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QUESTION: My mom went to eR doctor and doc said she had bronchitis. Well my question. Is she was prescribed azithromycin for 4 days and prednizone for 4 or 5 days. My question is would longer treatment be better as she requested it to doc but that's what she was prescribed pls advise. Also I noticed doctor only checked her with stethoscope on back shouldn't she have had her dovdeep breathing and put stethoscope near heart or have med practices changed?

ANSWER: Hi Kim,
   ER practices today have gotten weaker, if the presentation does not appear life-threatening.  It seems as if the organizations are pushing the docs to increase volume, at the sacrifice of proper diagnostic workup. As in this case, 90% of bronchitis is viral, which would be noted in a CBC (complete blood count). The guidelines are specific in that you do not prescribe antibiotics without evidence of bacterial infection. This is a major reason for antibiotic resistance. If your mother has asthma, there are only 2 bacteria that trigger asthma: chlamydia pneumonia and mycoplasma pneumonia...and the antibiotic of choice for both is azithromycin.  But viral respiratory infections also trigger the inflammation...so it is imperative to verify the cause. We are finding that azithromycin is showing less effectiveness due to overuse.
  Regarding length of therapy..azithromycin ( 2 tabs to start, then  tab daily for  more days ) actually provides coverage for 10 full days. The guideline for prednisone, hoping the patient has a peak flow meter with up-to-date personal best numbers, is taking the prednisone until peak flow values return to 80% of normal. For the coughing, using an albuterol inhaler works best. Cough syrups don't provide much relief since they don't open the inflammed airways. It is not uncommon to use a combo asthma drug, e.g. Advair, or Symbicort, to both reduce the inflammation and keep the airways open. Bronchitis due to viral infection can last 6-8 weeks. Therefore, inhalation steroid would not have the adverse effect of long-term oral prednisone, and would not have to be weaned off.
  Hopefully this helps you.

Sincerely,

Marc

---------- FOLLOW-UP ----------

QUESTION: So my mom was diagnosed with bronchitis. So is this viral? She was prescribed antibiotic for 4 or 5 days and prednisobe 4 or 5 days. SD o r u saying she should have got antibiotics or prednisobe for 10 days? What is the best cough syrup for coughing?

ANSWER: Hi Kim,
  Never got the notice of your request from All Experts..

  No...that is not what I'm saying.  Docs are often improperly prescribing antibiotics without testing first if there is actually a bacterial infection. Antibiotics are not used in viral infections. 90% of bronchitis cases are due to viruses, so, unless the diagnosis of a bacterial infection is confirmed by actual testing, they should not be prescribed. The 5 day prednisone dose is more appropriate, and is sometimes given in conjunction with a steroid/bronchodilator inhaler to improve breathing and reduce coughing. These are commonly prescribed in asthma and COPD patients. THis is the best approach for the coughing since the cough is due to airway inflammation and airway narrowing: both issues addressed by the combo inhaler (Advair/Symbicort or Dulera)

Sorry for the delay  

Sincerely,

Marc

---------- FOLLOW-UP ----------

QUESTION: Hi thanks so prednisobe wasn't good thing to prescribe her? Prednisobe always seems to help my Mom it seems. Also u didnt answer my ques about stethescope. Didn't seem doc checked her breathing with my mom taking deep breaths. Only checked from her back. Is this common practices at er care centers?

Answer
Hi Kim, and Merry Christmas!
   Hope your mom is doing better!
   Regarding common practice...I've never been trained (nor any other pharmacists in the course of professional development) in using a stethoscope. If your mother is rather large busted, I'd conjecture that the sounds from the front may be suppressed. Also, the front approach would also be appropriate for listening to heart sounds. Finally, like in all fields, there are those who are passionate about their work, and thus, very thorough, and then the average "Joe" who treats it as a job.
    Have a wonderful day today!

Sincerely,
  Marc

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Marc Rubin, RPh Asthma Educator

Expertise

I have worked directly with patients as well as caregivers for over 30 years. Have made presentations throughout Illinois educating school nurses as well as the teaching and coaching staff of public schools about asthma, and how they should respond to these students needs. Presented a public education program on asthma through the US Department of Public Health. Specialize in helping guide asthmatic patients to take control of their disease in order to live a near-normal, fully active life.

Experience

Practicing pharmacist for 40 years, specializing in asthma and COPD for 12 years. Developed nationwide education to nurses, teachers and athletic coaches regarding asthma and exercise induced bronchospasm. In addition, and closer to home. my daughter has asthma, and my son has exercise induced bronchospasm. In addition, I serve on the boards and committees of a number of asthma organizations: Sports, Exercise and Fitness Committee of AAAAI, Population Health Committee and Sports Medicine Committee of ACAAI, Sports Medicine Committee of the World Allergy Association. Board of Directors of the Chicago Asthma Consortium, Board of Directors of the Christopher D. Redding Youth Asthma Foundation, as well as the advisory board of a medical education company, Emmi Solutions. Directly involved in the creation of public education programs for asthma, COPD and diabetes.

Organizations
American Academy of Allergy, Asthma and Immunology / Sports Medicine Committee, American College of Allergy, Asthma and Immunology / Population Health Committee and Sports Medicine, American College of Chest Physicians, American Thoracic Society. World Allergy Association, Chicago Asthma Consortium / Professional Development Committee, Christopher D. Redding Youth Asthma Foundation, and Respiratory Health Association of Metropolitan Chicago: Development Committee for AE-C prep class, and presenter.

Publications
AAAAI PowerPoint on the new guidelines for EIB (Exercise Induced Bronchospasm), AAAAI Powerpoint on Asthma in School Setting for Teachers and Coaches, Annals of Allergy, Asthma and Immunology: Transition guide for teens with food allergies or asthma going out of the home to live independantly.

Education/Credentials
BScPharm, RPh, (NAECB Certified asthma educator in 2002), NIPCO Certified Respiratory Care Pharmacist

Past/Present Clients
Emmi Solutions, Chicago Next Level Health, Chicago

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