and Welcome to our 42nd anniversary season of doctors on call I'm Dr Ray Christensen faculty member of the Department of Family Medicine and biobehavioral health at the University of Minnesota medical school campus and a family physician at the Gateway Family Health Clinic in m Lake Minnesota I am your host for our season premier tonight on upper Airway and lower airway respiratory diseases RSV sinusitis pneumonia and bronchitis this season we will again be rotating hosts from the medical school which include Dr Mary Owen Dr Peter nen and myself please remember the success of this program is very dependent on you the viewer and your participation so please call in your questions and tonight uh tonight or you can email them to askas wdc.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr Krill leov a pulmonary medicine specialist at Essentia Health Dr Carly Richie a family medicine physician with the CMH Raider clinic in clo and Dr Dylan W Wyatt an emergency medicine physician at St Luke's Hospital our medical students answering the phone tonight are Gabe Graves from Esco Minnesota Alex Higgins from Stewartville Minnesota and con Connor skik from Little Falls Minnesota and now on to tonight's program on upper and lower respiratory infections and diseases and this season 42 of doctors on call Dr lipatov as you're close to me uh why don't you introduce yourself and just tell us a little bit about your your current work and what you do yes I'm kill leav I'm one of the uh lung specialists at Essential Health I spend about half of my time working in clinic and on uh pulmonary consults in the hospital and then half of my time is dedicated to taking care of intensive care patients at Essential Health Dr Richie I'm Dr Karly Richie I just started at the CMA Raider Family Clinic in clo um and so I'm doing a lot of primary care there Dr Wyatt I'm Dr Dylan Wyatt I'm an emergency medicine doctor at St Luke's hospital um and I also occasionally show up on couple other television programs in the area and uh really enjoy what I do Dr Richie we always like to start with family physicians okay the real Foundation of medicine right um what what is an upper respiratory infection an upper respiratory infection is what we would think about as like the common cold cough congestion um sometimes you can have sore throat and ear pain and fevers but it's generally what we think about with the common cold and Dr lipov Lower respiratory infections because that probably is where your specialty is right right I think the easiest way to to perhaps characterize it as uh any part of respiratory symptom system uh any part of our body that is responsible for breathing that is kind of neck and below so we're talking about the main air pipe the trachea and then the its branches the broni and then the lung itself Dr Wyatt you can talk a little bit about what you see on the emergency room and also maybe what do you think uh tell us a little bit about sinusitis so with each of those different concerns you know upper and lower we see different kinds of presentations although especially with drainage from the upper part of the you know the sinuses and the nose going downwards there can be a little bit of overmal app with symptoms sinusitis is just inflammation of the sinuses is what the word literally means right and that can be more likely than not viral but there's still this notion that we need antibiotics for everything for all the sinus infections which is not true generally unless it's been about a week we stay away from antibiotics especially in adults because it's been shown to actually have more issues rather than help things more just sinus rinses and symptom control is more important thank you I want to jump right into immunizations I think we need to talk about them it's to me it's kind of confusing this year with RSV flu and Co and how do we handle that so you're all three experts um who wants to jump in and take this one to start it Carly go for it suppose I can uh vaccines are really important um this year thinking about the respiratory ones specifically um we have our annual flu shot that is updated every year we have the new coid booster that's updated for the stengths that are going around this year and then we have an RSV vaccine this year which is actually new as well um which is really exciting cuz r RSV the respiratory sensial virus has been um causing a lot of people to get sick over the years and it's good to finally have a vaccine so um those are all available this year the RSV vaccine is not available for everyone though I believe it is 65 and up or 60 and up and children and children now yep Dylan you've been shaking your head a bit does you want to add into that I I see so much RSV in the emergency department both in the very old and the very young of course we see it in between but that for most people it's like a common cold but for those little kiddos and for those who are very old it's it's awful it can be fatal um and so to have this vaccine available where instead of having to go through the supportive measures because we don't have great treatments for it right we just have to sort of support them we can prevent it from happening entirely with the vaccine is incredible it's amazing I think everybody should get it they can so KR how do you tell the difference between influenza and RSV well it's it's quite difficult in in my line of work a lot of folks that I see already have some degree of lung disease and generally they have worsening of their symptoms they have worsening cough shortness of breath uh wheezing just typical symptoms that they know to experience uh but uh in an exacerbation um now in terms of in terms of trying to figure it out we can certainly do some testing some respiratory viral panel that is available and uh then try to figure out exactly which virus it is treatment a lot of times is the same with some caveats um and uh I I again want to stress what my colleagues were saying vaccination and prevention is probably the most important part we do have some oral medications for influenza don't