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Albuterol breathing treatment for bronchitis. Albuterol and Ipratropium Inhalation: A Comprehensive Guide for Respiratory Relief

by alexxlab

How does albuterol and ipratropium inhalation work. What are the proper techniques for using an inhaler or nebulizer. What precautions should be taken when using this medication. How can patients maximize the effectiveness of their treatment.

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Understanding Albuterol and Ipratropium Combination Therapy

Albuterol and ipratropium inhalation is a powerful combination therapy used to treat respiratory conditions such as bronchitis, chronic obstructive pulmonary disease (COPD), and asthma. This medication combines two bronchodilators that work in different ways to open up the airways and improve breathing.

Albuterol is a short-acting beta-2 agonist that relaxes the smooth muscles in the airways, while ipratropium is an anticholinergic that reduces mucus production and further relaxes the airway muscles. Together, they provide quick and effective relief from breathing difficulties.

How does this combination therapy work?

The albuterol component acts rapidly to dilate the bronchial tubes, providing quick relief from symptoms like wheezing and shortness of breath. Ipratropium, on the other hand, works more slowly but has a longer-lasting effect, helping to keep the airways open for an extended period. This dual-action approach makes the combination particularly effective for managing chronic respiratory conditions.

Proper Administration of Albuterol and Ipratropium Inhalation

Correct administration of albuterol and ipratropium inhalation is crucial for achieving optimal results. The medication is available in two forms: a solution for use with a nebulizer and a spray for use with an inhaler. Each form has specific instructions for proper use.

Using a Nebulizer

A nebulizer is a device that converts liquid medication into a fine mist that can be easily inhaled. To use albuterol and ipratropium with a nebulizer:

  1. Prepare the nebulizer according to the manufacturer’s instructions.
  2. Pour the prescribed amount of solution into the nebulizer cup.
  3. Connect the mouthpiece or mask to the nebulizer.
  4. Turn on the machine and breathe normally through the mouthpiece or mask until all the medication is used (usually about 5-15 minutes).
  5. Clean the nebulizer after each use to prevent contamination.

Using an Inhaler

The inhaler form of albuterol and ipratropium comes in cartridges designed to provide 120 inhalations. To use the inhaler correctly:

  1. Hold the inhaler upright with the orange cap closed.
  2. Turn the clear base in the direction of the white arrows until it clicks.
  3. Open the orange cap fully.
  4. Exhale completely, away from the inhaler.
  5. Place the mouthpiece between your lips and seal them around it.
  6. Inhale deeply and slowly through your mouth while pressing the dose release button.
  7. Hold your breath for 10 seconds, then exhale slowly.
  8. Close the orange cap.

Dosage and Frequency of Use

The typical dosage for albuterol and ipratropium inhalation is four times a day. However, it’s essential to follow your doctor’s specific instructions, as dosage may vary based on individual needs and the severity of the condition being treated.

Can additional doses be taken if symptoms persist?

In some cases, your doctor may advise using additional doses if you experience persistent symptoms such as wheezing, difficulty breathing, or chest tightness. However, it’s crucial to follow these instructions carefully and not exceed the recommended additional doses. For the nebulizer solution, no more than 2 extra doses per day should be used. With the inhalation spray, usage should not exceed six times in 24 hours.

If you find yourself needing extra doses more frequently, it’s important to contact your healthcare provider. This could indicate that your condition is worsening or that your current treatment plan needs adjustment.

Potential Side Effects and Precautions

While albuterol and ipratropium inhalation is generally well-tolerated, like all medications, it can cause side effects. Being aware of these potential effects and taking necessary precautions can help ensure safe and effective use of the medication.

Common side effects

  • Dry mouth
  • Cough
  • Headache
  • Nausea
  • Dizziness
  • Nervousness

Serious side effects requiring immediate medical attention

  • Chest pain
  • Irregular heartbeat
  • Severe dizziness or fainting
  • Allergic reactions (rash, itching, swelling)

One crucial precaution is to avoid getting the medication in your eyes. Albuterol and ipratropium can potentially cause or worsen narrow-angle glaucoma. If the medication comes into contact with your eyes, you may experience symptoms such as eye pain, redness, blurred vision, or seeing halos around lights. In such cases, rinse your eyes thoroughly with water and seek medical attention immediately.

