9.2 (Parts of 8.2) Cough and other pulmonary symptoms

Question 1

List THREE categories of causes of reduced cough function

Answer 1

• Muscle factor
• Airway factor
• Mucociliary clearance

Table 9.2.1

Question 2

Give FOUR examples of muscle factor causes of reduced cough function

Answer 2

◆ General debility
- anaemia
- weakness
- dec LOC

◆ Resp muscle weakness
- cachexia syndrome
- steroid myopathy

◆ Resp muscle ineffectiveness
- weak abs
- gross ascites
- hepatomegaly

◆ Neuro problem
- brain tumor
- spinal cord compression

Table 9.2.1

Question 3

Give TWO examples of airway factor causes of reduced cough function

Answer 3

◆ Vocal cord problem
- paralysis
- head & neck cancer

◆ Non-compressible airway
- tumor
- stent insertion

Table 9.2.1

Question 4

Give TWO examples of mucociliary clearance causes of reduced cough function

Answer 4

◆ Due to inc viscosity & adhesiveness of mucous/ciliary dyskinesia
- dehydrated mucus
- smoking*
- asthma
- chronic obstructive airway disease*
- chronic bronchitis
- bronchiectasis
- cystic fibrosis*

Table 9.2.1

Question 5

What are the three phases of cough?

Answer 5

1. Inspiratory phase: with lengthening of expiratory muscles
2. Compression phase: where glottis is closed
3. Expiratory phase

Question 6

List four central antitussives and one peripheral antitussives

Answer 6

◆ Central
- dextromethorphan
- opioid: codeine/morphine/hycodan
- gabapentin
- ipratropium

◆ Peripheral
- guaifenesin*
- sodium cromgylcate (two puffs twice daily)
- levodropropizine
- benzonatate
- moguisteine

6th Ed. lists gaba in the “central” paragraph. 5th Ed. lists it as “peripheral”

FS: DOGGI

Question 7

What is bronchorrhea?

List 3 conditions that cause this

Answer 7

◆ Production of more than 100mL of watery sputum daily
- average 25 mL

◆ Causes:
1. Bronchioalveolar carcinoma*
2. metastatic cancer growing in bronchioalveoloar pattern
3. chronic bronchitis*
4. asthma*
5. bronchiectasis

Question 8

List THREE possible treatments for bronchorrhoea

Answer 8

◆ Inhaled indomethacin (75–150 mg/day)(NSAID)*

◆ Erythromycin (600 mg/day)

◆ Steroids*
- injection (methylprednisolone 100 mg/day),
- oral form (prednisolone 60 mg/day)
- inhaler alone or in combination with clarithromycin

◆ Octreotide (300 to 500 mg/day or combo w/ chemotx)*

◆ Tyrosine kinase inhibitors (gefitinib and erlotinib) have been used in bronchorrhoea associated with secretory lung cancer

Question 9

What physiologic mechanism handles low viscosity secretions?

Answer 9

ciliary clearance

Question 10

What physiologic mechanism handles high viscosity secretions?

Answer 10

cough

Question 11

What are four definitions of massive hemoptysis

Answer 11

1. Expectoration of more then 300mL of blood in single episode
2. 500mL blood/24h
3. hemoptysis needing fluid resuscitation
4. hemoptysis causing airway obstruction and asphyxia

6th Ed. moves away from a formal def for “massive”

Question 12

A patient presents with hemoptysis and a CXR identifies there is likely bleeding in R lung. What position will you put the pt in while starting resuscitative efforts?

Answer 12

lateral decubitus position with bleeding side (R) down

Question 13

List three systemic treatments for hemoptysis

Answer 13

◆ O2*
◆ TXA*
◆ aerosolized vasopressin (mild-mod hemoptysis)*
◆ recombinant activated factor VII for severe hemoptysis

Question 14

List 2 interventional techniques for hemoptysis management

Answer 14

Bronchial artery embolization (IR)
Endobronchial treatment (resp)
Surgery

6th Ed. no longer lists sx

Question 15

List five complications of cough in advanced illness

Answer 15

• Ribs #s
• chest wall pain
• incontinence
• sleep disturbance
• exhaustion
• social embarassment
• sweating
• impaired QoL

Similar to hiccup:
- sleep + fatigue
- psych: low QOL + social embarassment
- chest pain

Question 16

Two supportive interventions for a pt with non-fatal, non massive hemoptysis (besides O2, TXA, vasopressin)

Answer 16

◆ fluid resuscitation
◆ blood products if needed

Question 17

Name THREE groups of mucoactive agents and ONE example of each.

Answer 17

◆ Mucolytics*
- N-acetylcysteine (NAC)
- Dornase alfa

◆ Expectorants*
- hypertonic saline
- mannitol

◆ Mucokinetics
- Ambroxol
- Bromhexine

◆ Mucoregulators*
- carbocysteine
- erdosteine
- anticholinergics (ipratropium, scopo, atropine, glyco)*
- epidermal growth factor receptor inhibitors
- macrolide antibiotics

Table 9.2.3

Question 18

Name TWO broad categories of non-pharm airway clearance techniques - name one example each

Answer 18

◆ Manual assisted airway clearance techniques:
- manual assisted cough
- postural drainage
- Percussion
- Vibration
- shaking of chest wall

◆ Unassisted airway clearance techniques including:
- forced expiratory technique and huffing
- active cycle of breathing technique,
- autogenic drainage
- use of devices for generation of high-frequency chest wall oscillation (oscillatory positive expiratory pressure)

Suction
High frequency chest wall oscillation
Cough assist machine