12.1.2 Cough and haemoptysis

Question 1

What is coughing and haemoptysis?

Answer 1

Coughing
- Protective mechanism that forcefully expels air from the lungs to clear secretions, foreign bodies, and irritants from the airway.
- Triggers: voluntary vs reflex to airway irritants/triggers.
- Mechanical vs chemical vs Thermal

Mechanical: Infectious or obstructive pulmonary disorders → ↑ mucus production → triggering of cough reflex. The normal cilia of the respiratory tract clear mucus and particulate matter out of the bronchi (mucociliary clearance). Cough may be induced when mucociliary clearance is weakened or overloaded (e.g., with large particulate matter).

Inhaled/aspirated solid or particulate matter (e.g., smoke, dust)
Mucus

Chemical:
Gastric acid(GERD)
Inflammatory mediators

Thermal:
Cold air

Haemoptysis
- expectoration of blood from the lower respiratory tract

• Sources of bleeding :
  Bronchial arteries (90% of cases)
  Pulmonary arteries (5% of cases)
  Systemic arteries (5% of cases)
  Diffuse alveolar hemorrhage (0.2% of cases)

Question 2

Approach(NB)

Answer 2

• ## coughing is a symptom not a diagnosis.

Question 3

Case 1:History taking

Question 4

NB: Duration and frequency of cough

Answer 4

Cough < 2 weeks and not recurrent: PACK GUIDELINES
- associated symptoms of fever.tachycardia and tachypnoea : pneumonia

vs

cough > 2 weeks and is reccurent

Question 5

Character of cough

Question 6

Common cause of dry cough

Answer 6

• Upper resp tract inf.
• Lower resp tract inf.
• Inhaled irritants: smoke, dust, fumes
  -Drugs

Question 7

Productive cough
what to know from the patient?

Answer 7

• Quantity or change in quantity (in patient with chronic lung disease)

Question 8

Color changes in a productive cough

Answer 8

• Clear (mucoid):COPD/Bronchiectasis without current infection

Question 9

Haemoptysis

Answer 9

• Appearance i.e clots vs blood stained
• quantity
• Associated features: severe nosebleeding. vomiting blood confused with coughing blood
  Ascertain

Question 10

symptoms and diagnosis not to miss: Haemoptysis

Answer 10

• Short history/bloodstained

Question 11

Further history

Answer 11

• intrusive vs delibearte
• Triggers: swallowing vs cold air vs exercise
• Associated symptoms
  high blood patients
  smoker’s cough

Question 12

What to know from the patient?

Answer 12

1. Occupational history
   - Exposure to irritants

• Family history

Question 13

Patient’s agenda

Answer 13

• Fears
• Beliefs
• Expectations

aid in the experience of care for the patient and job satisfaction for the health practitioner

Question 14

haemoglob: acute vs chronic
white cell count: infection

Question 15

Most common causes of chronic cough

Answer 15

• Chronic postnasal drip
  -Asthma
  -Gastro bronchiectasis

Question 16

most common causes of dry cough in children

Answer 16

• Asthma

Question 17

Red flags : presenting with a cough

Answer 17

Age>50 yrs
- Smokinh history
- Asbestos history exposure
-Persistent cough
- Overseas travel
- TB exposure
- Hemoptysis
- Unexplained weigh loss