Respiratory failure
Philip Woodrow in Nursing Acutely Ill Adults, 2015
Usual incubation time for infection is about 48 hours, so infections occurring after 48 hours in hospital are classified as HCAIs. Although any organism can cause pneumonia, bacteria are usually responsible, so initially broad-spectrum antibiotics are usually prescribed, until sputum can be cultured. Chronic obstructive pulmonary disease (COPD) causes persistent airflow limitation that is usually progressive and is associated with inflammatory responses in airways (GOLD, 2013).It is usually caused bybronchitis oremphysema.COPD usually results from smoking (Brusselle et al., 2011; GOLD, 2013), is progressive, and eventually fatal. Incidence of COPD is increasing (Martinez et al., 2011); worldwide, it is the fourth leading cause of death (GOLD, 2013). Most people with COPD are managed in the community, but acute exacerbations (usually from chest infections) often necessitate acute hospital admission. Care therefore focuses on curing acute exacerbations, and managing the chronic element. Bronchitis is inflammation of bronchioles, restricting airflow into the lungs. Emphysema (from the Greek for ‘puffed up’) occurs when chronic distension of alveoli causes loss of elasticity, and therefore failure to adequately ventilate. Less frequently, genetic deficiency of alpha antitrypsin 1 (a protective enzyme) causes early-onset COPD, especially in smokers. Many patients with AECOPD need non-invasive bilevel ventilation on admission to acute hospitals. Asthma is a chronic inflammatory disorder of the airways (Global Initiative for Asthma, 2012, but hospital admission is usually only necessary with severe acute exacerbations.More often a childhood disease, a significant incidence also occurs in adults, usually before the age of 40 (To et al., 2012).UK incidence of asthma is among the highest in the world (To et al., 2012).Core treatment for asthma isoxygenbronchodilatorssteroids.
Functional Assessment
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Pneumonia and UTI commonly present as delirium in the elderly. Endocarditis can present very insidiously as otherwise unexplained weight loss. Many of these “atypical” symptoms go unnoticed or are attributed to normal aging, delaying diagnosis, and exacerbating the infection's impact on the patient's health and functional status (see also Chapter 2: Clinical Manifestations of Infections). The high prevalence of chronic medical conditions further complicates the treatment of elderly patients with infections. Chronic diseases can exacerbate the loss of homeostatic reserve leading to greater functional decline. Specific diseases such as chronic obstructive pulmonary disease (COPD), congestive heart failure, and dementia affect both the respective organ system and the presentation of and response to the treatment of an acute infection. In the case presentation, the development of pulmonary edema was likely the result of diminished cardiovascular reserve or occult cardiovascular disease (e.g., diastolic dysfunction). Hypoxemia, resulting from COPD and pneumonia, exacerbated the delirium and likely precipitated myocardial ischemia. Dementia diminishes cognitive reserve increasing the risk of delirium from even the modest physiological insult of an infection; in turn, delirium increases the risk of aspiration, anorexia, and undernutrition (including subsequent dehydration and hypotension). In many instances, chronic illness itself is exacerbated by an acute infection. COPD exacerbations are common in pneumonia and bronchitis. Diabetic control commonly worsens in the face of new infections. Even the appropriate management of acute infection by antibiotic therapy, hospitalization, or surgery has the potential to further complicate a patient's course of illness and recovery. Medication interactions are common and are especially troublesome in those individuals receiving medical therapy for multiple chronic illnesses. Addition of antibiotics to a patient's regimen has the potential to increase adverse drug events, side effects, and drug-drug interactions; these concerns are further augmented by renal insufficiency or liver dysfunction. For example, hospitalization of elderly patients with digoxin toxicity is associated with concomitant administration of the antibiotic clarithromycin, presumably due to inhibition of P-glycoprotein, which normally promotes clearance of digoxin (4). Hospitalization presents the possibility of iatrogenic complications, whose rates increase with the age of the patient. Peripheral and central venous catheters carry an inherent risk of infection. The common act of inserting a Foley catheter can lead to undesirable events such as development of simple and complicated UTI, delirium, and complications of enforced immobility, a result of the catheter acting as a tether that restrains the patient's movement. Delirium occurs commonly within the context of acute infections and hospitalizations, often causing agitation, insomnia, and combative behavior; physical restraints and psychopharmacological agents, notably antipsychotics, diphenhydramine, and benzodiazepines, are often employed for control of these symptoms. However, these medications have the potential to cause serious adverse effects in elderly patients.
