenges Analgesia a

25 Remedies Zinc Gluconate Vitamin C Chicken Soup Vapors

26 You’ve got the worst cold I’ve seen all day

27 Are you miserable? You look miserable.

28 I wish we had better treatments for bad colds

29 but as you know there’s no cure yet

30 Your cold comes from a viral infection.

31 Un fortun ate ly,

32 And furthermore,

33 YOUR body will fight this off just like it’s always done.

34 Your body’s immune system works best when you give it plenty of rest

35 In the meantime, let’s see if we can treat the symptoms so you’re not suffering so much.

36 If it’s helping, keep taking the oil of newt

37 If you get worse,

38 I HOPE YOU FEEL BETTER SOON

39 bye

40 NO I AM NOT JUST GOING TO GIVE YOU THE ANTIBIOTICS

41 Approach to the common cold ____________________________________ ____________________________________ H & P Diagnosis - consider flu, bacterial complications, allergy, strep Ascertain Expectations Reassure (but don’t minimize) Express sympathy Educate Offer symptomatic relief


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