Especially Important for Pulmonary Fibrosis Patients
Part 1 of 2
In medicine the only intervention better than an effective treatment for a disease is a way to prevent getting the disease in the first place. As Influenza (Flu) season approaches, I am always reminded that in our high tech world of modern medicine with pills that can cost $100,000 per year, one of the most effective tools to prevent you from getting sick in the fall and winter is a $25 Flu vaccination. If you have Pulmonary Fibrosis it’s important to take the Flu seriously.
What is the Flu?
Flu or influenza is a viral infection that is easily transmitted and has a very high rate of infection amongst people that are exposed. There are two types of Flu virus (A and B). Then there are many different strains. The influenza virus is a respiratory virus that is acquired by contact with respiratory droplets (a cough, sneeze, snot from wiping your nose). You can pick up the virus by touching something that has infected respiratory droplets on it (such as a shopping cart at the grocery store or a door handle). You then might rub your eye, scratch your nose or put your finger in your mouth. Then you have introduced the virus into your system. The virus begins to replicate in your respiratory tract (nose, airways). This leads to cough, sore throat, nasal congestion and sneezing. Onset of symptoms typically begins within 2-4 days after exposure. In uncomplicated Flu, within a day of developing respiratory symptoms patients develop fever and muscle aches. The onset of these symptoms is quite abrupt and it can feel as though you were hit by a truck. In contrast to the common cold, you actually feel quite sick with Flu. The average duration of uncomplicated influenza is about 4-5 days. You are quite contagious during the week or so that you have symptoms (typically starting a day before you actually feel sick and lasting through the period of feeling poorly).
Some patients who get Flu develop viral pneumonia and can become very ill. These patients experience shortness of breath and often require hospitalization. Factors associated with more severe illness include age less than 2 and greater than 65, chronic lung or heart disease, neurologic disorders, patients with impaired immune systems, pregnant women, and obesity. Viral pneumonia can be life-threatening.
Another problem that can develop after Flu is bacterial pneumonia. This is more common in patients over 65 years old. Patients typically start improving only to develop worsening fever, cough and shortness of breath. You should present immediately to your doctor for evaluation. Prompt treatment with antibiotics is important if bacterial pneumonia develops.
Other complications of Influenza include confusion, especially in older patients. Severe muscle injury can develop. This hallmark of this is severe muscle pain and tenderness usually involving the leg muscles. There are some very rare but devastating neurologic complications that can develop and these include nerve and spinal cord dysfunction (Guillain-Barre Syndrome and Transverse Myelitis). Patients with these problems have progressive weakness.
Diagnosis of Flu
There are a variety of tests that can be done to diagnose influenza. The most commonly used test is a Rapid Flu nasal swab. This test gives results back in a few minutes. However, it only detects Influenza type A and may miss some of the strains of Influenza A. A more reliable test is called a Multiplex PCR nasal swab. A swab is used to collect secretions from the back of your nose and throat. Then using PCR technology the same swab is tested for about a dozen different viral infections. It takes about an hour to get the results.
The decision to test is part science and part art of medicine. In the emergency department I find that testing is useful as I am able to make a specific diagnosis very quickly. In the office even though the Multiplex PCR test can give results in an hour, the reality is that it takes a day to get the results. As a result, I have to make a clinical decision about whether the results will change my management. I generally test much less frequently in the office setting.
Stay tuned for Part 2 of this article next week on Preventing and Treating Flu.