Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2866_Библиотеки_им_академика_М_И_Перельмана.pdf
Chapter 10. Obesity
12. Jay M, Gillespie C, Schlair S, Sherman S, Kalet A.Physicians’ use
of the 5As in counseling obese patients: is the quality of counseling associated with patients’ motivation and intention to lose
weight? BMC Health Serv Res. 2010;10:159.
13. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley
DL, Jastreboff AM, et al. American Association of Clinical
Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of
patients with obesity. Executive summary complete guidelines available at https://www.aace.com/publications/guidelines.
Endocr Pract. 2016;22(7):842–84.
14. Silk AW, McTigue KM.Reexamining the physical examination
for obese patients. JAMA. 2011;305(2):193–4.
15. Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire: a
practical approach to screen for obstructive sleep apnea. Chest.
2016;149(3):631–8.
16. Sharma AM, Kushner RF.A proposed clinical staging system for
obesity. Int J Obes. 2009;33(3):289–95.
1 7. Atlantis E, Sahebolamri M, Cheema BS, Williams K.Usefulness
of the Edmonton Obesity Staging System for stratifying the presence and severity of weight-related health problems in clinical
and community settings: a rapid review of observational studies.
Obes Rev. 2020;21(11):e13120.
18. Bray GA, Fruhbeck G, Ryan DH, Wilding JP. Management of
obesity. Lancet. 2016;387(10031):1947–56.
19. Vallis M.Quality of life and psychological well-being in obesity
management: improving the odds of success by managing distress. Int J Clin Pract. 2016;70(3):196–205.
20. Look ARG. Eight-year weight losses with an intensive lifestyle
intervention: the look AHEAD study. Obesity (Silver Spring).
2014;22(1):5–13.
21. Diabetes Prevention Program Research Group, Knowler WC,
Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, et al.
10-year follow-up of diabetes incidence and weight loss in
the Diabetes Prevention Program Outcomes Study. Lancet.
2009;374(9702):1677–86.
22. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton
SD, et al. Comparison of weight-loss diets with different
compositions of fat, protein, and carbohydrates. N Engl J Med.
2009;360(9):859–73.
23. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S,
Greenberg I, et al. Weight loss with a low-carbohydrate,
Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229–41.
229
230
J. S. Ruddock and G. Goswami
24. Wylie-Rosett J, Davis NJ.Low-carbohydrate diets: an update on
current research. Curr Diab Rep. 2009;9(5):396–404.
25. Makris A, Foster GD. Dietary approaches to the treatment of
obesity. Psychiatr Clin North Am. 2011;34(4):813–27.
26. Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric
intake at breakfast vs. dinner differentially influences weight
loss of overweight and obese women. Obesity (Silver Spring).
2013;21(12):2504–12.
2 7. Garaulet M, Gomez-Abellan P, Alburquerque-Bejar JJ, Lee YC,
Ordovas JM, Scheer FA.Timing of food intake predicts weight
loss effectiveness. Int J Obes. 2013;37(4):604–11.
28. Sun M, Feng W, Wang F, Li P, Li Z, Li M, etal. Meta-analysis
on shift work and risks of specific obesity types. Obes Rev.
2018;19(1):28–40.
29. Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA,
Melanson EL. Effectiveness of intermittent fasting and timerestricted feeding compared to continuous energy restriction for
weight loss. Nutrients. 2019;11(10):2442.
30. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG,
Donato KA, etal. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the
American College of Cardiology/American Heart Association
task Force on practice guidelines and The Obesity Society.
Circulation. 2014;129(25 Suppl 2):S102–38.
31. Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz
RI, etal. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011;365(21):1969–79.
32. Sharretts J, Galescu O, Gomatam S, Andraca-Carrera E, Hampp
C, Yanoff L.Cancer risk associated with lorcaserin—the FDA’s
review of the CAMELLIA-TIMI 61 trial. N Engl J Med.
2020;383(11):1000–2.
33. Sjostrom L.Review of the key results from the Swedish Obese
Subjects (SOS) trial—a prospective controlled intervention
study of bariatric surgery. J Intern Med. 2013;273(3):219–34.
34. Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL,
Nanjee MN, etal. Weight and metabolic outcomes 12 years after
gastric bypass. N Engl J Med. 2017;377(12):1143–55.
35. Yanovski SZ.Weight management in adults with Obesity: what
is a primary care clinician to do? JAMA. 2018;320(11):1111–3.
36. Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe
AM, Kim J, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients
Chapter 10. Obesity
undergoing bariatric procedures—2019 update: cosponsored by
American Association of Clinical Endocrinologists/American
College of Endocrinology, the Obesity Society, American
Society for Metabolic & Bariatric Surgery, Obesity Medicine
Association, and American Society of Anesthesiologists—executive summary. Endocr Pract. 2019;25(12):1346–59.
3 7. Mehta M, Istfan NW, Apovian CM.Obesity: overview of weight
management. Endocr Pract. 2021;27(6):626–35.
38. Stanford FC, Alfaris N, Gomez G, Ricks ET, Shukla AP, Corey
KE, etal. The utility of weight loss medications after bariatric
surgery for weight regain or inadequate weight loss: a multicenter study. Surg Obes Relat Dis. 2017;13(3):491–500.
39. Ibrahim N, Alameddine M, Brennan J, Sessine M, Holliday C,
Ghaferi AA.New onset alcohol use disorder following bariatric
surgery. Surg Endosc. 2019;33(8):2521–30.
40. Aronne LJ, Wadden TA, Peterson C, Winslow D, Odeh S, Gadde
KM. Evaluation of phentermine and topiramate versus phentermine/topiramate extended-release in obese adults. Obesity
(Silver Spring). 2013;21(11):2163–71.
41. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF,
Lingvay I, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989.
42. Davies M, Faerch L, Jeppesen OK, Pakseresht A, Pedersen SD,
Perreault L, et al. Semaglutide 2.4 mg once a week in adults
with overweight or obesity, and type 2 diabetes (STEP 2): a
randomised, double-blind, double-dummy, placebo-controlled,
phase 3 trial. Lancet. 2021;397(10278):971–84.
43. Wadden TA, Bailey TS, Billings LK, Davies M, Frias JP, Koroleva
A, etal. Effect of subcutaneous semaglutide vs placebo as an
adjunct to intensive behavioral therapy on body weight in adults
with overweight or obesity: the STEP 3 randomized clinical trial.
JAMA. 2021;325(14):1403–13.
44. Rubino D, Abrahamsson N, Davies M, Hesse D, Greenway FL,
Jensen C, etal. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with
overweight or obesity: the STEP 4 randomized clinical trial.
JAMA. 2021;325(14):1414–25.
231
Part III
Respiratory
Chapter 11
Cough
IsraaSoghier andKiyoshiKinjo
Brief Introduction
Cough is one of the most common presentations to both primary and secondary care providers. Globally, the prevalence
of chronic cough is estimated at 9.6% of adults [1]. In most
cases, the cause of cough can be identified with history taking,
physical examination, and simple diagnostic tests. Sometimes,
chronic cough can be challenging to manage and will require
referral to a specialist.
Decision-Making/Differential Diagnosis
The first step to determine the etiology of cough is to estimate the duration of the symptom at the time of presentation
to the provider. Acute cough lasts for less than 3weeks while
I. Soghier (*)
Division of Pulmonary Critical Care, Department of Medicine,
Massachusetts General Brigham/Salem Hospital, Salem, MA, USA
e-mail: ISoghier@partners.org
K. Kinjo
Division of General Medicine, Department of Internal Medicine,
Okinawa Chubu Hospital, Uruma City, Okinawa, Japan
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2022
E. Sydney et al. (eds.), Handbook of Outpatient Medicine,
https://doi.org/10.1007/978-3-031-15353-2_11
235
236
I. Soghier and K. Kinjo
subacute cough has a duration of 3–8weeks. Cough lasting
for longer is considered chronic cough [2].
