The common cold is an acute, self-limiting viral infection of the upper respiratory tract involving the nose, sinuses, pharynx and larynx. Drug therapies for the common cold are normally aimed at relieving the symptoms of the illness. Over-the-counter cough and cold medications should not be used in children younger than four years old because of potential harms and lack of benefit. Antibiotics, antitussives, anti-histamines, and inhaled corticosteroids are not effective in children. Products that may improve symptoms in children include expectorants, mucolytics, honey, vitamin C, zinc lozenges, geranium extract, and nasal saline irrigation. In adults, antihistamines, intranasal corticosteroids, codeine, intranasal ipratopium, and antibiotics are not effective. Decongestants, antihistamine/decongestant combi-nations, expectorants, and mucolytics may improve cold symptoms in adults. Nonsteroidal anti-inflammatory drugs and acetaminophen reduce pain secondary to upper respiratory tract infection in adults. Among complementary and alternative medicinetherapeutics, products containing vitamin C, zinc, or garlic may improve cold symptoms in adults. Prophylactic use of probiotics may decrease the frequency of colds in adults and children.
Acetaminophen ; Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Antitussive Agents ; Ascorbic Acid ; Child ; Codeine ; Common Cold* ; Complementary Therapies ; Cough ; Drug Therapy* ; Expectorants ; Garlic ; Geranium ; Histamine Antagonists ; Honey ; Humans ; Larynx ; Nasal Decongestants ; Nonprescription Drugs ; Nose ; Pharynx ; Probiotics ; Respiratory System ; Respiratory Tract Infections ; Zinc

This report offers descriptive data about the drugs utilized in outpatient department (OPD) of Yeungnam University Hospital (YUH) in the period of March to August in 1985. The data in this report were produced by the computerized totalization of the number of mentions of individual drugs included in the prescriptions. The 100 drug entries that were most frequently recorded are listed in rank order. The listing is arbiturarily restricted to the drugs that were prescribed as single preparations, the drugs of basis of compound preparations and the drugs of adjuvant or corrective of compound preparations that have significant therapeutic effects either by generic names. And in addition, the listing also involves the compound preparations used in relatively large frequency, and the individual components of which have the unique pharmacological actions each other by proprietary names. And all routes of administrations were allowed. The 10 drugs most frequently named are diazepam, aluminum compounds, acetaminophen, isoniazid, metoclopramide, polaramine®, carboxymethylcystein, ephedrine, codeine and caroverine in order. The 521, 855 drug mentions listed as above are described by the chief therapeutic usage that each is intended to apply generally. The drugs which account the largest proportion of total mentions were those acting on the central nervous system (20.57%), including tranquillizers and sedative hypnotics (11.71%), analgesic antipyretics (5.55%), antidepressants (2.15%) etc. Gastrointestinal drugs and smooth muscle preparations (18.64%) included antacids and antiulcer drugs (9.24%), antiemetics (3.57%), spasmolytics (3.14%) and others. Respiratory drugs (16.11%) included expectorants and cough preparations (10.99%) and bronchodilators (5.12%). Chemotherapeutic agents (15.12%) included the antiTbc drugs (7.09%) most frequently, and the penicillins (3.33%) accounted the largest proportion among the antibiotics. Cardiovascular drugs (5.64%) included cardiac drugs and coronary vasodilator (4.12%) and antihypertensives and vasodilators (1.06%). And antiinflammatory drugs (4.33%), vitamins of single preparations (3.76%), hormones and their antagonists (3.29%), common cold preparations (3.12%), diuretics (2.81%), drugs supporting liver function (2.02%), drugs affecting autonomic nervous system (1.89%) including antiglaucomas, atropine and cerebral vasodilators, antihistamine drug (1.02%) and disinfectants (0.74%) were following in order. The data in the report were compared to those reported by H. Koch, et al. in United States (US), 1981 as “Drugs Most Frequently Used in Office Practice : National Ambulatory Medical Case Survey, 1981.” Cardiovascular drugs prescribed in YUH were much less in proportion than in US (10.56%), but gastrointestinal drugs accounted the larger proportion than in US (3.72%). Expectorants and preparations in YUH also accounted the larger proportion than in US (2.74%). In conclusion, in the period of March to August, 1985, OPD of YUH prescribed the CNS drugs including diazepam most frequently, and gastrointestinal, respiratory and chemotherapeutic drugs in next orders. It is supposed that the eating habits of Koreans and a unique atmospheric condition in Taegu as a basin were some important factors that affected the proportions of drugs acting on gastrointestinal and respiratory tracts.
Acetaminophen ; Aluminum Compounds ; Antacids ; Anti-Bacterial Agents ; Antidepressive Agents ; Antiemetics ; Antihypertensive Agents ; Antipyretics ; Atropine ; Autonomic Nervous System ; Bronchodilator Agents ; Cardiovascular Agents ; Central Nervous System ; Codeine ; Common Cold ; Cough ; Daegu ; Diazepam ; Disinfectants ; Diuretics ; Eating ; Ephedrine ; Expectorants ; Gastrointestinal Agents ; Humans ; Hypnotics and Sedatives ; Isoniazid ; Liver ; Metoclopramide ; Muscle, Smooth ; Outpatients ; Parasympatholytics ; Penicillins ; Prescriptions ; Respiratory System ; Therapeutic Uses ; United States ; Vasodilator Agents ; Vitamins