we Carly the one that you probably hear about the most or most familiar with is Tamiflu um the it's an antiviral medication it works best if it's given right when you get symptoms within the first 48 8 hours um so when you start getting sick and you're worried it might be the fluid consider going in to get tested and see if you need to get T flu it's also really helpful if you have underlying medical problems chronic lung disease things like that um that way then you can help prevent get getting as sick with the flu if you can get the tlu in early enough but that won't do any good with RSV not for RSV only for influenza so Dylan how do I know if I have a cold or its allergies boy that's that's the million-dollar question isn't it um well that's why you're in the emergency exactly the answer is it's hard to know right everyone can have different allergy symptoms usually fever is a very clear differentiator though most folks aren't going to be getting fever with their seasonal allergies and they will show up to some degree with respiratory infections the quality of sort of the drainage you can get can be different it can be thicker with infections versus sort of a looser clear with um allergies and it should be unless you're moving to a new area allergies should be something you've exper experien before it should be consistent with previous seasonal allergy episodes and if it deviates from that that would be a suggestion that maybe should isolate and get tested because you could be developing the early signs of an upper respiratory infection nice answer so possibly some contention in the panel I don't know and I don't care who goes into this one but how do you advise getting all three of these shots do you get them all at the same time do you spread them out help me out I'm generally a proponent of getting them all at the same time um you're more likely if you're in the office to get them all at once rather than having to come back for multiple times um then you only have the one time where you might get a sore arm and where you might have some of that 24hour sort of um immune system response where you feel kind of crummy you only have to go through that once and then they're all just as effective um other people might feel differently but so and I'm thinking all three it's got Co RSV and flu yep I think there's the data on that is that there's I believe it's RSV is you're supposed to do a little bit of separation from the other two I think the flu and Co you can do at the same time but I think there's data that it's a slight amount but like you said if the difference is not getting it at all or doing it all at once 100% doing it all at once is is the way to do it there might be a little data but then again yeah how much is that data actually C set us straight yeah I I think that getting the vaccines is is perhaps a lot more important overall than than than the timing and if the convenience of getting them all at the same time is something that will push you to get them I think you just do them at at once I'm unaware of any compelling evidence that you know getting them all at the same time would make them less effective or cause more sight effects but of course you know some of these are quite new so uh we're going to find out in the future so Carly what's the best over-the-counter medication for a respiratory infection well that depends what symptoms you're dealing with if you're trying to get more of a decongestant or more of a cough medicine um I feel like most people have a favorite uh they go for the same one every time uh if you want a decongestant things like psea fed uh DayQuil and NyQuil have a decongestion in there um I'm partial to Mucinex and um robotussin for cough uh they have cough medicines in there and then Mucinex has the decongestion as well um there's a lot of different options and most most are not better than the other it's just what you personally prefer what about a netti pot netti pot people either love it or hate it that's the sinus rinse um it can be really helpful but some people really don't like having to do the the act of rinsing their sinuses you gentlemen have thoughts on that one I'm a big proponent of sinus rinse I deal with a lot of patients who have chronic cough whether it's related to lung disease or not and I know that that's uh something that many of my patients um really like and and it really helped their chronic cough a lot so yes second vote for sinus Rin how do we navigate upper respiratory infections with young children and their time at school the little Petri dishes that's tough because on one it's always the balancing act right you don't want to keep the kids out of school for too long because they got to be there to learn right but on the other hand you got to keep everybody else safe and not just the kids they're coming in contact with but the parents and other family members of those kids and and you know the people steps and steps beyond that so knowing your child and what their normal allergy symptoms are and things of that nature can be very helpful because like I said then deviations from that you can at least maybe keep them home for a day see if they're having development of additional symptoms um and then just keeping an open communication with your older children about hey did you have sick friend are your friends sick is anyone else at school sick so then then you kind of know these are questions we routinely asking the ER when we're dealing with sick kids and and I think they're good for most folks to know about too from their kiddos the question comes up should I wear a mask if I'm having a respiratory infection that is not coid absolutely an n95 short and sweet done um am I more likely to get a cold if I've had my tonsils removed I look your way I don't know Carly I won't do that to you I don't know pulmonology yeah I'm not I'm not aware of any um compelling evidence that that you know removing tonsil is something that's going to prevent you getting cold in the future and and I think for for most people it's going to be a really a