What is the best approach to diagnose and manage respiratory symptoms such as cough or shortness of breath?

From the Guidelines

The best approach to diagnose and manage respiratory symptoms like cough or shortness of breath begins with a thorough medical evaluation to identify the underlying cause, starting with a detailed history and physical examination, including respiratory auscultation, followed by appropriate diagnostic tests such as chest X-ray, pulmonary function tests, or blood work depending on the suspected diagnosis. This approach is supported by the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society guidelines 1.

Key Components of Diagnosis

• A detailed history to determine the duration and characteristics of the cough or shortness of breath, as well as any potential risk factors such as smoking history or exposure to environmental pollutants 1.
• Physical examination, including respiratory auscultation to identify signs of respiratory disease such as wheezing, crackles, or decreased breath sounds 1.
• Diagnostic tests such as chest X-ray to rule out other diseases that may cause similar symptoms and signs, and pulmonary function tests to assess for airflow obstruction 1.

Management Strategies

• For acute cough due to viral infections, supportive care with rest, hydration, and over-the-counter medications like dextromethorphan (15-30mg every 6-8 hours) for cough suppression or guaifenesin (200-400mg every 4 hours) to thin mucus may help 1.
• For bacterial infections, antibiotics such as amoxicillin (500mg three times daily for 5-7 days) or azithromycin (500mg on day one, then 250mg daily for 4 days) might be prescribed 1.
• For asthma-related symptoms, inhaled bronchodilators like albuterol (2 puffs every 4-6 hours as needed) and corticosteroids such as fluticasone (1-2 puffs twice daily) are typically used 1.
• COPD management often includes long-acting bronchodilators like tiotropium (18mcg once daily) or combination inhalers 1.

Lifestyle Modifications

• Smoking cessation is crucial for patients with respiratory symptoms, as it can help improve lung function and reduce the risk of further respiratory disease 1.
• Avoiding triggers such as environmental pollutants or allergens can also help manage respiratory symptoms 1.
• Pulmonary rehabilitation is an essential component of long-term management for chronic respiratory conditions, and can help improve quality of life and reduce symptoms 1.

The approach must be individualized based on the specific diagnosis, severity of symptoms, and patient characteristics, and should prioritize reducing morbidity, mortality, and improving quality of life 1.

From the FDA Drug Label

• LABA medicines such as salmeterol help the muscles around the airways in your lungs stay relaxed to prevent symptoms, such as wheezing, cough, chest tightness, and shortness of breath.

• Wixela Inhub® is used for asthma and COPD as follows: Asthma: o Wixela Inhub® is a prescription medicine used to control symptoms of asthma and to prevent symptoms such as wheezing in adults and children aged 4 years and older. COPD: Wixela Inhub® 250/50 is a prescription medicine used to treat COPD.

The best approach to diagnose and manage respiratory symptoms such as cough or shortness of breath is to use a combination of inhaled corticosteroid (ICS) medicine and long-acting beta2-adrenergic agonist (LABA) medicine, such as Wixela Inhub®, under the guidance of a healthcare provider.

• Asthma diagnosis and management: Wixela Inhub® can be used to control symptoms of asthma and prevent symptoms such as wheezing in adults and children aged 4 years and older.
• COPD diagnosis and management: Wixela Inhub® 250/50 can be used to treat COPD and improve symptoms of COPD for better breathing and to reduce the number of flare-ups. 2

From the Research

Diagnostic Approach

• Respiratory auscultation is a fundamental diagnostic tool for respiratory conditions, and the stethoscope is used as the first line diagnostic tool in assessing patients with pulmonary symptoms 3, 4.
• However, the diagnostic accuracy of lung auscultation has been debated, with a meta-analysis showing a low sensitivity of 37% and specificity of 89% for lung auscultation in adult patients with acute pulmonary pathologies 3.
• The use of digital stethoscopes and artificial intelligence (AI) may enhance the accuracy and reliability of lung sound analysis, and potentially standardize sound categorization and improve diagnostic accuracy 5.

Management of Respiratory Symptoms

• Bronchodilators are central in the treatment of airways disorders, and are the mainstay of the current management of chronic obstructive pulmonary disease (COPD) and are critical in the symptomatic management of asthma 6.
• The use of inhaled route is currently preferred to minimize systemic effects, and fast- and short-acting agents are best used for rescue of symptoms, whereas long-acting agents are best used for maintenance therapy 6.
• The incorporation of once-daily dose administration is an important strategy to improve adherence, and several once-daily β(2)-AR agonists or ultra-long-acting β(2)-AR-agonists (LABAs) are already in the market or under development for the treatment of COPD and asthma 6.

Clinical Practice

• Auscultation of the lung is an important part of the respiratory examination and is helpful in diagnosing various respiratory disorders, and it is necessary to distinguish normal respiratory sounds from abnormal ones 4.
• Bedside teaching should be strengthened to avoid erosion in this age-old procedure in the era of technological explosion 4.
• The correct procedure for respiratory assessments using a stethoscope, including how to use a stethoscope and how to interpret findings, is essential for accurate diagnosis and management of respiratory symptoms 7.