Respiratory Disease Case No1. Non Specific upper Respiratory URTI.

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Respiratory Disease Case No1. Non Specific upper Respiratory URTI.

Non Specific upper Respiratory Infection ( Common cold)

Non specific URTI or Common cold এ কোনো একক উপসর্গ বা Symptoms প্রাধান্য পায় না। Common cold সাধারণত ভাইরাস দ্বারা সৃষ্ট হয়,Direct contact,Contaminated surface & Infected person er Respiratory Droplets দিয়ে একজন থেকে আর একজন infected হয়।

সাধারণত যেসকল ভাইরাস দিয়ে হয়ে থাকে___

• Rhinovirus

• Coronaviruses

• Parainfluenza virus

• Respiratory syncytial virus

• Influenza Virus

• Adenovirus

•Metap-neumovirus &bocavirus

URIs depends on exposure, immunity, general health, genetics, microbiome-related fac-tors, and mental health and social factors, including stress.

Symtoms & Sign

Common রেস্পিরেটরি ভাইরাস গুলো সুপ্তকাল বা Incubation period ( 2-8) দিন। লক্ষণগুলি সাধারণত ধীরে ধীরে শুরু, হয়_যেমন Nasal Obostruction, রাইনোরিয়া, গলা ব্যথা, ল্যারিঞ্জাইটিস,lymphadenopathy,কাশি & Lowe grade Fever অনেক সময় রোগীর Myalgia থাকতে পারে।

but this feature usually is not as prominent as ইনফ্লুয়েঞ্জা। Epistaxis is common with frequent nose blowing___________________

On physical examination,

রোগীর কনজংটিভাইটিস,ফ্যারিঞ্জিয়াল এরিথেমা,pharyngeal exudates or cobblestoning!! নির্ভর করে Phase of illness এর উপর ,Nasal mucosa ফ্যাকাশে, ঘোলাটে, বা লাল এবং ফোলা ( Swollen)হতে পারে। Nasal মিউকোসা Watery to purulent হতে পারে।Oscultation এ Lungs clear অথবা রোগীর diffuse wheezing or bronchial breath sounds consistent with a viral ইনফেকশন। লক্ষণগুলি সাধারণত 5-10 দিন স্থায়ী হয় তবে প্রায়ই 14 দিন পর্যন্ত স্থায়ী হয়।

Treatment Management:-

Children & Adult সবার ক্ষেত্রেই ট্রিটমেন্ট Symptoms based_জ্বর,গলা ব্যাথা ,Myalgias Treated by প্যারাসিটামল বা NSAID( Ibuprofen)

Tablet 1.Pyrenol (Paracetamol+Caffeine)(500mg+65mg) (AS A Non opioid analgesics).

Indications of Tablet:-Pyrenol (Paracetamol+Caffeine)(500mg+65mg) (AS A Non opioid analgesics).

Pyrenol is indicated in the following conditions-

Headache
Migraine
Toothache
Neuralgia
Feverishness
Period pain
Sore throat
Backache
Help to reduce the temperature
Aches and pain of colds and flu

Pharmacology of Tablet:-Pyrenol (Paracetamol+Caffeine)(500mg+65mg) (AS A Non opioid analgesics).

This is a combination of Paracetamol and Caffeine. Paracetamol has analgesic and antipyretic properties with weak anti-inflammatory activity. Caffeine is an alkaloid which is a theophylline-like xanthine derivative. By intermolecular association with Paracetamol, Caffeine increases the solubility and transmembrane permeation of Paracetamol. In addition, Caffeine increases the pain threshold and tolerance of pain. Caffeine has also an intrinsic power to raise vessel tone in the brain, which provides another benefit to treat migraine and headache.

Side Effects of Tablet:-Pyrenol (Paracetamol+Caffeine)(500mg+65mg) (AS A Non opioid analgesics).

Side effects of paracetamol are usually mild, though haematological reactions including thrombocytopenia, leukopenia, pancytopenia, neutropenia, and agranulocytosis have been reported. Pancreatitis, skin rashes, and other allergic reactions occur occasionally.

Pregnancy & Lactation of Tablet:-Pyrenol (Paracetamol+Caffeine)(500mg+65mg) (AS A Non opioid analgesics).

Pregnant mothers should consult with doctors before taking Paracetamol & Caffeine. Paracetamol & Caffeine can be taken whilst breast feeding.

Therapeutic Class of Tablet:-Pyrenol (Paracetamol+Caffeine)(500mg+65mg) (AS A Non opioid analgesics).

