Accurately identify the most likely etiology when patients present with a runny nose, sore throat, or earache, through history, diagnostic tests, and patient findings on examination, to enable the pharmacist to recommend effective treatment or refer the patient to an appropriate provider.
Use the knowledge of the pathophysiology, etiology, and common presentation of upper respiratory tract diseases to review prescription orders for appropriateness and to accurately educate patients about their disease and its treatment.
Use the knowledge of the pathophysiology, etiology, and common presentation of upper respiratory diseases to accurately interpret the diagnostic process to enable the pharmacist to advise providers regarding the most appropriate prescription therapy.
Common disorders of the upper respiratory tract are among the most frequent disorders dealt with by all health professionals. The runny or stuffy noses, earaches, and sore throats are universal afflictions dealt with by everyone. They may also be associated with a cough that is not the predominant symptom. Differential diagnosis of cough as the most significant symptom will be covered in more detail in the chapter 8. These symptoms can occur alone or in combination, and carefully identifying the cause can allow prompt and effective treatment or referral to definitive care.
Two common viral infections, allergic rhinitis, vasomotor rhinitis, and bacterial sinusitis make up the most common among the vast number of diseases that present with the chief complaint of a runny or stuffy nose. Table 7.1 provides the diagnostic schemata and comparative presentations.
||Download (.pdf) TABLE 7.1
|A. DIAGNOSTIC SCHEMATA FOR RUNNY/STUFFY NOSE |
| ||Bacterial Sinusitis |
|B. DIFFERENTIAL DIAGNOSIS OF STUFFY/RUNNY NOSE |
|SUBJECTIVE ||Cold ||Allergic Rhinitis ||Vasomotor Rhinitis ||“Flu”/Super Virus ||Bacterial Sinusitis |
|Location ||N/A ||N/A ||N/A ||N/A ||N/A |
|Onset ||“Feel cold coming on” slow onset (12 to 48 hours) symptoms that progressively worsen ||Relatively sudden onset. May be off and on ||Similar to allergic rhinitis ||Acute onset—quicker onset/progression than cold ||Cold lasts >7 days. Starts to get better or plateau, then gets worse or allergic rhinitis active in spite of antihistamines/ intranasal corticosteroids |
|Quantity ||Varies ||Usually copious ||Usually copious ||Varies ||Varies |
|Quality ||Nasal discharge that is initially clear and thin but progresses to mucoid, then to green tinged after 3 to 5 days ||Nasal discharge that is clear and watery ||Nasal discharge that is clear and watery ||Nasal discharge like cold ||Nasal discharge is purulent, opaque, foul tasting/smelling, and/or blood tinged, brown to dark yellow throughout the day |
|Setting ||September-March “others have it” ||March-September (may be year round) ||During dry, windy, dusty conditions ||September-March “others have it” ||After a cold or allergic rhinitis |
| || ||If seasonal, exposure to allergen || || || |
| || ||History of allergy || || || |
|Associated symptoms ||Minimal sneezing, feverish, cough usually worse at night, dry mild sore ...|