18. Cough Flashcards
In smokers with persistent cough, assess for what?
for chronic bronchitis (chronic obstructive pulmonary disease) and make a positive diagnosis when it is present. (Do not just diagnose a smoker’s cough.)
Name COMMON DDX of cough (6)
- Post infectious (URTI/pneumonia/sinusitis/bronchitis)
- Upper Airway Cough Syndrome (UACS, previously Postnasal Drip)
- Asthma
- COPD
- GERD
- Medication - ACE-inhibitor
What to always consider in DDX of cough? (11)
Respirology
* Pneumothorax
* Pulmonary Embolism
* Tuberculosis
* Pneumonia
* Lung cancer or mets
* Aspiration/Foreign body
* Interstitial lung disease
* Workplace exposure
* Obstructive sleep apnea
_
* Heart failure
* Complicated GERD
Describe : Chronic cough management (6)
- Smoking cessation
- Consider ACE-inhibitor
- Consider Post-infectious cough (3w-8w after acute respiratory infection)
- CXR (2-view) if >8w, r/o tuberculosis or lung mass (malignancy, sarcoidosis)
- If normal CXR, no ACE-i, no exposure to irritants (smoking/occupational), consider Upper Airway Cough Syndrome (UACS), asthma and GERD = Sequential treatment
- If all failed, diagnose cough sensitivity syndrome (idiopathic, refractory cough)
Describe tx : Post-infectious cough (3)
- Self-limited will resolve spontaneously
- Trial of inhaled ipratropium (Atrovent)
- Trial of combined inhaled ipratropium with inhaled corticosteroids
Describe : UACS (previously “post-nasal drip syndrome”) (2)
- Sensation of secretions/irritation of back of the throat, nasal congestion and discharge, throat clearing
- Allergic rhnitis, non-allergic rhinitis
Describe tx : Allergic rhinitis (4)
- Allergen avoidance
- Nasal corticosteroids
- Second generation antihistamines
- Combination corticosteroid/antihistamine inhaler and/or cromolyn
Describe tx : Non-Allergic rhinitis (4)
- First-generation antihistamine plus decongestant (care in hypertension), glaucoma
- Atrovent
Describe prise en charge : Asthma (cough-variant) (2)
- Spirometry, add methacholine challenge if non-diagnostic
- Inhaled corticosteroids
Describe tx : GERD (4)
- Dietary modifications
- PPI twice daily
- Addition of prokinetic if no response
- If failed, objective testing for GERD (barium esophagography, upper endoscopy, 24h esophageal pH)
If sequential treatment fails (UACS, Asthma, GERD), what to do? (5)
Diagnose cough sensitivity syndrome (idiopathic, refractory cough)
* Speech pathology treatment
* Neuromodulating medication (Gabapentin, Pregabalin)
* CT scan if suspect lung cancer, bronchiectasis or ILD
* Referral to specialty
Name DDX INFECTION of cough in peds (6)
- Bordetella Pertussis
- URTI / Pneumonia
- Recurrent viral infection (infants and toddlers)
- Bacterial bronchitis or rhinosinusitis (Productive/wet cough)
- Bronchiectasis/Cystic fibrosis (wet productive cough, weight loss)
- Croup (Barky night time cough)
Describe : Bordetella Pertussis (3)
- paroxysms of coughing
- post-tussive vomiting/whoop
- age 8-11yo
Name DDX of cough in peds (6)
- Infectious
- Lung
- Cardiac (heart failure)
- Allergy
- GI
- Congenital anomalies (neonatal onset)
Name DDX LUNG of cough in peds (2)
- Physical/Chemical irritants
- Asthma (nighttime, wheeze)
Describe : Evaluation Of Persistent Chronic Cough In Healthy Adults (Algorithm)