Acute Cough
Acute cough is most commonly caused by viral upper respiratory infections. Other causes include pneumonia, bacterial
tracheobronchitis, pertussis, acute exacerbations of chronic
conditions like asthma, chronic obstructive pulmonary disease (COPD) or bronchiectasis, congestive heart failure
(CHF), and pulmonary embolism (PE). Tuberculosis should
be considered in patients from endemic areas and in high-risk
populations regardless of the duration of the cough. Acute
cough can also be an early presentation of subacute or
chronic cough. Other etiologies include foreign body inhalation, inhalational injury, pneumothorax, and some types of
interstitial lung disease such as acute interstitial pneumonia
and hypersensitivity pneumonitis.
Subacute Cough
Subacute cough is most often postinfectious. Bordetella pertussis may play a role in unvaccinated patients with exposure
to young children. Other causes include exacerbations of
asthma, COPD, or upper airway cough syndrome and overlap
with chronic cough.
Chronic Cough
Chronic cough is evaluated with a stepwise approach. After
excluding life-threatening causes, e.g., cancer and tuberculosis, diagnostic work-up should focus on asthma, COPD, gastroesophageal reflux (GERD), non-asthmatic eosinophilic
bronchitis, and upper airway cough syndrome. More than one
condition was found to be contributing to the persistence of
Chapter 11. Cough
chronic cough in up to 62% of patients [2]. Uncommon
causes of chronic cough include sleep apnea, chronic aspiration, recurrent tonsillitis, external ear canal irritation (e.g.,
earwax impaction), and psychogenic causes. Approximately
5–10% of patients will have unexplained chronic cough that
remains undiagnosed after investigation and trial of therapy
[3]. Referral to specialists (pulmonary, otolaryngology, or
gastroenterology) is necessary.
237
Evaluation/Investigation
History taking should focus on the duration of the cough and
presence of associated symptoms like upper airway symptoms, wheezing, dyspnea, sputum production, and heartburn.
One study suggested that the characteristics and timing of the
cough were not usually helpful in differentiating the common
causes [4]. Significant sputum production points to an underlying pulmonary disease, e.g., bronchiectasis. The American
College of Chest Physicians recommends actively searching
for red flags (Table11.1; Fig.11.1) [5]. Symptoms of whooping
cough (paroxysmal cough, posttussive vomiting, inspiratory
whooping, and absence of fever) should be elicited in patients
with cough lasting 14days or more [6].
Many patients report cough starting after an upper respiratory tract infection. Searching for triggers/aggravating factors including exposures, both at home and at work, travel,
tobacco use, illicit drugs, and vaping may help identify the
etiology. Some prescription drugs are frequently associated
with cough, e.g., angiotensin converting enzyme inhibitors.
Case reports suggest sitagliptin may also cause or exacerbate
cough, particularly in those with a history of allergic rhinitis
[7]. A history of past respiratory or cardiac disease should be
elicited. A family history of cough can be seen in atopic
patients and in those with an anatomic or neurological abnormality [8, 9]. The history should also reveal the presence of a
foreign body or inhalation injury.
