internal medicine
Internal Medicine Clinic
01
Influenza
If suddenly the body becomes sore with symptoms of high fever, coughing, sore throat, runny nose, etc. in the winter, it may not a normal cold but possibly influenza Influenza may not be threatening for health people but is a very dangerous for elderly and chronic disease patients because it may cause sever complications, resulting in death.
02
Bad cold? Influenza?
Influenza which is commonly known as 'bad cold' is a acute febrile respiratory disease which is extremely contagious and infected by influenza A or B viruses. The swine flu which started in the U.S. in Apr. 2009 and damaged all the world including Korea is also a kind of influenza, and it is known that influenza infects 10~20% of world population every winter.
Usually, it may be spread through saliva or coughing of infected patients, direct contact such as handshaking, etc., or through clothes, bedding, etc. Compared to normal cold, symptoms of influenza are similar but similar. But influenza must be gone through differential diagnosis as it may causes fatal complications such as pneumonia.
03
Diagnosis
| Type | Cold | Influenza |
|---|---|---|
| Causes | More than 200 viruses | Specific viruses (Influenza A, B) |
| Symptoms | Fever, chill, headache, muscle pain, feeling of fatigue, cough, sore throat | High fever, chill, headache, muscle pain, feeling of fatigue, cough, sore throat |
| Differences | gradually appeared mild fever, light symptoms | Sudden high fever(38-41℃), feeling of fatigue, muscle pain, joint pain, etc. Severly sore body which makes the daily life difficult |
| Treatments | Treatment for relieving symptoms | Getting rid of reason virus using antiviral agent |
| Prevention | No | Influenza vaccination |
04
Symptoms and complications of influenza
As those aged 65 and more, who have lung diseases such as heat disease, diabetes, asthma, etc. and chronic diseases such as dysfunction of kidney, infants under the age of 2, pregnant women, etc are at high risk of complications, it is very important for them to get early treatment when influenza is suspected. The possible complications are as follows. Influenza viral pneumonia, bacterial pneumonia, aggravation of chronic obstructive lung disease.
And here are rare but possible complications. Myositis, rhabdomyolysis, myocarditis, toxic shock, encephalitis, Reye syndrome, etc.
05
Diagnosis of influenza
Between November and December after the influenza warning has issued, those who have one of respiratory symptoms, such as fever above 37.8℃, coughing, sore throat, or runny nose, etc. are defined as similar symptom patient , and about 70% of these patients are diagnosed with influenza. Aside from this, influenza is diagnosed through confirmation test or rapid test.
Virus culture test (confirmation test)
Influenza can be diagnosed through virus culture test or gene amplification test using collected faucal mucus, nasal discharge, phlegm, etc. However, it takes more than a day to get the result, so the result cannot be immediately checked at the site.
Rapid antigen detection test
It takes about 10~15 min. to get the result after examining the secretion collected in the throat and after confirm the result, administration of antiviral agent is decided. However, it should be noted that even the result of rapid test is negative, the result of confirmation test may be positive.
06
Treatment for influenza
-
Antiviral agent Currently, there are two most widely used anti viral agents;
Tamiflu whose advantage is a systemic effect and Rerenza which is a powder typ and designed to affect on the respiratory system by inhaling using inhaler. Antiviral agent reduces frequency of complications' occurrence, but they also have the side effecs. Therefore symptoms must be observed carefully. -
Antibiotic therapy When acute bacterial complications are suspected or condirmed from influenza patients,
antibiotic therapy is performed. -
Symptom relief therapy Acetaminophen(prouct name: Tylenol) can be administered in order to relieve headache, muscle pain, and fever.
However, aspirin should be avoided because it may cause Reye's syndrome in children under age of 18.
Coughing mostly improves but if it is severe and may cause a problem, medication which contains codeine can be used.
07
The most effective prevention “Vaccination”
The influenza vaccine cannot fully prevent influenza from occurring, but it has effect on relieving symptoms, lowering risks of hospitalization and death.
Influenza vaccine becomes effective only when vaccinated at least a month before epidemic. Therefore, vaccination for high-risk group should be done in October and November.
08
Bronchial Asthma
Bronchial asthma is a disease which makes it difficult to breathe normally because the bronchi, the airways where the air comes into and out of lungs, has become highly sensitive and narrowed, resulting in symptoms of shortness of breath, wheezing, and severe coughing. It is an allergi disease caused by an allergic inflammatory reaction of the bronchi, and symptoms appear repeatedly and spasmodically, and it is caused by a combination of genetic and environmental factors.
