4 - Cough Flashcards
What are the 3 main subtypes of cough?
Acute: < 3 weeks
Subacute: 3-8 weeks
Chronic: >8
Physiologic effects of cough?
Sudden, forceful and sometimes frequent -> increased intrathoracic and intrabdominal pressure
Symptoms that go along with coughs?
Cough syncope Dysrhythmias Headache Subconjunctival hemorrhage Inguinal hernia GRD
MC cause of acute cough?
Viral respiratory tract infection (RTI)/acute bronchitis
- pneumonia
- pulmonary embolism
Acute bronchitis causes
Influenza Parainfluenza Coronavirus Rhinovirus Respiratory synchytial virus Pertussis
Clinical features of acute cough and acute bronchitis?
Cough (+/-) sputum Few/no systemic sxs Chest wall tenderness Wheezing possible Rhonchi clearing after cough
What testing is required for acute cough?
Usually a good hx and pe is all that you need
Who gets a CXR?
Suspected pneumonia
Pulse > 100 R >24 T > 100.4 Crackles on PE Consolidation
Do old people get fevers with pneumonia?
Sometimes they do not. You must focus on:
- respiration rate
- SpO2
- Mental status
What treatments do we do for symptomatic acute cough?
Antitussive
Anti-inflammatory mucolytics
Antihystamine-decongestant
Bronchodilators
Dont really help
When do sub-acute coughs usually present?
Post infection
- may linger long after RTI sxs resolve
MC causes of chronic cough?
Post-nasal drainage (PND) (90%)
Asthma
GERD
Less common causes of chronic cough?
ACEI Bronchiectasis and cystic fibrosis Chronic bronchitis Bronchiolitis Neoplasm
S/S of PND?
Rhinorrhea
Nasal congestion
Throat “tickle”
Throat clearing
PE for PND?
Nasal bogginess/congestion
Oropharyngeal mucus “cobblestoning”
“Silent” (sometimes)
Sinusitis s/s?
Copious sputum
Sinus mucosal thickening
What is upper airway cough syndrome (UACS)
New name for PND
Tx for PND/UACS?
Avoid allergens Intranasal corticosteroids Oral antihistamines Oral decongestants Oral montelukast Abx: only from proven sinusitis (image)
How long does chronic cough usually take to get better with tx?
1-2 weeks
2nd MC cause of chronic cough?
Cough variant asthma
What is required for a Dx of asthma?
A response to therapy (SABA)
How long does the cough for cough variant asthma usually take to improve?
6-8 weeks of asthma therapy
What may cause 40% of cough?
GERD
It will be on the pance
Does sputum color matter?
Not at all
When does GERD cough get worse?
Night
While supine
After eating
Tx for GERD cough?
Treat the GERD
Avoid fatty foods, caffeine, chocolate, ETOH Stop smoking Lose wt Elevate head of bed PPI
How long does tx of GERD take to get rid of the cough?
3 months should do it
When does the ACEI cough usually start?
1 week after initiation. It could be up to 1 year
Bronchiectasis ?
Chronic inflammation or infection leading to progressive airway damage
Permanent abnormally dilated bronchi
Chronic inflammatory cells -> mucus pooling
S/s of bronchiectasis?
Large volume of sputum (2tbsp +) Dyspnea Hemoptysis Pleuritic chest pain Wt loss Anemia
CXR for bronchiectasis shows?
Tubular or cystic structures
“Tracks” or “rings”
Dilated mucus filled bronchi
What about bronchiectasis pts with non diagnostic CXR?
CT is preferred
What is the accuracy of CT for diagnosing bronchiectasis?
95%
The study of choice
Tx for bronchiectasis?
Abx 10-14 days
Chest physiotherapy
Postural drainaige
Inhaled bronchodilators
Do bronchiectasis patients get cough suppressants?
No
What is a common bug that causes bronchiectasis?
Pseudomonas
What is the MC cause of severe chronic lung disease in young adults?
Cystic fibrosis
What is the death rate of Cystic fibrosis?
1:32000 it is the MC fatal hereditary dz of whites in the United States
Carriers of cystic fibrosis?
1:25 people are carriers
What is the classic presentation of Cystic fibrosis?
Chronic lung disease and pancreatic insufficiency resulting from thick mucus secretions
What is a common pathology of cystic fibrosis?
Mucus plugging of various exocrine ducts and inflammation
- MC at lungs, pancreas and testes
Pulmonary symptoms of cystic fibrosis?
Cough Sputum Decreased exercise tolerance Recurrent hemoptysis Clubbing A/P diameter increased Hyperresonance Crackles at apex
Non pulmonary S/S of cystic fibrosis?
Sinus tenderness Nasal polyps Steatorrhea Diarrhea Abdominal pain Congenital bilateral absence of vas deference Gallstones
PFTs for cystic fibrosis?
Mixed obstructive > restrictive
- decreased FVC, FEV1 and TLC
- elevated RV to TLC ration
- reduced DLCO
Labs for cystic fibrosis?
ABG’s
- hypoxemia
- compensated respiratory acidosis
What do Cystic Fibrosis centers do?
Clear/reduce secretions Reverse bronchoconstriction Treat RTI’s Replace pancreatic enzymes Nutritional/psychosocial support
Cystic fibrosis treatment?
Postural drainage, percussion/vibration, cough
Inhaled recumbent human deoxyribonuclease (rhDNAse)
Inhaled hypertonic saline
Short/long term abx
SABA
Ivacaftor
Long transplant
What is the goal of rhDNAse?
Decrease sputum viscosity which improves FEV1
What is ivacaftor?
Oral medication for specific gene mutation
Do lung transplants help with CF?
Yeah but the 3 yr post transplant survival is only 55%
What usually causes death in CF patients?
Pulmonary complications
What is bronchiolitis?
Genetic term for inflammatory processes affecting bronchioles
Airways are <2mm
Who gets bronchiolitis?
MC in infants and children
What causes bronchiolitis?
Usually its RSV
Do adults get bronchiolitis?
Yes but its less common and they have many subtypes
What do adults with bronchiolitis usually have?
A hx of exposure to something
S/S of bronchiolitis?
Insidious onset of cough and dypsnea not following asthma/COPD pattern
Tachypnea, crackles and wheezing
What about radiology for bronchiolitis?
CXR: nothing
CT: air trapping, similar to asthma
How is bronchiolitis diagnosed?
Lung biopsy
Or clinically
How is bronchiolitis treated?
Cease the exposure Corticosteroids Bronchiodilators Cough suppressaants O2 to keep above 88