Respiratory Infections
Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar in Handbook of Refugee Health, 2021
Acute bronchitis is usually caused by a lower respiratory tract infection affecting the large airways. Chronic bronchitis occurs in the context of chronic obstructive pulmonary disease (COPD).
Impact of Changes in Regular Use of Marijuana and/or Tobacco On Chronic Bronchitis
Published in COPD: Journal of Chronic Obstructive Pulmonary Disease, 2012
Donald P. Tashkin, Michael S. Simmons, Chi-Hong Tseng
We sought to evaluate possible changes in the prevalence of chronic bronchitis in relation to continuing or changing smoking status for marijuana and/or tobacco. For this purpose we followed 299 participants in a longitudinal cohort study of the impact of heavy habitual use of marijuana alone or with tobacco on respiratory symptoms over a mean of 9.8 years during which subjects underwent repeated administration of a detailed drug use and respiratory questionnaire at intervals of ≥1 yr. Using logistic regression, we calculated odds ratios to assess the relationship between chronic bronchitic symptoms and smoking status for marijuana and tobacco at the first visit (current smoking versus never smoking) and at the last follow-up visit (continuing smoking versus, separately, never smoking and former smoking). We found that continuing smokers of either marijuana or tobacco had a significantly increased likelihood of having chronic bronchitis at follow-up compared to both never smokers and former smokers. On the other hand, former smokers of either substance were no more likely to have chronic respiratory symptoms at follow-up than never smokers. These findings demonstrate the benefit of marijuana smoking cessation in resolving pre-existing symptoms of chronic bronchitis.
The management of acute bronchitis in children
Published in Expert Opinion on Pharmacotherapy, 2007
Douglas M Fleming, Alex J Elliot
Acute bronchitis is one of the most common infections reported in children under 5 years of age, and is a leading cause of hospitalisation. In general practice, confusion surrounds the clinical diagnosis of acute bronchitis, especially when distinguishing it from asthma. The microbiological causes are mostly known, but the contribution of each is much less clear, and they are non-specific in their clinical expression in individual cases. Viral pathogens, particularly respiratory syncytial virus and rhinoviruses are cited as the leading agents in the development of serious episodes, but other pathogens may also be important. This article covers a range of issues surrounding acute bronchitis, including epidemiology and pathogenesis, as well as the management, prevention and treatment of disease in children.
Health status and costs of exacerbations of chronic bronchitis and COPD: how to improve antibiotic treatment
Published in Expert Review of Pharmacoeconomics & Outcomes Research, 2005
Up to 10% of the adult population in most countries may be affected by chronic bronchitis or chronic obstructive pulmonary disease. The course of the disease is characterized by frequent exacerbations with increased respiratory symptoms. Exacerbations are the most important cause of morbidity and mortality, and significantly impair the health status of chronic bronchitis and chronic obstructive pulmonary disease patients. It has been observed that impairment in health status associated with exacerbations may not recover completely if recurrent exacerbations occur. Therefore, strategies to prolong the time free of exacerbations are a cornerstone of therapy. Antibiotics have demonstrated additional benefits to bronchodilators and corticosteroids in the treatment of exacerbations. Furthermore, the possible role of antibiotics in preventing exacerbations and reducing the costs of chronic bronchitis and chronic obstructive pulmonary disease patients is discussed.