01 ffy rhinitis common cold

8/18/2019 01 Ffy Rhinitis Common Cold

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INFEKSI RESPIRATORIK AKUT(IRA) ATAS

Finny Fitry Yani

Respirologi Bagian IKA

RS M Djamil-FK Unand


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2

The upperrespiratory tractconsists of the partsoutside the chest cavitythe air passa!es of thenose" nasa# cavities"pharyn$" #aryn$" and

upper trachea


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%O&&ON %O'

3


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...COMMON COLD

n acte! sel" limited! mild pper respiratory

#iral illness

nee$ing! nasal congestion and disc%arge&r%inorr%ea'! sore t%roat! cog%! lo( grade"e#er! %eadac%e and malaise)

to *e distingis%ed "rom in+en$a!

p%aryngitis! acte *ronc%itis! acte *acterialsinsitis! allergic r%initis! and pertssis)

,


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irus

R%ino#irses

orona#irses

In+en$a #irses

Respiratory syncytial #irs

.arain+en$a #irses

Adeno#irses

/ntero#irses

Metapnemo#irs

Esti*ated annua# proportion of cases (percent

31-1

1-

-

4

4

Un0no(n

ira# cause of the co**on co#d


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5iral transmission may occr #ia

– in%alation o" small particle aerosols!

–

deposition o" large particle droplets on nasalor conjncti#al mcosa!

– or direct trans"er #ia %and-to-%and contact

6

...COMMON COLD


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Symptoms sally appear -2 days a"ter #iralinoclation

symptoms are not t%e reslt o" #iral destrction

o" t%e nasal mcosa)nasal epit%elim remains intact! alt%og% t%ere

an in+7 o" .M8s into t%e nasal s*mcosa anepit%elim

iral in"ection increases #asclar permea*ility it%e nasal s*mcosa! releasing al*min and0inins

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...COMMON COLD


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• olored nasal disc%arge

– ~ increased presence o" .M8s

– : increase in positi#e *acterial cltre

– presence o" .M8s &yello( or (%ite color' or o"

.M8 en$ymatic acti#ity &green color'

;

...COMMON COLD


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• Symptomatic t%erapy

– may inclde antipyretics! saline nasal irrigation!

ade?ate %ydration! and t%e se o" a %midi=er – %ildren (it% reacti#e air(ay disease or ast%ma

s%old se *eta-agonist medications to relie#e

associated *ronc%ospasm)

1

...COMMON COLD


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• Antipyretics

– Acetaminop%en &or i*pro"en! in c%ildren greate

t%an 6 mont%s o" age' may *e sed to alle#iate

"e#er dring t%e =rst "e( days

...COMMON COLD


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• Saline irrigation

– In in"ants! *l* sction (it% saline nose drops m

%elp to temporarily remo#e nasal secretions

– in t%e older c%ild! a saline nose spray may *e

sed)

2

...COMMON COLD


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• Anti%istamines


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• Decongestants

– sympat%omimetic medications t%at case

#asoconstriction o" t%e nasal mcosa)

– a#aila*le in oral and topical "ormlations)

– psedoep%edrine l! and p%enylep%rine l! a

o7ymeta$oline)

,


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– In adlts decrease nasal congestion and increas

patency!

– no stdies demonstrating t%e e@ecti#eness o"

t%ese medications in c%ildren) – Side e@ects may inclde tac%ycardia! ele#ated

diastolic *lood pressre! and palpitations)

...COMMON COLD


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Becase o" t%e s*stantial ris0s o" t%ese prodcts(it%ot pro#en *ene=t

not recommended "or pediatric se)

It is concei#a*le t%at t%e older adolescent may*ene=t as an adlt (old "rom t%e se o" adecongestant! sc% as psedoep%edrine

6

...COMMON COLD


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• Anti*iotic t%erapy

–


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%e se o" anti*iotics s%old *e reser#ed "or

clearly diagnosed secondary *acterialin"ections! inclding *acterial otitis media!sinsitis! and pnemonia

;


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• .R/5/8


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A''ER+I% R,INITIS

21


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)))allergic rhinitis

%e occrrence o" annoying nasal symptoms

inclding disc%arge! itc%ing! snee$ing!congestion! and pressre

2


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• Allergic r%initis

– associated (it% a symptom comple7 c%aracteri$

*y paro7ysms o" snee$ing! r%inorr%ea! nasal

o*strction! and itc%ing o" t%e eyes! nose! andpalate)

– It is also "re?ently associated (it% postnasal dri

cog%! irrita*ility! and "atige

22



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st *e distingis%ed "rom t%e ot%er "orms

r%initis

pisodic e7posre to in%aled allergens sc% a

cat sali#ary proteins! %orse dander! mrinerinary proteins! pollen! or %ose dst mite"eces may pro#o0e acte allergic symptoms

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•

•

•

•

Allergic! seasonal! and perennial

.erennial nonallergic

In"ectios

Miscellaneos categories! (%ic% incldecom*inations o" t%e a*o#e

2,



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llergic r%initis is classi=ed as seasonal i" symptoms typicall

occr at a particlar time o" t%e year!

or perennial i" symptoms occr year rond)

2



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• perennial allergic r%initis

– more t%an 2 %ors per day and "or E > mos o" t%

year

– sally re+ects allergy to indoor allergens li0e d

mites! coc0roac%es! or animal dander

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•.ersistent G symptoms are present more t%an "or days per (ee0 an"or more t%an "or (ee0s