Proper Maintenance and Storage of Inhalers

Proper maintenance and storage of your albuterol and ipratropium inhaler are essential for ensuring its effectiveness and longevity. Here are some key points to remember:

How should the inhaler be stored?

Store your inhaler at room temperature, away from direct sunlight and heat. Keep it in a dry place and avoid exposing it to extreme temperatures. Do not store it in the bathroom, as the humidity can affect the medication’s efficacy.

When should the inhaler be replaced?

Each cartridge of albuterol and ipratropium inhalation spray is designed to provide 120 inhalations, which typically lasts one month with regular use. The inhaler has a dose indicator on the side that keeps track of remaining medication. When the pointer enters the red area, it’s time to refill your prescription to avoid running out of medication.

It’s important to note that the inhaler should be discarded three months after assembly, regardless of whether all doses have been used. Mark the discard date on the inhaler label to help you remember.

Maximizing the Effectiveness of Albuterol and Ipratropium Inhalation

To get the most benefit from your albuterol and ipratropium inhalation therapy, consider the following tips:

  • Use the medication as prescribed, even if you’re feeling better.
  • Learn and practice proper inhalation technique to ensure you’re receiving the full dose.
  • Keep track of your symptoms and medication use to discuss with your healthcare provider.
  • Clean your inhaler or nebulizer regularly to prevent contamination and ensure proper functioning.
  • Always have a backup inhaler or medication supply on hand.

How can patients improve their inhalation technique?

Proper inhalation technique is crucial for the medication to reach the lungs effectively. Here are some tips to improve your technique:

  • Exhale completely before inhaling the medication.
  • Create a tight seal around the mouthpiece with your lips.
  • Inhale slowly and deeply when activating the inhaler.
  • Hold your breath for 5-10 seconds after inhalation to allow the medication to settle in your lungs.
  • Wait at least 30 seconds before taking a second puff if prescribed.

Consider asking your healthcare provider or a respiratory therapist to review your technique periodically to ensure you’re using the inhaler correctly.

Interactions and Contraindications

While albuterol and ipratropium inhalation is safe for most people when used as directed, it’s important to be aware of potential interactions with other medications and conditions that may contraindicate its use.

What medications may interact with albuterol and ipratropium?

Several medications can interact with albuterol and ipratropium, potentially altering their effectiveness or increasing the risk of side effects. These include:

  • Beta-blockers (used for heart conditions and high blood pressure)
  • Diuretics (water pills)
  • Other bronchodilators
  • Certain antidepressants
  • Monoamine oxidase inhibitors (MAOIs)

Always inform your healthcare provider about all medications you’re taking, including over-the-counter drugs and supplements, to avoid potential interactions.

Are there any conditions that preclude the use of this medication?

Certain medical conditions may contraindicate the use of albuterol and ipratropium inhalation or require special precautions. These include:

  • Narrow-angle glaucoma
  • Prostatic hypertrophy or bladder neck obstruction
  • Heart disease
  • High blood pressure
  • Diabetes
  • Thyroid disorders
  • Seizure disorders

If you have any of these conditions, discuss them with your healthcare provider before starting albuterol and ipratropium inhalation therapy. They may need to adjust your dosage or recommend alternative treatments.

Long-term Management of Respiratory Conditions with Albuterol and Ipratropium

While albuterol and ipratropium inhalation provides effective symptom relief, it’s important to view it as part of a comprehensive long-term management strategy for chronic respiratory conditions. This approach often involves a combination of medication, lifestyle changes, and regular medical follow-ups.

How can patients incorporate this medication into a broader treatment plan?

To effectively manage your respiratory condition over the long term:

  • Use albuterol and ipratropium inhalation as prescribed, alongside any other medications your doctor has recommended.
  • Develop and follow an action plan with your healthcare provider to manage symptom flare-ups.
  • Attend regular check-ups to monitor your condition and adjust treatment as needed.
  • Make lifestyle changes that support respiratory health, such as quitting smoking, maintaining a healthy weight, and avoiding triggers.
  • Consider pulmonary rehabilitation programs to improve your overall lung function and quality of life.

Remember, while albuterol and ipratropium inhalation is a powerful tool in managing respiratory conditions, it works best as part of a comprehensive treatment approach tailored to your individual needs.

What role does patient education play in successful treatment?

