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130: Professional Practice 2 > Acute cough > Flashcards

Acute cough Flashcards

1
Q

what is acute cough

A
  • caused by many resp diseases, aim is to protect resp tract
  • voluntary or involintarily activated reflex arc
  • triggered by chemical or mechanical stimuli
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2
Q

how is cough stimulated

A
  • receptors in head, neck and chest are stimulated
  • information transmitted to cough centre in medulla via afferent limb of vagus nerve
  • get increased neural activity in efferent pathway to moth repsiratory musculature and airway
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3
Q

what are the 3 categories of acute cough

A

acute (lasting <3 weeks)

subacute (lasting 3–8 weeks)

chronic (lasting >8 weeks)

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4
Q

what is the most common cause of acute cough

A

viral ifnections of upper respiratory tract

*coughs can persist after infection (postinfectious)

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5
Q

what causes a cough in viral infections

A

arises from stimulation of cough relfex in upper resp tract caused by postnasal drip, cleaing or throat or both

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6
Q

what is an indication of a Bordetella pertussis or B. parapertussis infection

A

patients with subacute or chronic cough

or when the cough is paroxysmal or accompanied by vomiting

*refer

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7
Q

when to refer for acute cough

A

if breathing is compromised

high fever

seizures

frequent vomiting episodes

or the patient becomes dehydrated.

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8
Q

what are common causes of cough

A

Asthma

Chronic obstructive pulmonary disease

Drugs, e.g., ACE inhibitors, beta-blockers, ASA or NSAIDs in sensitive individuals

Environmental/occupational irritants, e.g., air pollution, cigarette smoke, asbestos

Foreign body

Gastroesophageal reflux disease

Heart failure

Pulmonary embolism

Rhinitis: allergic, nonallergic

Sinusitis

Upper airway cough syndrome (formerly postnasal drip syndrome)

Upper/lower respiratory tract infection (viral or bacterial): acute or postinfectious

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9
Q

what are less common causes of cough

A

Bronchiectasis

Cystic fibrosis

Interstitial lung disease

Lung cancer

Psychogenic cough

Unexplained cough (idiopathic)

Zenker diverticulum (esophageal pouch)

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10
Q

what are the goals of therapy for treatment of acute cough

A

Alleviate symptoms

Diagnose and treat underlying cause, when possible

Prevent complications

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11
Q

non pharmacologic therapy for treatment of acute cough

A
  • not sufficient evidence but hydration w/ oralliquids and humidification of room air can be beneficial

* Room humidifiers used as preventive measures should be well cleaned to avoid aerosolizing mould

  • nasa saline irrigation may help to relieve symptoms of nasal congestion

*Avoid exposure to inhaled irritants such as smoke, dust, pollutants and allergens.

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12
Q

treatment for viral respiratory infection

A
  • no cure
  • despite lack of evidence many use nonspecific treatments like nonprescription antitussives and protussives (expectorant) depending on mucus
  • do not recommend tho bc lack of evidence
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13
Q

evidence for non prescription cough medication

A

lac of evidence for or against

  • probably mostly placebo
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14
Q

antihistamines for treatment of acute cough

A
  • First generation
    • small effect on cough caused by upper respiratroy tract infections
    • anticholinergic properties can reduce postnasal drop (mechanism resposibe for cough in common cold)
    • effect is modest
    • side effect” drowsiness, dry mouth and confusion
    • NOT recommended until more evidence comes out
  • Second generation
    • lack significant anticholinergic efects
    • not effective for acute cough treatment unless secondary to allergic rhinitis
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15
Q

antitussive for treatment of acute cough

A
  • act centrally to supress cough

exact mechanism not known -> thought to involve brainstem

  • not recommended when cough performs a useful function, then are retaining mucus you dont want to be
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16
Q

Dextromethorphan and codeine for treatment of acute cough

A
  • commonly used to treat cough related to upper respiratory tract infections

*little evidence for efficacy

  • some studies show no more effective than placebo

*extromethorphan has been abused for its euphoric properties, while codeine carries a risk of dependence and addiction

* not recommend centrally acting cough suppressants for cough secondary to upper respiratory tract infections.