BACKGROUND: Reduced lung compliance and increased lung resistance are the primary lung mechanical abnomalities in acute respiratory distress syndrome (ARDS). Although there is little information regarding the mecha nisms responsible for the increases in the respiratory resistance of ARDS, bronchodilators have been frequently administered in mechanically ventilated ARDS patient. To determine the effect of a bronchodilator on the respiratory mechanics depending on the level of applied positive end-expiratory pressure (PEEP), the change in the respiratory mechanics by salbutamol ingalation was measured under the variable PEEP level in patients with ARDS. METHODS: Fifteen mechanically ventilated paralyzed ARDS patientss (14 of male, mean age 57 years) were enrolled in this study. The respiratory system compiance, and the maximum and minimun inspiratory occlusion method during constant flow inflaction using the CP-100 pulmonary monitor (Bicore, Irvine, CA, USA). The measurements were performed at randomly applied 8, 10 and 12 cm H2O PEEP before and 30 mins after administrating salbutamol using a meter-dose-inhaler (100 micro gram X 6). RESULTS: 1) The maximum inspiratory resistance of the lung was higher than the reported normol values due to an increase in the minimal inspiratory resistance and additional resistance. 2) The maximum inspiratory resistance and peak airway pressure were significantly higher at 12 cm H2O of PEEP compared with those at 10cm H2O of PEEP. 3) Salbutamol induced a significant decrease in the maximum and the minimum inspiratory resistance but no significant change in the additional resistance only was observed at 12 cm H2O of PEEP (from 15.66+/-1.99 to 13.54+/-2.41, from 10.24+/-2.98 to 8.04+/-2.34, and from 5.42+/-3.41 to 5.50+/-3.58 cm H2O/l/sec, respectively). 4) The lung compliance did not change at the applied PEEP and salbutamol inhalation levels. CONCLUSIONS: The bronchodiator response would be different depending on the level of applied PEEP despite the increased respiratory resistance in patients with ARDS.
Albuterol ; Bronchodilator Agents ; Humans ; Inhalation* ; Lung ; Lung Compliance ; Male ; Positive-Pressure Respiration ; Respiratory Distress Syndrome, Adult* ; Respiratory Mechanics* ; Respiratory System