Patient education is crucial for the successful management of chronic respiratory conditions. Understanding your condition, its triggers, and how to use your medications correctly can significantly improve treatment outcomes. Consider the following educational aspects:

  • Learn about your specific respiratory condition and its long-term implications.
  • Understand how each of your medications works and why they’re prescribed.
  • Master proper inhaler or nebulizer technique through practice and regular review.
  • Recognize the signs of worsening symptoms and know when to seek medical help.
  • Stay informed about new developments in respiratory care and treatment options.

Your healthcare provider, pharmacist, or a respiratory therapist can be valuable resources for ongoing education and support. Don’t hesitate to ask questions or seek clarification about any aspect of your treatment plan.

Albuterol and Ipratropium Oral Inhalation: MedlinePlus Drug Information

The combination of albuterol and ipratropium comes as a solution (liquid) to inhale by mouth using a nebulizer (machine that turns medication into a mist that can be inhaled) and as a spray to inhale by mouth using an inhaler. It is usually inhaled four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use albuterol and ipratropium exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Your doctor may tell you to use additional doses of albuterol and ipratropium inhalation if you experience symptoms such as wheezing, difficulty breathing, or chest tightness. Follow these directions carefully, and do not use extra doses of medication unless your doctor tells you that you should. Do not use more than 2 extra doses of the nebulizer solution per day. Do not use the inhalation spray more than six times in 24 hours.

Call your doctor if your symptoms worsen, if you feel that albuterol and ipratropium inhalation no longer controls your symptoms, or if you find that you need to use extra doses of the medication more often.

If you are using the inhaler, your medication will come in cartridges. Each cartridge of albuterol and ipratropium inhalation spray is designed to provide 120 inhalations. This is enough medication to last one month if you use one inhalation four times a day. After you use all 120 doses, the inhaler will lock and will not release any more medication, There is a dose indicator on the side of the inhaler that keeps track of how much medication is left in the cartridge. Check the dose indicator from time to time to see how much medication is left. When the pointer on the dose indicator enters the red area, the cartridge contains enough medication for 7 days and it is time to refill your prescription so that you will not run out of medication.

Be careful not to get albuterol and ipratropium inhalation into your eyes. If you get albuterol and ipratropium in your eyes, you may develop narrow angle glaucoma (a serious eye condition that may cause loss of vision). If you already have narrow angle glaucoma, your condition may worsen. You may experience widened pupils (black circles in the center of the eyes), eye pain or redness, blurred vision, and vision changes such as seeing halos around lights, or seeing unusual colors Call your doctor if you get albuterol and ipratropium into your eyes or if you develop these symptoms.

The inhaler that comes with albuterol and ipratropium spray is designed for use only with a cartridge of albuterol and ipratropium. Never use it to inhale any other medication, and do not use any other inhaler to inhale the medication in a cartridge of albuterol and ipratropium.

Before you use albuterol and ipratropium inhalation for the first time, read the written instructions that come with the inhaler or nebulizer. Ask your doctor, pharmacist, or respiratory therapist to show you how to use it. Practice using the inhaler or nebulizer while he or she watches.

To prepare the inhaler for use, follow these steps:

  1. Put the inhaler together before you use it for the first time. To start, take the inhaler out of the box, and keep the orange cap closed. Press the safety catch and pull off the clear base of the inhaler. Be careful not to touch the piercing element inside of the base
  2. The inhaler must be discarded three months after you put it together. Write this date on the label of the inhaler so you will not forget when you need to discard your inhaler.
  3. Take the cartridge out of the box and insert the narrow end into the inhaler. You can press the inhaler against a hard surface to be sure it is inserted correctly. Replace the clear plastic base on the inhaler.
  4. Hold the inhaler upright with the orange cap closed. Turn the clear base in the direction of the white arrows until it clicks.
  5. Flip the orange cap so that it is fully open. Point the inhaler toward the ground.
  6. Press the dose release button. Close the orange cap.
  7. Repeat steps 4-6 until you see a spray coming out of the inhaler. Then repeat these steps three more times.
  8. The inhaler is now primed and ready for use. You will not need to prime your inhaler again unless you do not use it for longer than 3 days. If you do not use your inhaler for more than 3 days, you will need to release one spray toward the ground before you start to use it again. If you do not use your inhaler for more than 21 days, you will need to follow steps 4-7 to prime the inhaler again.

