From the Guidelines
The patient with influenza and shortness of breath (SOB) despite a clear chest X-ray should be treated with Oseltamivir (Tamiflu) 75mg orally twice daily for 5 days if they present within 48 hours of symptom onset, as recommended by 1.
Recommendation
- Administer Oseltamivir (Tamiflu) 75mg orally twice daily for 5 days to reduce the severity and duration of flu symptoms, as supported by 1 and 1.
- For symptom relief, consider acetaminophen (Tylenol) 650mg orally every 4-6 hours as needed for fever and body aches, not to exceed 4 grams in 24 hours.
- Encourage the patient to stay hydrated by drinking plenty of fluids.
- Monitor oxygen saturation levels and provide supplemental oxygen if the saturation level falls below 92% on room air.
- Consider a bronchodilator such as albuterol via inhaler for acute relief of bronchospasm if the patient has a history of asthma or COPD, or if wheezing is present, as suggested by 1 and 1.
It is crucial to closely monitor the patient's condition for any signs of worsening, such as increased respiratory distress, chest pain, or decreased oxygen saturation, which may necessitate further evaluation and potential hospitalization, as emphasized by 1 and 1.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
2.1 Dosage and Administration Overview Administer oseltamivir phosphate for oral suspension for the treatment of influenza in patients 2 weeks of age or older 2. 2 Recommended Dosage for Treatment of Influenza Initiate treatment with oseltamivir phosphate for oral suspension within 48 hours of influenza symptom onset.
The patient is experiencing shortness of breath (SOB) with a clear chest X-ray, but the provided drug label for oseltamivir does not directly address the treatment for SOB in patients with influenza.
- Treatment with oseltamivir may be appropriate if initiated within 48 hours of influenza symptom onset, but it does not specifically address the symptom of shortness of breath.
- The label does provide dosage recommendations for the treatment of influenza in various patient populations, but it does not provide guidance on managing specific symptoms like SOB. 2
From the Research
Treatment for Influenza with Shortness of Breath
- For a patient with influenza who has a clear chest X-ray but is experiencing shortness of breath (SOB), the appropriate treatment is not directly stated in the provided studies 3, 4, 5, 6, 7.
- However, the studies suggest that shortness of breath can be a symptom of various underlying conditions, including pulmonary embolism, acute heart failure, and severe pneumonia 3, 6.
- In patients with shortness of breath, it is essential to determine the underlying cause of the symptom, as treatment will depend on the specific diagnosis 4, 7.
- The use of semi-automatic decision support tools, such as the Netherlands Triage Standard (NTS), may not always accurately allocate urgency levels for patients with shortness of breath 6.
- Further evaluation, including diagnostic tests and clinical assessment, may be necessary to determine the appropriate treatment for a patient with influenza and shortness of breath 5, 7.
Diagnostic Considerations
- A clear chest X-ray does not rule out the possibility of underlying conditions that may be causing shortness of breath, such as pulmonary embolism or acute heart failure 3, 6.
- Diagnostic tests, such as CT scans or spirometry, may be necessary to determine the underlying cause of shortness of breath 3, 5.
- Clinical evaluation, including patient history and physical examination, is also essential in determining the appropriate treatment for a patient with influenza and shortness of breath 4, 7.