I. Soghier and K. Kinjo
238
T . Clinical Symptoms and risk factors for serious pulmonary disease
Red flags
Smoker >45years with a new cough, change in cough, or voice
disturbance
Adults at increased risk of lung cancer (aged 50–80years who
have a 20 pack-year smoking history and currently smoke or
who have quit within the past 15years)
Hemoptysis
Dyspnea
Hoarseness
Systemic symptoms: Fever, Weight loss
Lower extremity edema
Dysphagia
Vomiting
Recurrent pneumonia
Abnormal respiratory exam
Abnormal chest imaging
Cough
Rule out Red Flags
History
Physical exam
Chest Imaging
Life-threatening disease
• Pneumonia
• Severe acute exacerbation of
chronic pulmonary disease
(asthma, COPD)
• CHF
• Pulmonary embolism
• Pneumothorax
• Acute interstitial pneumonias
• Cancer
• Tuberculosis
• Inhaled foreign body
• Inhalational injury
Acute (<3 weeks)
• Viral URI (commonest)
• Bacterial
tracheobronchitis
• Exacerbations of
chronic pulmonary
disease
F . Management of cough
Non life-threatening disease
Subacute (3-8 weeks)
• Post infectious cough
• Pertussis
• Exacerbations of
chronic pulmonary
disease
• Early manifestation of
chronic cough
Duration
Chronic (>8 weeks)
• ACE inhibitor
• Asthma
• Upper airway cough
syndrome
• Non-asthmatic
eosinophilic bronchitis
• GERD
• COPD
• Bronchiectasis
• Interstitial lung disease
Chapter 11. Cough
239
Disease-Specific Features
Acute Cough
Acute cough is relatively easy to evaluate. When a patient
presents with cough accompanied by fever, rhinorrhea,
malaise, and myalgia/arthralgia with history of a sick contact
and they look relatively healthy, the likely diagnosis is upper
respiratory infection. Current guidelines do not recommend
routine investigations, e.g., chest X-ray, spirometry, sputum
cultures, or viral respiratory panels as there is little evidence
for benefit [10].
Influenza has similar symptoms but is usually more severe
and can only be differentiated from viruses causing common
cold by specific testing. It can cause serious complications
such as pneumonia, acute respiratory distress syndrome, multiorgan failure, and death. Certain patients are more susceptible to poor outcomes, specifically elderly patients (>65years)
and those with chronic diseases like diabetes, heart failure,
chronic pulmonary diseases, renal failure, cancer, and immunosuppressive conditions [11].
Pneumonia is usually not accompanied by rhinorrhea or
other upper respiratory symptoms. Purulent sputum is commonly seen in pneumonia but purulence is not specific to
pneumonia (sinusitis and bronchitis can be also associated
with purulent sputum). “Atypical pneumonia” presents often
with dry cough. Bronchial breathing or crackles can be heard
when auscultating the chest.
The Infectious Diseases Society of America (IDSA) and
the American Thoracic Society (ATS) recommend using a
prediction score, either the CURB-65 score [12] or the
Pneumonia Severity Index (PSI) [13], to determine whether
the patient can be treated as an outpatient or requires hospitalization [14, 15]. Implementing the PSI results in fewer
admissions without an increase in adverse events [16]. Other
factors should also be taken into consideration, e.g., the ability to reliably take oral medications, the patient’s functional
status, other comorbidities, and their social situation. Beyond
240
I. Soghier and K. Kinjo
chest imaging, obtaining routine diagnostic tests to identify
an etiologic diagnosis, e.g., blood and sputum culture is not
currently recommended for patients with communityacquired pneumonia (CAP) treated at home due to their low
yield and failure to demonstrate an improvement in outcome
[14, 17]. Blood cultures also generate false positives from skin
contaminants and increase unnecessary antibiotic use [18].
Testing for influenza with a nucleic acid amplification test is
recommended in periods of high influenza activity in the
community because of the benefit of added antiviral therapy
to antibiotics and infection prevention. In contrast, testing for
pneumococcal Ag and legionella is not recommended except
in severe CAP or if indicated due to outbreaks or travel.
Acute exacerbation of asthma, COPD, or CHF in patients
with a history of known illness can be easily diagnosed by history
and physical exam. Chest imaging showing pulmonary edema
can confirm CHF.All three can present with cough accompanied
by dyspnea, orthopnea, and wheeze. (Table 11.2). Patients with
asthma tend to get worse very early in the morning.
Clinical presentation of PE is variable but patients rarely
present only with cough. They usually complain of sudden
onset dyspnea, pleuritic chest pain, hemoptysis, or syncope.
T . Differentiating symptoms between asthma, COPD, and
CHF exacerbation
Asthma COPD CHF
Cough Dry/scant
sputum
Wheezing + + +/−
Orthopnea + + +
Night
symptom
Leg edema − − Often
Weight gain
Late night
to early
morning
− −
Increased sputum
production or
purulent sputum
Frothy
pink
sputum
Early
night
+