To inhale the spray using the inhaler, follow these steps:

  1. Hold the inhaler upright with the orange cap closed. Turn the clear base in the direction of the white arrows until it clicks.
  2. Open the orange cap.
  3. Breathe out slowly and completely.
  4. Place the mouthpiece in your mouth and close your lips around it. Be careful not to cover the air vents with your lips.
  5. Point the inhaler toward the back of your throat and breathe in slowly and deeply.
  6. While you are breathing in, press the dose release button. Continue to breathe in as the spray is released into your mouth.
  7. Hold your breath for 10 seconds or as long as you comfortably can.
  8. Take the inhaler out of your mouth and close the orange cap. Keep the cap closed until you are ready to use the inhaler again.

To inhale the solution using a nebulizer, follow these steps:

  1. Remove one vial of medication from the foil pouch. Put the rest of the vials back into the pouch until you are ready to use them.
  2. Twist off the top of the vial and squeeze all of the liquid into the reservoir of the nebulizer.
  3. Connect the nebulizer reservoir to the mouthpiece or face mask.
  4. Connect the nebulizer reservoir to the compressor.
  5. Put the mouthpiece in your mouth or put on the face mask. Sit in a comfortable, upright position and turn on the compressor.
  6. Breathe in calmly, deeply, and evenly through your mouth for about 5 to 15 minutes until mist stops forming in the nebulizer chamber.

Clean your inhaler or nebulizer regularly. Follow the manufacturer’s directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your inhaler or nebulizer.

Albuterol Sulfate Inhalation: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Read the Patient Information Leaflet provided by your pharmacist before you start using this medication and each time you get a refill. This medication is used with a special machine called a nebulizer that changes the solution to a fine mist that you inhale. Learn all instructions for the use of this medication and the nebulizer. If a child is using this medication, a parent or other responsible adult should supervise the child. If you have any questions, consult your doctor, pharmacist, or respiratory therapist.

This product should be clear and colorless to light yellow. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Use the dropper supplied by the manufacturer to carefully measure the prescribed amount of medication and place in the nebulizer with sterile saline as directed. If you are using the single dose package, empty the contents of the package in the nebulizer and add sterile saline as directed. Gently swirl the nebulizer to mix the solution.

Do not rinse the dropper. Replace the dropper and tightly close the bottle after each use. To avoid contamination, do not touch the dropper tip or let it touch any other surface. Discard any unused mixed solution. Do not save for future use.

Using a mouthpiece or face mask with the nebulizer, inhale the prescribed dose of medication into your lungs as directed by your doctor, usually 3 or 4 times daily as needed. Each treatment usually takes about 5 to 15 minutes. Use this medication only through a nebulizer. Do not swallow or inject the solution. Do not mix with other medicines in your nebulizer. To prevent infections, clean the nebulizer and mouthpiece/face mask according to the manufacturer’s directions.

Dosage is based on your medical condition, age, weight, and response to treatment. Do not increase your dose or use this drug more often than prescribed without your doctor’s approval. Using too much of this medication will increase your risk of serious (possibly fatal) side effects.

Learn which of your inhalers/medications you should use every day (controller drugs) and which you should use if your breathing suddenly worsens (quick-relief drugs). Ask your doctor ahead of time what you should do if you have new or worsening cough or shortness of breath, wheezing, increased sputum, worsening peak flow meter readings, waking up at night with trouble breathing, if you use your quick-relief inhaler/medication more often (more than 2 days a week), or if your quick-relief inhaler/medication does not seem to be working well. Learn when you can treat sudden breathing problems by yourself and when you must get medical help right away.

Tell your doctor if your symptoms do not improve or if they worsen.

The Diagnosis and Treatment of Wheezing

How Do I Find Out the Cause of My Wheezing?

To determine the cause of your wheezing, your doctor will ask questions about your symptoms and what triggers them. For example, if you have no history of lung disease and you always wheeze after eating a certain food or at a certain time of year, the doctor may suspect that you have a food or respiratory allergy.

The doctor will listen to your lungs with a stethoscope to hear where the wheezing is and how much wheezing you have.

If this is the first time you’ve been evaluated, your doctor will probably ask you to perform a breathing test (spirometry) and may also order a chest X-ray.

Other blood tests and procedures may be necessary, depending on what the doctor learns from interviewing and examining you.

If it seems like allergies may be related to your wheezing, there are a variety of other tests your doctor may use to verify allergies, including skin testing or blood tests.

What Are the Treatments for Wheezing?