Non opioid analgesics

Rhinorrhoea এর ক্ষেত্রে আমরা Ipratropium bromide

Respirator solution 2:-Ipramid 250mcg/ml 20ml Bottle (AS A Ipratropium Bromide Anticholinergic bronchodilators).

Indications of Respirator solution :-Ipramid 250mcg/ml 20ml Bottle (AS A Ipratropium Bromide Anticholinergic bronchodilators).

Nebuliser Solution: It is indicated for the treatment of reversible bronchospasm associated with chronic obstructive pulmonary disease (COPD). It is also indicated, when used concomitantly with inhaled beta 2-agonists, for treatment of reversible airway obstruction as in acute and chronic asthma.

Inhaler: As bronchodilator in the treatment of chronic reversible airway obstruction as in asthma and chronic obstructive pulmonary disease including chronic bronchitis and emphysema. Treatment of acute reversible airway obstruction.

Pharmacology of Respirator solution :-Ipramid 250mcg/ml 20ml Bottle (AS A Ipratropium Bromide Anticholinergic bronchodilators).

Ipratropium Bromide is a quaternary ammonium compound with anticholinergic properties. It appears to inhibit vagal reflexes by antagonising the action of acetylcholine (the transmitter agent released from the vagus nerve). Anticholinergics prevent the increase in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) caused by interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle.

Dosage of Respirator solution :-Ipramid 250mcg/ml 20ml Bottle (AS A Ipratropium Bromide Anticholinergic bronchodilators).

Nebuliser Solution-

Adults (including the elderly) and children over 12 years of age: 250-500 micrograms (i.e. 1 ml or 2 ml) 3 to 4 times daily.

For treatment of acute bronchospasm: 500 micrograms/2 ml. It is advisable not to exceed the recommended daily dose during either acute or maintenance treatment. Daily doses exceeding 2 mg in adults and children over 12 years of age should only be given under medical supervision.

Children 6-12 years of age: 250 micrograms (i.e. 1 ml) up to a total daily dose of 1 mg (4 ml). The time interval between doses may be determined by the physician.

Children 0-5 years of age (for treatment of acute asthma only): 125-250 micrograms (i.e. 0.5 ml-1 ml) up to a total daily dose of 1 mg (4 ml). Ipratropium bromide should be administered no more frequently than 6 hourly in children under 5 years of age. Repeated doses can be administered until the patient is stable. The time interval between the doses may be determined by the physician.

Ipratropium Nebuliser Solution may be combined with a short-acting beta 2-agonist in the same nebulizer chamber. The solution should be used as soon as possible after mixing and any unused solution should be discarded. Ipratropium Nebuliser Solution can be administered using a range of commercially available nebulizing devices. The dose of nebulizer solution may need to be diluted in order to obtain a final volume suitable for the particular nebulizer being used (usually 2-4 ml); if dilution is necessary use only sterile sodium chloride 0.9% solution. The unit dose Ipratropium Nebulizer Solution is intended only for inhalation with suitable nebulizing devices and should not be taken orally or administered parenterally.

Inhaler-

Adults: The usual dose is 1-2 puffs (20 gm/spray) three or four times daily. Single dose upto 80 gm (4 puffs) may be required to obtain maximum benefit during early treatment. Patients may take additional inhalations as required; however, the total number of inhalations should not exceed 12 in 24 hours.

Children:

6-12 years: Usually 1-2 puffs two to three times daily.
Below 6 years: The usual dose is 1 puff (20 gm) three times daily.
In order to ensure that the inhaler is used correctly, the administration should be supervised by an adult.
No specific information on the use of the product in the elderly is available. Clinical trials have included patients over 65 years and no adverse reactions specific to this age group has been reported.

Side Effects of Respirator solution :-Ipramid 250mcg/ml 20ml Bottle (AS A Ipratropium Bromide Anticholinergic bronchodilators).

Nebuliser Solution:

Common: Headache, Dizziness, Cough, Inhalation induced bronchospasm, Dryness of mouth, Vomiting.
Uncommon: Urticaria, Tachycardia, Skin rash, Pruritus. Rare: Anaphylactic reaction, Eye pain, Mydriasis, Intraocular pressure increased, Palpitations, Atrial fibrillation, Nausea.