09
Symptoms of bronchial asthma
Patients have symptoms of wheezing(breathing with a whistling sound in the chest), chest tightness, shortness of breath, coughing(become worse at night), phlegm, etc. However, there are many case that patients complain of non-typical symptoms besides of typical ones. Normally, symptom of shortness of breath becomes worse after catching a cold or symptoms of shortness of breath, heavy breathing, etc. appear after doing exercise such as running etc.
- 01
Patients complain of symptoms of repeted hacking coughs
- 02
chest tightness or feeling of chest compression
- 03
feeling of phlegm being stuck in the throat.
10
Causal factor of bronchial asthma
Bronchial asthma is a typical allergic disease caused by a combination of allergic constitution inherited from parents and environmental factor.
Environmental factor which is encountered as grow older is as important as genetic factor is, therefore, parents with allergies should try to manage environment in order to prevent their children from developing asthma.
11
To diagnose bronchial asthma, doctor's thorough observation and examination are important
The most important thing when diagnose asthma is thorough observation and examination of a doctor, and consulting an experienced doctor whose specialty is allergy and asthma is more important than any tests and examinations. Therefore, detailed information on the medical history should be provided to the doctor when consulting, so that asthma and its causig factors can be identified through examination. Tests and examinations to diagnose asthma include pulmonary function test, bronchial challenge test, sputum examination, etc.
-
Pulmonary function test Since bronchial asthma makes the bronchu more sensitive than normal ones, when the bronchu are irritated, they become narrower. Pulmonary function test helps to diagnose by checking how narrow they, are and whether they widen enough after inhaling bronchodilator.
-
Bronchial challenge test Bronchial challenge test is a method to assist in the diagnosis of asthma.
Asthma is diagnosed by proving the hypersensitiveness of the bronchu by inhaling bronchoconstrictor. -
Sputum examination Sputum examination is a test which directly observes allergy inflammatory cells in sputum and it helps decide further treatment by measuring level of allergic inflammation in bronchu as well as diagnose asthma. Tests and examinations to find the causes of bronchial asthma include allergic skin prick testing, allergy specific antibody examination, allergen bronchial challenge test, etc.
12
How to treat bronchial asthma
Bronchial asthma is a chronic and recurrent disease, so treatment aims to maintain everyday life normally by controlling symptoms well and to minimize the side effects of treatment.
For treatment, two types of therapies are used; medicinal therapy which relieves symptoms and avoidance therapy which minimizes exposure to causative allergen by figuring out causative agent of asthma. And sometimes immunotherapy which improves allergic constitution by injecting a small dose of causative agent is used. Each treatment is decided in consideration of patient's symptoms, severity, age, and general condition.
| Medicinal therapy |
Symptom-relieving medication which relieves the narrowed bronchu in a short period of time and disease-controlling medication which prevents asthma attacks by inhibiting bronchial allergic inflammation are used. drugs represented by theophylline, parasympatholytic(anticholinergics) are widely used. Disease-controlling medication : Anti-inflammatory(oral and inhaled), leukotriene modifier are used in order to improve lung function. |
|---|---|
| Avoidance therapy | It is a method to minimized exposure to the causative agent when the specific allergen which causes asthma has found through allergy specific antibody examination. |
| Immunotherapy | It is a method that can be performed when the cause of allergy is certain but it is difficult to treat effectively by doing only environmental management. It is effective only when the cause is a certain allergen sush as dust mites and pollen. It usually becomes effective when treatment continues for more than a year, and the treatment normally continues for 3~5 years, but in many cases it takes longer. |
13
“Daily management” is important for
bronchial asthma patients
Like other allergic diseases, it it important to take good care of bronchial asthma in other not for symptoms to appear. Asthma will deteriorates and symptoms will not be controlled if medication is used only when there are symptoms and patient see a doctor only when symptoms worsen.
Patients with asthma are especially highly sensitive to climate change such as temperature, atmospheric pressure, humidity, etc., and sudden exposure to the cold air may cause asthma attack.
Therefore, it should be recommended to wear masks and scarves when going out and to keep indoor humidity about 40~50%. Particularly, cold in winter is the major cause of aggravation. It is also recommended to relieve bronchitis by getting treatment before the change of seasons in advance, and to have vaccination against influenza for preventing getting it. It is especially important for the patients with persistent asthma and elderly with asthma. When catching a cold even after preparing as mentioned above, it is better to see a doctor again. It is important for the doctor to be noticed about asthma in order to prescribe suitable medication.