First off, see a doctor to determine the cause of your wheezing and then receive treatment for the specific cause.

If wheezing is caused by asthma, your doctor may recommend some or all of the following to reduce inflammation and open the airways:

  • A fast-acting bronchodilator inhaler — albuterol (Proventil HFA, Ventolin HFA), levalbuterol (Xopenex) — to dilate constricted airways when you have respiratory symptoms
  • An inhaled corticosteroid — beclomethasone (Qvar), budesonide (Pulmicort), ciclesonide (Alvesco), flunisolide (Aerospan), fluticasone (Flovent), mometasone (Asmanex)
  • A long-acting bronchodilator/corticosteroid combination — budesonide/formoterol (Symbicort), fluticasone/salmeterol (Advair)
  • A long-acting anticholinergic — tiotropium bromide (Spiriva Respimat). This drug is used in addition to a regular maintenance medication for better symptom control, and is available for use by anyone age 6 years and older.
  • An asthma controller pill to reduce airway inflammation — montelukast (Singulair), zafirlukast (Accolate)
  • A non-sedating antihistamine pill — cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin, Alavert) — or a prescription nasal spray — budesonide (Rhinocort), fluticasone propionate (Flonase), mometasone furoate (Nasonex), triamcinolone acetonide (Nasacort AQ) — if you have nasal allergies. Flonase, Nasacort Allergy 24HR and Rhinocort Allergy are also available over the counter.

If you have acute bronchitis, your doctor may recommend some or all of the following:

Generally, any mild wheezing that accompanies acute bronchitis disappears when the infection does.

Call 911 if you have any difficulty breathing. In emergencies, a medical team may administer any of the following:

What Do I Need to Know?


Choose an AuthorAaron Barber, AT, ATC, PESAbbie Roth, MWCAdam Ostendorf, MDAdriane Baylis, PhD, CCC-SLPAdrienne M. Flood, CPNP-ACAdvanced Healthcare Provider CouncilAila Co, MDAlaina White, AT, ATCAlana Milton, MDAlana Milton, MDAlecia Jayne, AuDAlessandra Gasior, DOAlex Kemper, MDAlexandra Funk, PharmD, DABATAlexandra Sankovic, MDAlexis Klenke, RD, LDAlice Bass, CPNP-PCAlison PeggAllie DePoyAllison Rowland, AT, ATCAllison Strouse, MS, AT, ATCAmanda E. Graf, MDAmanda Smith, RN, BSN, CPNAmanda Sonk, LMTAmanda Whitaker, MDAmber Patterson, MDAmberle Prater, PhD, LPCCAmy Coleman, LISWAmy Dunn, MDAmy E. Valasek, MD, MScAmy Fanning, PT, DPTAmy Garee, CPNP-PCAmy Hahn, PhDAmy HessAmy Leber, PhDAmy LeRoy, CCLSAmy Moffett, CPNP-PCAmy Randall-McSorley, MMC, EdD CandidateAnastasia Fischer, MD, FACSMAndala HardyAndrea Brun, CPNP-PCAndrea M. 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Acute uncomplicated bronchitis

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Author: John G.Bartlett, MD

Exciters:

  • Viruses: rhinovirus, parainfluenza virus, coronavirus, respiratory syncytial virus, metapneumovirus
  • Influenza: the only treatable virus
  • Chlamydophila pneumonia
  • Mycoplasma pneumonia
  • Whooping cough ( Bordetella pertussis )
  • Other factors: allergens, smoking, toxic fumes

Clinic:

  • Medical history : acute respiratory tract infection, cough is the predominant complaint
  • Physical examination : Fever is predominant in influenza or parainfluenza.On examination of the lungs, wheezing or stridorious breathing may be found, but not a crunch or signs of damage to the lung tissue.
  • Differential diagnosis for cough: subclinical asthma, postnasal drip *, allergy, whooping cough, chronic heart failure, GERD, neoplasm, reaction to ACE inhibitors

Diagnostics

  • Clinical diagnosis is based on symptom complex and physical examination to rule out pneumonia.
  • Indications for carrying out Rg chest : abnormal symptoms (heart rate> 100, temperature> 38 90 112 o 90 113 C, NPV> 20) or wheezing and cough> 3 weeks.