Inhaler:

Potentially life-threatening effects– Idiosyncratic reactions to Ipramid are rare. Severe adverse effects due to the inhibition of muscarinic receptors and ganglion blockade are theoretically possible but unlikely with the metered-dose aerosol.
Severe/Irreversible adverse effects– No effects of this kind is reported.
Symptomatic adverse effects– Regular use of Ipramid can lead to a dry mouth through inhibition of salivary low.
Observed during clinical practice– The most common adverse reactions reported are dryness of the oropharynx (5%); cough, exacerbation of symptoms, & irritation from aerosol (3%); headache (2%); nausea, dizziness, blurred vision/difficulty in accommodation & drying of secretions (1%). Less frequently reported adverse reactions to include tachycardia, nervousness, paresthesias, drowsiness, coordination difficulty, itching, hives, flushing, alopecia, constipation, tremor & mucosal ulceration. Case of precipitation or worsening of narrow-angle glaucoma, acute eye pain & hypotension have been reported. Allergic-type reactions such as skin rash, angioedema of the tongue, lips & face, urticaria (including giant urticaria), laryngospasm and anaphylactic reactions have been also reported; with positive rechallenges in some cases. Ipramid does not produce adverse effects on mucociliary clearance, in contrast to atropine and other muscarinic antagonists. There is no evidence that in the therapeutic dose range, Ipramid has any adverse effect on bronchial secretion.

Pregnancy & Lactation of Respirator solution :-Ipramid 250mcg/ml 20ml Bottle (AS A Ipratropium Bromide Anticholinergic bronchodilators).

The safety of Ipratropium Nebulizer Solution during human pregnancy has not been established. The benefits of using Ipratropium Nebuliser Solution during pregnancy must be weighed against the possible hazards to the fetus. It is not known whether ipratropium bromide is excreted into breast milk. Caution should be exercised when Ipratropium Nebulizer Solution is administered to nursing mothers.

Therapeutic Class of Respirator solution :-Ipramid 250mcg/ml 20ml Bottle (AS A Ipratropium Bromide Anticholinergic bronchodilators).

Anticholinergic bronchodilators

Nasal Congestion এ আমরা oxymetazoline (Afrin Drop/Nazolin Nasal spray!)–৫ দিন

Nasal Drop 3.Afrin 0.025% 10ml drop (AS A Oxymetazoline Hydrochloride AS A Nasal Anti-histamine preparations, Nasal Decongestants & Other Nasal Preparations).

Indications of Nasal Drop:-Afrin 0.025% 10ml drop (AS A Oxymetazoline Hydrochloride AS A Nasal Anti-histamine preparations, Nasal Decongestants & Other Nasal Preparations).

Afrin is indicated for the treatment of nasal congestion associated with acute or chronic rhinitis, common cold, sinusitis, upper respiratory allergies, epistaxis and hay fever. It is also used as nasal decongestant in otitis media.

Pharmacology of Nasal Drop:-Afrin 0.025% 10ml drop (AS A Oxymetazoline Hydrochloride AS A Nasal Anti-histamine preparations, Nasal Decongestants & Other Nasal Preparations).

Oxymetazoline Hydrochloride is an imidazoline derivative sympathomimetic amine. It is a direct agonist at α-adrenoceptors but has no action on β- adrenoceptors. It is used as a topical agent on the nasal mucosa, produces a rapid and long acting vasoconstriction of the arterioles, thus reducing the blood flow and diminishing swelling of the mucosa. This results in improved potency of the airway and better drainage of the nasal sinus.

Dosage of Nasal Drop:-Afrin 0.025% 10ml drop (AS A Oxymetazoline Hydrochloride AS A Nasal Anti-histamine preparations, Nasal Decongestants & Other Nasal Preparations).

Oxymetazoline nasal spray-

Adults and children (6 years of age and older): 2 or 3 sprays in each nostril twice daily for 3-5 days.
Elderly: There is no need for dosage reduction in the elderly for nasal administration.
Children below 6 years of age: It is not suitable for children below 6 years of age.

Oxymetazoline nasal drop-

Adults & children 6 years of age: 2-3 drops of 0.05% Nasal Drops in each nostril twice daily in the morning and evening.
Children 2-5 years of age: 2-3 drops of 0.025% Nasal Drops in each nostril twice daily in the morning and evening

Side Effects of Nasal Drop:-Afrin 0.025% 10ml drop (AS A Oxymetazoline Hydrochloride AS A Nasal Anti-histamine preparations, Nasal Decongestants & Other Nasal Preparations).

Occasionally it may cause local irritation and dryness of the mouth and throat. Temporarily discomfort such as burning, stinging, sneezing or increase in nasal discharge may occur.

Pregnancy & Lactation

The safety of Oxymetazoline Hydrochloride Nasal Spray during pregnancy and lactation has not been established, but is not thought to constitute a hazard during those periods.