Mild G 8one o" t%e items listed *elo( "or moderate-se#ere are preseModerate-se#ere G Cne or more o" t%e "ollo(ing items is present

–

–

–

–

- Sleep distr*ance

- Impairment o" sc%ool or (or0 per"ormance

- Impairment o" daily acti#ities! leisre andHor sport acti#ities

-


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asal e7amination nasal mcosa "re?ently displays a pale

*lis% %e or pallor along (it% tr*inate edema! &not ani#ersal =nding'

e7i*le =*eroptic r%inoscopy &E years o" age' may "acilitat

e7amination

lear r%inorr%ea may *e #isi*le anteriorly or! (it% nasalo*strction! dripping do(n a posterior p%aryn7 t%at resemco**lestones

3



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• Allergen-speci=c testing

– properly per"ormed s0in testing may pro#ide an i

#i#o assessment o" *iologically rele#ant Ig/

anti*odies) It is t%e most con#enient and leaste7pensi#e screening met%od to detect allergicsensiti$ation) Ct%er tests are less se"l)

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/RJ/8 A5CIDA8/


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•


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• .ARMACCJI C.


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Intranasa# !#ucocorticoids

( IN+%s)opical I8Js are presently t%e most e@ecti#e singlmaintenance t%erapy and case "e( side e@ects att%e recommended doses)

particlarly e@ecti#e in t%e treatment o" nasalcongestion)

*eclomet%asone! +nisolide! *desonide! +ticaso

propionate! mometasone "roate! and +ticasone"roate)

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Second !eneration

antihista*ines

• inclde loratadine! cetiri$ine! and a$elastine

• Cnset o" action is (it%in %or "or most agents!

and pea0 serm le#els are attained in 2 - 3 %ors

• less impact on nasal congestion compared to

I8Js)

3;



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%UTE -A%TERIA' SINUSITIS IN,I'REN

3>


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,1

common dring URI!sally spontaneosly

resol#es

(%en t%ere issecondary *acterial

in"ection o" t%e sinses

...acute bacterial sinusitis

EFINITIONS

• Sinsitis is in+ammation o" t%e mcosal lining o" one or more o" t%e paranasal sinses


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#iral in"ection associated (it% t%e common

cold is t%e most "re?ent etiology o" actesinsitis #iral r%inosinsitis)

ppr) 6 - 3 L o" #iral r%inosinsitis in c%ildre

is complicated *y ABS

,


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Uncomplicated #iral r%inosinsitis sally resol#e

(it%ot treatment in 9 - 1 days) Alt%og% ntreated ABS also may resol#e (it%ot

treatment

,2

anti*iotics %astens reco#ery and may decreaset%e ris0 "or or*ital and intracranial complications)



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Distingis%ing *et(een acte #iralr%inosinsitis and ABS

• is important anti*iotics can *e sed

jdiciosly

,3


acute bacterial sinusitis


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%#assi.cation

• Acte symptoms completely resol#e in 431 days

• S*acte symptoms completely resol#e in 31 and 4>

days

• Recrrent E3 episodes o" 431 days dration separatedinter#als o" 1 days (it%ot symptoms in a 6-mont%period! or E, sc% episodes in a 2-mont% periodN

indi#idal episodes respond *ris0ly to anti*iotic t%erapy

according to dration

and recrrence



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%ronic sinsitis is de=ned *y episodes o"

in+ammation o" t%e paranasal sinses t%at last E>ays! dring (%ic% patients %a#e persistent

symptoms &cog%! r%inorr%ea! nasal o*strction')may *e related to nonin"ectios conditions sc% as

allergy! cystic =*rosis! gastroesop%ageal re+7! ore7posre to en#ironmental polltants

,



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Anatomic o*strction & septalde"ormitiesN cranio"acial anomaliesN

adenoidal %ypertrop%y'

Mcosal irritants &dry air! to*acco smo0e!c%lorinated (ater'

Sdden c%anges in atmosp%eric pressre&descent in an airplane'

esscommon


Ris/ factors

• 5iral URI is t%e most important

• c%ildren (%o attend day care

• Allergic r%initis


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Streptococcs pnemoniae! aemop%ils in+en$a

&non-typea*le'! and Mora7ella catarr%alis are t%epredominant cases o" ABS

ecase o" its general e@ecti#eness! sa"ety! lo( cosand narro( spectrm! amo7icillin! (it% or (it%otcla#lanate! generally is considered to *e t%e =rstline agent "or t%e treatment o" ABS in c%ildren

,9



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For c%ildren (it% ncomplicated ABS t%at is o" mild

to moderate se#erity

–

Amo7icillin &, to >1 mgH0g per day in t(o di#ided dosesor Amo7icillin-cla#lanate &, to >1 mgH0g per day o" t%amo7icillin component in t(o di#ided doses'

,;

Anti0iotics



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For c%ildren (%o %a#e ncomplicated ABS o"

at least moderate se#erity – Amo7icillin-cla#lanate &;1 to >1 mgH0g per day

amo7icillin'

– e"dinir &, mgH0g per day in or 2 doses'! or

– e"ro7ime &31 mgH0g per day'! or

– e"podo7ime &1 mgH0g per day once daily'

,>

Anti0iotics



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c%ildren (it% #omiting t%at precldes

administration o" oral anti*iotics – A single dose o" ce"tria7one &at 1 mgH0g per da

i)#) or i)m

–


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01 ffy rhinitis common cold

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