Wednesday, 27 November 2013

Lower respiratory tract infection – Bronchitis Treatments In conventional medicine perspective

Lower respiratory tract infection
The lower respiratory tract infection are the infection consisting of the trachea (wind pipe), bronchial tubes, the bronchioles, and the lungs, including the bronchitis and pneumonia. According to  The World Health Report 2004 – Changing History(1), in 2002 lower respiratory track infection were still the leading cause of deaths among all infectious diseases, and accounted for 3.9 million deaths worldwide and 6.9% of all deaths that year.
Bronchitis is defined as a condition of an inflammation of the mucous membranes of the bronchi, the larger and medium-sized airways that carry airflow from the trachea into the lung parenchyma(7). Most cases of Bronchitis are as a result of recurrent injure to the airways caused by inhaled irritants and cigarette smoking(6).
F. Treatments
F.1. In conventional medicine perspective
The aim of the treatment is to relive the symptoms, such as cough, pain, breathing, etc.
A. Acute bronchitis
Cough is the most common symptom bringing patients to the primary care physician’s office, and acute bronchitis is usually the diagnosis in these patients. Getting more rest,  taking over-the-counter pamedicine to relieve the symptoms, drinking fluids, breathing in warm, moist air. According to the study by Hartford Hospital, Hartford, acute bronchitis should be differentiated from other common diagnoses, such as pneumonia and asthma, because these conditions may need specific therapies not indicated for bronchitis. Symptoms of bronchitis typically last about three weeks. The typical therapies for managing acute bronchitis symptoms have been shown to be ineffective, and the U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than six years. The supplement pelargonium may help reduce symptom severity in adults. As patient expectations for antibiotics and therapies for symptom management differ from evidence-based recommendations, effective communication strategies are necessary to provide the safest therapies available while maintaining patient satisfaction(49).
B. Chronic bronchitis
The syndrome of chronic obstructive pulmonary disease (COPD) consists of chronic bronchitis (CB), bronchiectasis, emphysema, and reversible airway disease that combine uniquely in an individual patient. Older patients are at risk for COPD and its components–emphysema, CB, and bronchiectasis. Bacterial and viral infections play a role in acute exacerbations of COPD (AECOPD) and in acute exacerbations of CB (AECB) without features of COPD(50).
Beside over counter medince to reduce symptoms of the disease, prescriptions medication may include
1. Antibiotics
Antibiotics are medication used to fight against the bacetrial invasion. Gemifloxacin is a fluoroquinolone antibiotic with broad spectrum of antibacterial activity. In the study to to evaluate the comparative effectiveness and safety of gemifloxacin for the treatment of patients with community-acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB), found that gemifloxacin 320 mg oral daily is equivalent or superior to other approved antibiotics in effectiveness and safety for CAP and AECB. The development of rash represents potential limitation of gemifloxacin(51). But other suggested that older patients are at risk for resistant bacterial organisms during their episodes of AECOPD and AECB. Organisms include the more-common bacteria implicated in AECOPD/AECB such as Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae.  Using a risk-stratification approach for elderly patients, first-line antibiotics (e.g., amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole, and doxycycline), with a more-limited spectrum of antibacterial coverage, are used in patients who are likely to have a low probability of resistant organisms during AECOPD/AECB. Second-line antibiotics (e.g., amoxicillin/clavulanic acid, second- or third-generation cephalosporins, and respiratory fluoroquinolones) with a broader spectrum of coverage are reserved for patients with significant risk factors for resistant organisms and those who have failed initial antibiotic treatment(52).
Side effects are ot limit to rash, diarrhea, abdominal pain, nausea/vomiting, drug fever, hypersensitivity (allergic) reactions, etc.
2. Blockade of the Epidermal growth factors  receptors (EGFR) therapy
In the study to examine the expression patterns of EGF and their receptors (EGFR1 and c-erbB2) in the bronchial mucosa from the biopsy specimens harvested from smoking and non-smoking CB patients, compared with their expression in normal controls, indicated that blockade of the EGFR pathway can be an alternative successful therapy(53).
3. Surgery
Chronic bronchitis is a common but variable phenomenon in COPD. It has numerous clinical consequences, including an accelerated decline in lung function, greater risk of the development of airflow obstruction in smokers, a predisposition to lower respiratory tract infection, higher exacerbation frequency, and worse overall mortality(54).  Lung reduction surgery can be potential helpful in removing the damage lung area. According to the study by University of Pennsylvania, lung-volume-reduction surgery increases the chance of improved exercise capacity but does not confer a survival advantage over medical therapy. It does yield a survival advantage for patients with both predominantly upper-lobe emphysema and low base-line exercise capacity(55).
4. Etc.

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