Therapeutic Class of Nasal Drop:-Afrin 0.025% 10ml drop (AS A Oxymetazoline Hydrochloride AS A Nasal Anti-histamine preparations, Nasal Decongestants & Other Nasal Preparations).

Nasal Anti-histamine preparations, Nasal Decongestants & Other Nasal Preparations

কফ relief এ আমরা Dextromethophan ( D-Cough)

Syrup 4:D-Cough 10mg/5ml 100ml bottle (AS A Dextromethorphan Hydrobromide AS A Cough suppressant).

Indications of Syrup :D-Cough 10mg/5ml 100ml bottle (AS A Dextromethorphan Hydrobromide AS A Cough suppressant).

D-cough is indicated in-

Chronic dry cough
Unproductive cough
Acute dry cough which is interfering with normal function or sleep.

Pharmacology of Syrup :D-Cough 10mg/5ml 100ml bottle (AS A Dextromethorphan Hydrobromide AS A Cough suppressant).

Dextromethorphan Hydrobromide is a cough suppressant which has a central action on the cough centre in the medulla. Although structurally related to morphine, it has no analgesic properties and in general it has little sedative activity. Addiction has not been observed after the administration of rather large doses for prolonged period. It is rapidly absorbed from the GI tract and exerts its effects in 15-30 minutes after oral administration. The duration of action is approximately 3-6 hours with conventional dosage form. Dextromethorphan hydrobromide is extensively metabolised in the liver and excreted in the urine as unchanged Dextromethorphan and demethylated metabolites including Dextrophan which has some cough suppressant activity. Urinary excretion of parent and metabolites accounts for up to 50% of the ingested dose over 24 hours. About 8% of the dose is excreted unchanged in the urine over the first 6 hours.

Dosage & Administration of Syrup :D-Cough 10mg/5ml 100ml bottle (AS A Dextromethorphan Hydrobromide AS A Cough suppressant).

Adults and Children over 12 years: 15 to 30 mg three to four times per day. However, 60 mg doses up to four times per day have been used without increased side effects.

Children between 6 and 12 years: 5-15 mg up to four times per day.

Children between 2 and 6 years: 2.5-5 mg up to four times per day.

Side Effects of Syrup :D-Cough 10mg/5ml 100ml bottle (AS A Dextromethorphan Hydrobromide AS A Cough suppressant).

Adverse effects with D-cough are rare, but nausea and dizziness sometimes occur. The drug produces no analgesia or addiction and little or no CNS depression. Excitation, confusion and respiratory depression may occur after overdosage.

Pregnancy & Lactation of Syrup :D-Cough 10mg/5ml 100ml bottle (AS A Dextromethorphan Hydrobromide AS A Cough suppressant).

There is little information on the use of this drug in pregnancy and therefore it should be avoided in the first three months of pregnancy. No information is available on secretion of dextromethorphan into breast milk, so nursing mothers should be advised not to take the drug.

Therapeutic Class of Syrup :D-Cough 10mg/5ml 100ml bottle (AS A Dextromethorphan Hydrobromide AS A Cough suppressant).

Cough suppressant

1 বছরের বেশি বাচ্চাদের মধু দেয়া যেতে পারে গলা ব্যথা &irrigation এ।

Norsol Drop &Sucction bubl use করা যেতে পারে..nasal decongestant এ

Nasal drop 5:Norsol 0.9% 25ml drop (AS A Sodium Chloride AS A Intravenous fluid preparations, Nasal Decongestants & Other Nasal Preparations).

Indications of Nasal drop :Norsol 0.9% 25ml drop (AS A Sodium Chloride AS A Intravenous fluid preparations, Nasal Decongestants & Other Nasal Preparations).

Eye/Ear/Nasal solution: is indicated for dry nasal membranes including dry nose resulting from cold and allergy medications. It moistens dry nasal passages from dry climates or from airplane travel, may help dissolve mucus from study noses and clears the nose after surgery. This sterile saline solution is also used to cleanse various parts of the body (wounds, body cavities) and medical equipment (e.g. bandages, catheters, drainage tubes). It is also used as a mixing solution (diluent) for other medications used to irrigate the body (e.g. bacitracin, polymyxin).

Intravenous Solution: For instance, in the management of metabolic alkalosis, in case of gastro-enteritis, during and after surgery. It may also be used as a priming fluid for haemodialysis procedures. Norsol 0.9% infusion is often used as diluents for infusion of drug additives etc. It is widely used for sterile irrigation and dilution process.

Pharmacology of Nasal drop :Norsol 0.9% 25ml drop (AS A Sodium Chloride AS A Intravenous fluid preparations, Nasal Decongestants & Other Nasal Preparations).