BACKGROUND: Intubation of the trachea frequently results in a rise in respiratory system resistance (Rrs) that is reversed by inhaled bronchodilators. In asthmatics, this reflex may occasionally result in profound bronchoconstriction, and anesthesiologists often try to avoid tracheal intubation if possible in asthmatics. The hypothesis of this study was that insertion of a laryngeal mask airway (LMA) would be less likely to result in reversible bronchoconstriction than would insertion of an endotracheal tube (ETT). METHODS: A total of 52 (45 male, 7 female) patients were randomized to placement of a 7.5 mm (females) or 8.0 mm (males) endotracheal tube or a #4 (females) or #5 LMA (males). Anesthesia was induced with 2 microgram/kg fentanyl and 5 mg/kg thiopental and airway placement facilitated with 1 mg/kg succinylcholine. After ensuring that a seal to greater than 20 cmH2O existed, Rrs was measured immediately following airway placement using the isovolumic method during positive pressure ventilation with oxygen. Correction was made for the resistance of the ETT but not for the resistance of the LMA, which was insignificant at the flows used. Inhalation anesthesia was then begun with isoflurane (ISF) to achieve an end-tidal concentration of 1.0% for ten minutes. Rrs was then measured again under identical conditions. In the LMA patients, fiberoptic laryngoscopy was then performed to ensure that the scope could be passed to the level of the cords without epiglottic obstruction. RESULTS: Among LMA patients, the initial Rrs was significantly lower than among ETT patients (9.2 0.7 vs 13.4 1.9 cmH2O/L/s, P <0.05). After 10 minutes of ISF, the resistance declined to 8.6 0.7 in the ETT group but remained unchanged at 9.1 0.7 cmH2O/L/s in the LMA group. The decline in Rrs in the ETT group of 4.7 1.4 cmH2O/L/s was highly significant compared to the lack of change in the LMA group (P <0.01). CONCLUSIONS: Despite the inclusion of the resistance of the LMA and the laryngeal resistance, Rrs in LMA patients was still clearly lower than in ETT patients. Furthermore, resistance dropped rapidly only in ETT patients after ISF, a potent bronchodilator, suggesting that reversible bronchoconstriction was present in ETT patients but not LMA patients. We conclude that an LMA is a better choice of airway to minimize airway reaction.
Anesthesia ; Anesthesia, Inhalation ; Bronchoconstriction* ; Bronchodilator Agents ; Fentanyl ; Humans ; Intubation ; Intubation, Intratracheal* ; Isoflurane ; Laryngeal Masks* ; Laryngoscopy ; Male ; Oxygen ; Positive-Pressure Respiration ; Reflex ; Respiratory System ; Succinylcholine ; Thiopental ; Trachea

BACKGROUND: Intubation of the trachea frequently results in a rise in respiratory system resistance (Rrs) that is reversed by inhaled bronchodilators. In asthmatics, this reflex may occasionally result in profound bronchoconstriction, and anesthesiologists often try to avoid tracheal intubation if possible in asthmatics. The hypothesis of this study was that insertion of a laryngeal mask airway (LMA) would be less likely to result in reversible bronchoconstriction than would insertion of an endotracheal tube (ETT). METHODS: A total of 52 (45 male, 7 female) patients were randomized to placement of a 7.5 mm (females) or 8.0 mm (males) endotracheal tube or a #4 (females) or #5 LMA (males). Anesthesia was induced with 2 microgram/kg fentanyl and 5 mg/kg thiopental and airway placement facilitated with 1 mg/kg succinylcholine. After ensuring that a seal to greater than 20 cmH2O existed, Rrs was measured immediately following airway placement using the isovolumic method during positive pressure ventilation with oxygen. Correction was made for the resistance of the ETT but not for the resistance of the LMA, which was insignificant at the flows used. Inhalation anesthesia was then begun with isoflurane (ISF) to achieve an end-tidal concentration of 1.0% for ten minutes. Rrs was then measured again under identical conditions. In the LMA patients, fiberoptic laryngoscopy was then performed to ensure that the scope could be passed to the level of the cords without epiglottic obstruction. RESULTS: Among LMA patients, the initial Rrs was significantly lower than among ETT patients (9.2 0.7 vs 13.4 1.9 cmH2O/L/s, P <0.05). After 10 minutes of ISF, the resistance declined to 8.6 0.7 in the ETT group but remained unchanged at 9.1 0.7 cmH2O/L/s in the LMA group. The decline in Rrs in the ETT group of 4.7 1.4 cmH2O/L/s was highly significant compared to the lack of change in the LMA group (P <0.01). CONCLUSIONS: Despite the inclusion of the resistance of the LMA and the laryngeal resistance, Rrs in LMA patients was still clearly lower than in ETT patients. Furthermore, resistance dropped rapidly only in ETT patients after ISF, a potent bronchodilator, suggesting that reversible bronchoconstriction was present in ETT patients but not LMA patients. We conclude that an LMA is a better choice of airway to minimize airway reaction.
Anesthesia ; Anesthesia, Inhalation ; Bronchoconstriction* ; Bronchodilator Agents ; Fentanyl ; Humans ; Intubation ; Intubation, Intratracheal* ; Isoflurane ; Laryngeal Masks* ; Laryngoscopy ; Male ; Oxygen ; Positive-Pressure Respiration ; Reflex ; Respiratory System ; Succinylcholine ; Thiopental ; Trachea