risk benefit conversation going through surgery like that and in hopes of preventing the you know something that you can experience for a few days and and get over with symptomatic care so yeah I'm not I'm not sure I certainly wouldn't necessarily routinely recommend tectomy for to prevent cold or flu and having been around a lot longer than any of you I agree with that and generally the tonsilectomy would be because of chronic tonsilitis and that's more than just one or two it's where you have a chronic problem so that good answer how do you treat pneumonia and high-risk individuals so that we haven't talked about Pneumonia shots let's go there right so if we're talking about Pneumonia shots specifically um that is indicated to um a variety of different uh individuals depending on their risk of infection and um you really want to go case-by case basis in terms of who it's indicated for there's different age groups different risk factors that you have to take into account um but the pneumonia shot is certainly something that um you really want to take seriously and you want to consider just as well as all the vaccines that we've been talking about before in terms of treating pneumonia it's uh it's as easy as as it as it is sometimes difficult um because you know um we are mostly aware of what bacteria cause uh community acquired pneumonia the pneumonia that you can catch um um just out there not in the hospital or in the emergency department in the healthcare setting and that could be treated with over the not over the counter but but oral medications that could be prescribed in variety of settings um but also there's a lot of mimickers to pneumonia in the sense that the there are conditions that cause symptoms very similar to pneumonia and you want to make sure that if you keep getting pneumonias over and over and over or if you have a lingering pneumonia that doesn't behave um like you expect with improvement with you know conventional antibiotics that we usually prescribe you really want to get help and you want to get evaluated and see if it's any of the other conditions that may may present like pneumonia but really uh represent something else so keep picking on you a little bit so it's mushroom picking season yeah so do I need to be concerned about getting a fungal respiratory infection blastomycosis yes so certainly everybody in this area are exposed to endemic uh what we call uh fungal infections these are these are fungal infections that uh you can pick up by just um you know not really knowing you're just doing your daily activities you're you're either um going out doing something outside or sometimes even indoors um but vast majority of the time even if people actually get um infection from these fungi that it resolves on its own without any treatment only minority of patient actually know to seek care because they feel ill and of them many Who present with fungal infections and we find fungal infections still don't necessarily require treatment um of course it's really patient dependent and some folks particularly at risk for for fungal infections um or or for complications of really serious illness from fungal infection uh they require treatment and sometimes this treatment uh could be um quite toxic in a sense of side effect so again um most of the time you really don't don't have to worry about being exposed to to to fungal infections um but if you are at risk you have suppressed immunity um that's somebody who should be careful thank you two weeks ago I had a cold and it seemed like I got better Carly I'm looking at you so it seemed like I was getting better but I still have a productive cough am I getting sick again so generally if you've had a cold a viral infection for two weeks and it seems like you're getting better and then all of a sudden you get worse again that's when we think about that you have a secondary bacterial infection like a sinusitis um so generally if after two weeks if you're getting worse again that's when you should go back in and see your doctor and see if you need antibiotics another question and any one of you can answer this should I get an RSV vaccine even if I've had an RSV infection in the past year um how do how do you determine it was RSV are you doing testing for that or is this a clinical diagnosis we do a I don't have an answer so we do a fair amount of testing in the environment mostly because we want to we frequently test for three Co flu and RSV the idea being that those are going to be viral infections that either Target particular groups or have danger toward Wards particular groups um and RSV of course for The Young and the old I would always recommend getting vaccines even if you've been exposed Co has taught us that people that have been infected that natural immunity so to speak can be augmented by vaccines and so you'll have an even stronger protective response and it doesn't last as long as we think it does oftentimes only a couple of months so I personally would advocate for the vaccine but I think that is a great conversation to have with your primary doctor or even with you know an infectious disease doc at that point because that's getting a little in the weeds and where I'm sitting as a primary care doc we don't know enough about the RSV vaccine yet it' be my question and so I think you do it it's kind of like the co early CO's and so on you do one but is it going to be like numac where we can uh have immunization for a long period of time or not we'll have to see on that one um 94 years old how important is it for me to get an RSV vaccination Carly I would say it's very important um the older we get the more likely we are to get much sicker from an infection like RSV more likely to be hospitalized and even more likely to die so I think that the older you get would highly recommend getting a vaccine 80y old with COPD same I think it's very important U particularly if you have chronic lung disease Carly it's somebody from your country I got Co last year and was told I have bronchiectasis what is bronchiectasis um I think maybe we'll