Nasal drop: Sodium Chloride nasal drop is a non-drug, isotonic saline solution that is used to moisturize nasal membranes. This formulation provides comfort for extensive and continuous use. Sodium Chloride 0.9% nasal wash moistures inside the nose by dissolving and softening thick or crusty mucus thus helps to remove the mucus from the nose and makes breathing easier. Excess sodium is predominantly excreted by the kidneys with small amounts lost in faeces and sweat.

Nasal spray: Sodium Chloride 0.9% Nasal Spray moistens inside the nose by dissolving and softening thick or crusty mucus thus helps to remove the mucus from the nose and makes breathing easier. Excess Sodium is predominantly excreted by the kidneys with small amount lost in faeces and sweat. In babies and young children with stufy noses who cannot blow their noses, using this product helps to make the mucus easier to remove with a nasal bulb syringe. This helps relieve stufness and makes breathing easier.

Dosage of Nasal drop :Norsol 0.9% 25ml drop (AS A Sodium Chloride AS A Intravenous fluid preparations, Nasal Decongestants & Other Nasal Preparations).

Nasal drop-

Nasal Congestion: In infants, 1-2 drops of Sodium Chloride nasal wash in each nostril before feeds will help relieve congestion and allow more effective suckling.
Ear Wax Removal: Allow the Sodium Chloride nasal wash to warm to room temperature before use. It is important to put the drops into the ear carefully. Lie down on one side and fill the ear canal with the drops and wait for a few minutes before standing up. Age: from 6 months onwards. Put 3 to 4 drops into the affected ear(s) 3 to 4 times a day for 3 to 5 days.

Nasal Spray-

Newborn to 12 months: 1 spray into each nostril for 2-3 times or as directed by the physician.
Children over 12 months & Adults: 1 to 2 sprays into each nostril for 2-3 times or as directed by the physician.

For eye use: 1 or 2 drops in each eye when needed.

For ear use: 3 to 4 drops into the affected ear(s) 3 to 4 times a day for 3 to 5 days.

Intravenous Solution: The concentration and dosage of Sodium Chloride solution for intravenous use is determined by several factors including age, weight and clinical condition of the patient. Usually, the adult dose is about 1000 ml of 0.9% injection.

Side Effects of Nasal drop :Norsol 0.9% 25ml drop (AS A Sodium Chloride AS A Intravenous fluid preparations, Nasal Decongestants & Other Nasal Preparations).

Eye/Ear/Nasal: No side effects are expected to occur. However stinging, sneezing, increased nasal discharge, or salty taste may occur in some cases.

Intravenous: Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation, and hypervolemia. If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and save the remainder of the fluid for examination if deemed necessary.

Pregnancy & Lactation of Nasal drop :Norsol 0.9% 25ml drop (AS A Sodium Chloride AS A Intravenous fluid preparations, Nasal Decongestants & Other Nasal Preparations).

Eye/Ear/Nasal: Tell your doctor if you are pregnant before using this medication. It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

Intravenous: Pregnancy Category C. Animal reproductive studies have not been conducted with Sodium Chloride Injection USP 0.9%. It is also not known whether Sodium Chloride Injection USP 0.9% can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Sodium Chloride Injection USP 0.9% should be given to a pregnant woman only if clearly needed.

Therapeutic Class of Nasal drop :Norsol 0.9% 25ml drop (AS A Sodium Chloride AS A Intravenous fluid preparations, Nasal Decongestants & Other Nasal Preparations).

Intravenous fluid preparations, Nasal Decongestants & Other Nasal Preparations

রোগীকে বলে দিতে হবে ১৪ দিন পর্যন্তএই সমস্যা থাকতে পারে।কাউনসিলিং করে দিতে হবে_________________

Red Flags

102°F এর জ্বর, বুকে ব্যথা (একটি টানা পেশী ছাড়া), শ্বাসকষ্ট, মাথা ঘোরা, বিভ্রান্তি, কান বা সাইনাস ব্যথা এবং 14 দিন ধরে স্থায়ী লক্ষণগুলি অন্তর্ভুক্ত।

Non specific RTI এর জটিলতা হিসেবে Otitis media & ব্যাকটেরিয়া সাইনোসাইটিস হতে পারে!!!!

তবে একজন রোগীর জন্য, Antibiotic is more likely to cause an adverse reaction than to prevent complications…..

চলবে

Raiyyan Tahsan Date:19-01-2025 Sunday Time:12-34-45 PM

Raiyyan Tahsan

Raiyyan Tahsan