Cough is one of the most common symptoms that can be occasionally very distressful and persistently troublesome. Chronic cough is usually defined as a cough persisting for three weeks or longer. The most common etiologies of chronic cough are postnasal drip, asthma, and gastroesophageal reflux, and more than one causes can be identified. Therapeutic trial with decongestants/first-generation antihistamines is usually effective in the diagnosis and management of postnasal drip syndrome. Even cough without postnasal drip can be improved with decongestant/antihistamine. Methacholline challenge bronchoprovocation test is indicated for the exclusion of asthma. The 24-hour esophageal pH monitoring is usually not indicated unless the symptoms are not improving despite the medical management and lifestyle modification for gastroesophageal reflux. Cough may be caused by gastroesophageal reflux in cases not complaining of heartburn or a sour taste in the mouth. Korean patients frequently confuse postnasal drip or throat clearing with sputum from the lower respiratory tract. There is an increasing attention to the pertussis in adults. The laryngeal spasm, that can cause a brief episode of choking sense with cough, is still not well recognized even among physicians. The bronchodilators are to frequently prescribed because many patients and physicians confuse throat clearing with cough or sputum. On the contrary, codein is too much reserved in the management of cough.
Adult ; Airway Obstruction ; Asthma ; Bronchodilator Agents ; Cough* ; Diagnosis ; Esophageal pH Monitoring ; Gastroesophageal Reflux ; Heartburn ; Histamine Antagonists ; Humans ; Laryngismus ; Life Style ; Mouth ; Pharynx ; Respiratory System ; Sputum ; Whooping Cough

The disorders of cardiac and pulmonary function as complications of scoliosis, have been described by numerous investigators since Hippocrates. The abnormalities of respiratory and cardiovascular function in scoliosis include reduced lung volume and compliance of the total respiratory system, arterial hypoxemia, which may be associated with hypercapnia, impaired chemical regulation of ventilation and increased pulmonary vascular resistance. We recently had experienced of two cases of severe scoliosis of Cesarean section (onse was a severe kyphoscoliotic patient) in Eul Zi Hospital, and was anesthetized with halothane or ethrane. The following conclusions were observed: 1) Arterial blood gas must be checked serially. 2) Anesthesiologists must know the degree of abnormality of the spine and the cardiopulmonary dysfunction. 3) During anesthesia, intermittent positive pressure breatheing(IPPB) or positive end expiratory pressure(PEEP) is needed for good oxygenation. 4) Intubation tube length and tube location are very important. 5) For treatment of postoperative complications, digitalization, bronchodilators, and mechanical ventilation may be needed.
Anesthesia ; Anoxia ; Bronchodilator Agents ; Cesarean Section* ; Compliance ; Enflurane ; Female ; Halothane ; Humans ; Hypercapnia ; Intubation ; Lung ; Oxygen ; Postoperative Complications ; Pregnancy ; Research Personnel ; Respiration, Artificial ; Respiratory System ; Scoliosis ; Spine ; Vascular Resistance ; Ventilation

