Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract disease in young children. Recent RSV strain in Utah is causing moderate to severe cough (especially during night), weakness and cold-like symptoms.
RSV infection is sometimes severe and is associated with hospitalization, mechanical ventilation, long-term complications, decreased quality of life, loss of work productivity and patient/caregiver stress.
RSV may cause inflammation and infection of small airways and lungs. Recovery time usually ranges from 7 to 14 days, but RSV can cause serious disease.
RSV combined with increasing flu circulation are keeping some hospitals and pharmacies occupied. Seventeen states are reporting that more than 80% of beds are full, according to the data. Children’s hospitals in Utah, Arizona, the District of Columbia, Maine, Minnesota, Rhode Island, and Kentucky are almost completely at capacity.
RSV can spread when
- viral droplets from a cough or sneeze of an infected person enter your eyes, nose, or mouth (masking can help reduce the transmission)
- You have direct contact with the virus, like kissing the face of a child with RSV
- You touch a surface that has the RS virus on it, like a doorknob, and then touch your face before washing your hands
Pharmacist consultation for management of RSV (Adult dosing):
- Manage Inflammation with over-the-counter NSAIDS/fever reducers and pain relievers, such as acetaminophen, naproxen or ibuprofen. Steroids like prednisone and dexamethasone can be prescribed in severe cases. (Never give aspirin to children.)
- Nasal symptoms: Use Vicks vapor rub and oxymetazoline / fluticasone nasal spray
- Manage Cough with OTC's like dextromethorphan or Delsym syrup; prescription medication like Benzonatate 200 mg and Promethazine with codeine syrup can be used in severe cases. Albuterol and combination steroid inhalers can be prescribed in severe cases.
- Phlegm and chest congestion: Menthol, Mucinex D
- Manage sleep with Benadryl and melatonin.
- Drink enough fluids.
- Manage viral infection with Famotidine 20 mg twice daily and warm caffeinated coffee (taken before noon), secondary bacterial pneumonia can be treated with prescription Azithromycin 250 mg and Doxycycline 100 mg as dosed by a doctor.
- Diet: regular, protein food (eggs, chicken soup, pulses etc.) helps with energy levels and fatigue
- Supplements: Fish oil 1000 mg and Zinc 50 mg daily, especially during first 3 days of infection. Vitamin D 50 mcg and C can help individuals with deficiency
- Gargle with saline water
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| Model of RSV pathogenesis in the human respiratory tract. Once RSV enters the upper respiratory tract, the virus primarily infects ciliated cells in the large airways. The viral NS2 protein induces cell rounding, extrusion, and detachment from the apical zone of the airway epithelium through, generating an accumulation of these cells in the lumen of the airway ducts. RSV also induces proliferation of goblet cells, via infection of basal cells, which differentiate, causing high mucus production and recruitment of eosinophils and massive numbers of neutrophils in the airway ducts. The latter immune cells release NETs in response to RSV infection. All of these components accumulate and move to the distal airways, leading to bronchial obstruction of the narrow ducts, and collapse of alveoli, causing acute inflammation and pathology in the lungs. |
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