let the pulmonologist answer this one yeah and the question is how what was it how that came together and what was that like so yeah go ahead yes so bronchia Actis is generally refers to a uh chronic pulmonary condition uh which um involves structural change of the air pipes in the lungs so normally you can think of your air pipes it's kind of like a tree there's a big air pipe comes down into the middle of a chest and then it branches out into two big branches and then from there it continues branching forward and it supposed to taper off so the further you get away from the middle of the chest the smaller these air pipes get and that's by Design so that uh when you attempt to cough um the you're able to to cough up mucus secretions or any potential infection a lot easier well that gets diminished quite a bit if you're particularly peripheral or more you know uh distant air pipes from the from the middle of the chest they get larger and larger so people are really having a lot of trouble clearing clearing their secretions and all that mucus all that junk stays back and it's antis for infection and and unfortunately it's a vicious cycle where more infection begets more inflammation in those air pipes and they continue uh changing permanently where these air pipes continue dilating so it could be a very serious condition unfortunately these folks are prone to having recurrent infections um a lot of breathing uh trouble a lot of respiratory symptoms hospitalizations and and you really want to see a specialist at the point where you develop it when it comes to coid specifically um I'm speculating here as I know very little in this scenario but well what could potentially um happen sometimes with overwhelming inflammation in the lungs from coid or any other infection really um is that the the lung starts scarring down and when it scars down it tends it tends to shrink and as it shrinks it starts creating a little bit of a pulling pressure on the walls of the air pipes and so air pipes dilate it's not necessarily that the air pipe structure has changed but rather it's the surrounding lung that creates that pole and so when you read a report from from an x-ray or a c scan it tends to mention bronchia acusis more of a as a result of the overall change to the along rather than you know the primary damage to the to the air pipes uh but again it it's it's hard to tell I'd have to know a little bit more great tutorial let's go one step further and maybe not a step further but down in the same area atelectasis one of you two want to take that on Dylan you haven't talked for a while yeah so the easiest way to explain this adalis can get a little complicated but the easiest way to think about it is your the farthest most parts of the lungs to use the tree example the leaves some some of them kind of crumpled down a little bit so they can't fill quite as well with air and we can try and prevent that with certain measures but essentially that can occur from a variety of conditions infection inflammation Etc but that's in essence what what atosis is so not full collapse but just sort of uh a quick we're kind of move go through some questions a little faster right now if I had have had Co how long do I have to wait before I get a CO vaccine um you can wait up to 90 days um and carry on the immunity that you've gotten just from getting the vaccine but there is no um harm in getting it sooner than that um so once you're feeling better once you're not having symptoms anymore you can get it right away but generally it wouldn't wait more than 90 days after that to get your vaccine and just a reinforcement it is okay to get RSV coid and flu together or we're talking at least two of those Co and flu um generally what I've always told people is everything the same day or two months apart and I don't know where you three fall on that one different different training and different backgrounds sometimes um Co lung what can I say what can we say uh they asked the question uh we've already talked about that what's honeycomb lung right so honeycom refers to a uh what we call a radiographic sign it is a it is a pattern on the X-ray certain type of picture you get on the on the X-ray or a CT scan that is generally a feature of of uh uh Advanced lung scarring now um it could be from a textbook worth of different causes uh generally as I've mentioned before any sort of inflammation whether it's related to infection or an autoimmune disease or occupational exposure environmental exposure any anything can potentially cause inflammation of the lung and if the inflammation uh continues on uncontrollably for a prolonged period of time the lung reconciles it by by essentially forming a scar and and again honeycombing is just is just a kind of a sign we see on the on Imaging that may suggest that the person is having lung scarring Carly is chlorum chloramine malate effective in chronic allergies um is that something that you prescribe a lot it's as OTC it's over the counter yeah I don't that's not something that I um recommend to my patients very often I don't know if you guys see that very often what do you use for chronic allergies um I usually recommend the antihistamine so things like zerc Claritin algra um The non-d Drowsy ones and then usually uh a flace nasal spray or Nasacort a steroid nasal spray can be really helpful it's a really good place to start er do plus the sinus rinses that's exactly that's what I would do and that's what I do someone that has allergies so I can speak for it well this is a great panel anything else that you want to add I really appreciate all three of you this was a a lot of fun tonight and a lot of really great questions thank you so much I want to thank our panelists Dr Krill leov Dr Karly Richie Dr Dylan Wyatt and our medical student volunteers Gabe Graves Alex Higgins and Connor skik please join Dr Mary Owen next week for a program on heart problems and high blood pressure when our panelists will be DR leaf Christensen Dr Ryan Harden and Dr Jason wall thank you so much for watching and have a great night