OBJECTIVE: A significant concern has been raised about the emerging resistance that is largely caused by the excessive or inappropriate use of antibacterial agents for viral respiratory infections. This study investigated the trend of respiratory tract infections (RTIs) and the use of antibiotics. METHODS: Utilizing the national level health insurance claims data from 2005 to 2008, we examined encounter days, antibiotic use, and the prescription rate for respiratory tract infections including upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), and otitis media in outpatient settings. The antibiotic use was measured as defined daily dose per 1,000 patients per day (DDD/1,000 patients/day). RESULTS: The visit for URTI increased from 141,693,465 in 2005 to 120,717,966 in 2008 and the visit for LRTI decreased from 61,778,718 to 66,930,122. For RTIs, prescription rates of antibiotics decreased from 65.2% to 58.5% for URTIs and 76.9% to 68.3% for LRTIs from 2005 to 2008. The antibiotic use decreased to 20.85 DDD/1,000 patients/day after a significant increase of 22.01 DDD/1,000 patients/day in 2006. Among antibiotics, J01CR had the highest use- 7.93 DDD/1,000 patients/day followed by J01DC of 3.71 DDD/1,000 patients/day and J01FA of 3.2 DDD/1,000 patients/day. One notable trend is that J01FA presented a continuous increase in antibiotic use from 2.3 in 2005 to 3.26 DDD/1,000 patients/day in 2008. CONCLUSION: The use of antibiotics had poor compliance to guidelines for RTIs. Despite decrease in the use of antibiotics, prescription rates for URTIs were still about 50% indicating that the delayed prescribing antibiotics (or wait-and-see) were not observed.
Anti-Bacterial Agents ; Compliance ; Humans ; Insurance, Health ; Otitis Media ; Outpatients ; Prescriptions ; Respiratory System ; Respiratory Tract Infections

Common cold is a conventional term for a mild upper respiratory illness characterized by symptoms of nasal stuffiness, rhinorrhea, sneezing, sore throat, and cough. Management of the common cold is intended to provide temporary relief of symptoms until the cold completes its natural history, as well as to reduce the risk of complications. However, most studies for cold preparations focus on adults, and there are limited and conflicting evidences for children. Various preparations for cough/cold are available, which include antihistamines, decongestants, antitussives, expectorants, analgesics/antipyretics, and some combination products. Nonpharmacologic therapies are also important and it is generally agreed that such supportive cares should form the mainstay of treatment for children with common colds. Adverse effects of the specific types of cold preparations should be considered carefully for very young children. In addition, it is very important to educate parents about the natural course of common cold, along with appropriate use correct dosages and potential adverse effects of cold preparations.
Adult ; Antitussive Agents ; Child ; Cold Temperature ; Common Cold ; Cough ; Expectorants ; Histamine Antagonists ; Humans ; Infant ; Nasal Decongestants ; Natural History ; Parents ; Pharyngitis ; Sneezing

Benzodiazepine derivatives, chlordiazepoxide(Librium), diazepam(Valium), nitrazepam(Mogadon) and oxazepam(Serenid-D) are mainly used as hypnotics at present. Diazepam has been used mainly for premedication in anesthesia and as an intravenous anesthetic agent. The pharmacological actions of these drugs are tranquilizing effects for central nervous system, slight depression on the cardiovascular and respiratory system, anticonvulsant, anxiolytic and antidepressant effects. A new benzodiazepine derivative, Flunitrazepam(Ro 5-4200) has strong hypnotic action, is anticonvulsant and antidepressant in spite of slight depression of the cardiovascular and respiratory systems. Furthermore the onset and duration of this drug are shorter than the others. In our clinical study, flunitrazepam in the dosage of 0.005mg/kg was administered intravenously, as an intravenous anesthetic induction agent, for 22 surgical adult patients. In each patient, the blood pressure, pulse rate, respiratory rate, minutes volume and arterial gas study were done, before and after administration of the Ro 5-4200. The results are as follows; 1. Dosage of this flunitrazepam is not constant as other benzodiazepines. 2. The effects of flunitrazepam on the cardiovascular system showed slight depression but no effect by one hour post-operation. 3. In respiratory system, the minute volume was depressed slightly and the respiratory rate was increased but negligibly. 4. Undesirable side effects attributed to this drug were not found, except the developing of cough (one case).
Adult ; Anesthesia ; Benzodiazepines ; Blood Pressure ; Cardiovascular System ; Central Nervous System ; Clinical Study* ; Cough ; Depression ; Diazepam ; Flunitrazepam ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Premedication ; Respiratory Rate ; Respiratory System ; Tranquilizing Agents