Treatment

Etiological treatment:

  • Principles : diagnosis = upper respiratory tract infection + cough. The doctor needs to exclude asthma, GERD, cancer, postnasal syndrome.Rg-examination of the chest only to exclude pneumonia, when abnormal signs appear. No antibiotics in treatment except for whooping cough.
  • Indications for antimicrobial therapy : Suspected whooping cough or influenza. If influenza is suspected, the appointment of anti-influenza drugs no later than 48 hours from the serological determination of the type of pathogen.
  • Influenza (see related module): Avian influenza medication should be considered if symptoms do not appear
  • Exceptions to antibiotic prescribing guidelines ( NICE): Antibiotics are prescribed in case of:

§

Serious comorbidities,

§

for immunocompromised patients,

§

age> 65 years plus diabetes,

§ heart failure

§

hospitalization within the last few years

  • Antitussives : codeine-containing drugs or dextromethorphan ( in the Russian Federation is presented as part of combined agents for symptomatic treatment / poisk_preparatov / lact_307.htm)
  • Colds: dexbrompheniramine (Russia is not represented, sold under the name Drixoral in the USA and Canada) and sedative antihistamines +/- decongestants (Actifed, Contac, Dimetapp are not presented in Russia, Actifed is available in Ukraine ), naproxen 500 mg 3 r / day PO x 5 days and / or atrovent nasal spray.
  • Allergic rhinitis: e.g. loratadine 10 mg PO once daily
  • Sinusitis: +/- antibiotic for severe symptoms or> 7 days of symptoms (efficacy unknown)
  • Exacerbation of chronic bronchitis : see relevant topic
  • Cough or bronchospasm (infectious-induced): inhaled albuterol, 2 inhalations every 4 to 6 hours.
  • If the cough lasts more than 3 weeks: it is necessary to exclude asthma, GERD, whooping cough, cancer.

Suspected or confirmed whooping cough

  • Antibiotics should not be used for bronchitis unless there is a suspected or confirmed case of whooping cough.
  • Most adult patients do not have typical whooping cough symptoms due to partial immunity. The most important clue will be severe paroxysms of cough for more than 3 weeks, a convulsive noisy gasp after coughing, or post-cough vomiting.
  • Preferred tests: nasopharyngeal swab for PCR and / or culture (insensitive)
  • Whooping cough: Erythromycin 500 mg PO 4 r / d x 14 days or azithromycin 250 mg PO 1 r / d x 4 days. Most people choose to use azithromycin because of the side effects of erythromycin.
  • Alternative: trimethoprim-sulfamethoxazole 1 DS 2 po x 14 days or clarithromycin 500 mg PO 2 po x 14 days.

Conclusion:

  • It is better for a patient who is scheduled for antibiotic-free therapy to say that he has “chilled chest” and not to use the term “bronchitis”
  • If there are abnormal symptoms (t> 38 90 112 o 90 113 C, heart rate> 100, respiratory rate> 20) and realizing that this is obviously not influenza, it is necessary to conduct Rg-lungs to exclude pneumonia.
  • However, the use of antibiotics is no less clear than the use of antibiotics under the NICE criteria (mentioned above)

Additional information

  • Several well-controlled studies indicate that antibiotic use is not warranted.
  • Academics continue to argue that antibiotics are ineffective, but the Cochrane Library has backed up this claim by careful analysis of the data.
  • NICE Review recommends antibiotics for patients with comorbidities and advanced age
  • Indications for antibiotics: severe exacerbations of chronic bronchitis, some cases of influenza and whooping cough

Literary sources :

  • Snow V, Mottur-Pilson C, Gonzales R; American Academy of Family Physicians; American College of Physicians-American Society of Internal Medicine; Centers for Disease Control; Infectious Diseases Society of America .Principles of appropriate antibiotic use for treatment of acute bronchitis in adults. Ann Intern Med. 2001 Mar 20; 134 (6): 518-20 http: // annals. org / article. aspx? articleid = 714360 is only available with a paid subscription.
  • Irwin RS, Madison JM. The diagnosis and treatment of cough . N Engl J Med. 2000 Dec 7; 343 (23): 1715-21. Full text at link http://www.nejm.org/doi/full/10.1056/NEJM200012073432308

* postnasal drip – there is still no generally accepted term in Russian. The essence of the syndrome is in patients’ complaints about the sensation of accumulation of mucus in the posterior parts of the nasal cavity and its flowing down the posterior wall of the pharynx. More details can be read, for example, here – http://www.consilium-medicum.com/article/16060

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