TREATMENT—General  measures  consist  of complete  bed  rest  and  administering  sufficient fluids  to  maintain  a  urinary  output  of  at  least 1500  ml  daily.  Penicillin  G  is  the  antibiotic  of choice with usual does of 600,000 units every 12 hours   IM.   Tetracycline   and   erythromycin   are alternatives when a patient is hypersensitive to penicillin.  Ventilation  and  oxygenation  are  of  a distinct value. The patient should be fed a liquid diet  initially,  and  when  improvement  occurs,  a normal  diet  as  tolerated. Other Bacterial Pneumonias Other   primary   bacterial   pneumonias   are caused  by  single  bacterial  species  other  than pneumococcus. To treat the pneumonia properly, the  specific  etiologic  agent  must  be  identified. Treatment   is   generally   the   same   as   for pneumococcal  pneumonia  except  that  a  broad- spectrum  antibiotic  is  used. Aspiration  Pneumonia This  is  an  especially  severe  pneumonia  with a 60 percent mortality rate. It is caused by aspira- tion  of  the  gastric  contents  and  inhalation  of hydrocarbons. Treatment is the same as for other pneumonias. Vigorous   antibiotic   therapy   is essential. Primary Atypical Pneumonia This type of pneumonia is caused by a variety of viral and mycoplasmal agents. The symptoms include  a  gradually  increasing  fever  with  a  history of   URI;   a   nonproductive   cough;   hoarseness; headache and malaise; and extreme fatigue. The treatment  is  similar  to  other  pneumonias. Acute Bronchitis Acute  bronchitis  is  an  inflammation  of  the bronchial tree caused by infections and physical and  chemical  agents.  Bronchitis  may  appear  as a primary disorder or as a prominent finding in many pulmonary diseases. The symptoms include dry,  scratchy  throat;  hoarse,  husky  voice;  fever; cough  that  produces  mucopurulent  sputum;  and musical  rhonchi  and  wheezing. TREATMENT—General  measures  consist  of bed  rest,  forcing  fluids  to  prevent  dehydration, and discontinuing smoking. Using steam or mist inhalators  is  frequently  beneficial  in  helping  to relieve   coughing. Severe   coughing   may   be controlled   with   antitussives.   Antihistamines should be administered to help relieve inflamma- tion. Headaches, sore throats, and fever may be treated  with  aspirin.  In  patients  with  impaired respiratory  or  cardiac  function,  or  in  patients debilitated  by  other  diseases,  antibiotic  therapy should  be  used  to  prevent  secondary  infections. One  of  the  complications  is  pneumonia. Chronic Bronchitis Chronic  bronchitis  is  marked  by  a  normally nonproductive   cough   of   long   duration.   If   the cough  is  productive,  the  sputum  is  usually  very thick.  There  are  usually  no  other  symptoms  of URI. TREATMENT—As in the treatment for acute bronchitis,  the  patient  with  chronic  bronchitis should be advised to discontinue smoking and to avoid  other  sources  of  lung  irritation  such  as fumes.  If  the  patient’s  cough  is  nonproductive, suppress it with antitussives. If it is productive, liquify  it  by  adequate  fluid  intake,  inhalation,  and expectorants. Other treatment is as indicated for acute  bronchitis. Asthma Asthma is a bronchial hypersensitivity disorder characterized by reversible airway obstruction. It is   produced   by   the   combination   of   mucosal edema,  hypertrophy  of  the  bronchial  musculature, and  excessive  secretion  of  mucus,  which  causes mucosal  plugs. SYMPTOMS—The   patient   experiences   re- peated   attacks   of   wheezing,   dyspnea,   and coughing   with   mucoid   sputum   produced. Nocturnal coughing and wheezing on exertion is common.  The  patient  usually  has  a  history  of frequent  colds  and  displays  nasal  symptoms,  such as  itching  and  congestion. TREATMENT—The first step is to eliminate the   source   of   any   known   allergies.   Maintain adequate rest and reassure the patient to relieve his or her apprehensions. Treat respiratory infec- tions  with  antibiotics.  Force  fluids  to  prevent dehydration  and  help  break  up  or  liquify  secre- tions. Epinephrine is the drug of choice, but may be  replaced  by  aminophylline  if  not  effective. Epinephrine  should  be  administered  cautiously  in patients  with  angina  or  hypertension.  Oxygen therapy  is  indicated  in  all  cases  of  moderate  to severe  symptoms.  Status  asthmatics  is  a  con- tinued, severe wheezing to a life-threatening point. The  patient  with  this  condition  should  be 2 - 7