  • effective for cough due to COPD, supressing cough counts be 40-60%, can use for short term relief
17
Q

example of expectorant for treatment of acute coughGuaifenesin

A

Guaifenesin

18
Q

use of expectorants to treat acute cough

A
  • protussive agents act peripherally
  • ex: Guaifenesin (shown to enhance cough effectiveness by clearing airway secretions), guaiacol and ammonium chloride (efficacy & safety not established
  • act by reduce sputum viscosity, permitting more effective removal of secretions from the respiratory tract
  • lack of evidence to support efficacy -> do not thin sputum nor increase sputum volume
  • Adequate hydration with oral liquids and inhalation of humidified air is perhaps the best protussive or “expectorant” measure.
19
Q

Honey for treatment of acute cough

A
  • can be effecive cough supressant in children
  • no studies in adults available

*Cochrane review concluded that honey administered before sleep is probably better than no treatment, placebo or diphenhydramine, and no different from dextromethorphan, at relieving cough symptoms.​

  • has demulcent, antioxidant and antibacterial effects
  • > demulcent effect may act to decrease cough

* risk of botulism, only give to immunocompetent children >1 year of age

20
Q

zinc lozenges for treatment of acute cough

A
  • used to alleviate cough due to the common cold
  • studies show conflicitng results, overall insufficient evidence to recomend sin preparations

* zing can also be associated with unpleasant taste, mouth irritation and nausea.

21
Q

anesthetics for treatment of acute cough

A

ex benzocaine, phenol and menthol

  • may reduce sensitivity of peripheral nociceptors
  • have been used as antitussives but evidence for efficacy is poor
22
Q

NSAIDs for treatment of acute cough

A

Inflammatory pathways have been largely investigated to play a role in the pathophysiology of cough

hNSAIDs were found to have no effect on cough symptoms.

23
Q

prescription therapy for cough

A

salbutamol or formotero

onky recommended for cough due to obstructive lung disease like asthma or COPD.

*Following a respiratory infection, patients sometimes develop a cough for which inhaled corticosteroids could be beneficial; the potential benefit of inhaled corticosteroids requires confirmation through further studies before making recommendations for their routine use.

24
Q

cough can be secondary to another medical condiiton, treat unerlying cause:

Allergic Rhinitis and Viral Rhinitis, Influenza, Sinusitis and Pharyngitis, Acute Bronchitis

A
25
Q

treating cough in children

A
  • little evidence supporting use
  • HC advises against use of products in children <6 due to rare serious side effects, misue and overdose
26
Q

wht prescription medication can you give to kids >6 for treatment of cough

A

dextromethorphan

  • evidence of efficacy in children is abdent but can b e uses to treat unproductive cough

-

27
Q

how should therapy for cough be monitored

A
  • Cough
    • patient to monitor daily, HC practitioner: next visit or by phone 2-3 days later
    • endpoint of therapy: patient can perform daily activites and able to sleep
    • if endpoint not met: change treatment or optimize non pharm measures
  • Drowsiness (antitussives)
    • patient to monitor daily, HCP: next visit or by phone when checking for efficacy
    • endpoint therapy: no drowsiness
    • if endpoint not met: change medication schedule (bedtime only) or change treatment
28
Q

cough treatment with codine

dose

adverse effects

drug interactions

comments

A
  • dose
    • Adult: 10-20mg Q4-6H
    • Max: 120 mg/day
    • *HC recommends against use for children <18
  • Adverse effects
    • drowsiness, sedation, N/V, constipation
  • Drug interactions
    • CNS depressants (alc) can enhance CNS side effects
    • MAIOs: risk serotonin syndrome
    • CYP2D6 inhibitors (fluoxetine, paroxetine) can inhibit conversion of codeine to active metabolite -> reduce clinical effect
  • COmments
    • causes less sedation then hydrocodone
    • metabolize to morphine
    • dependece/addiciton potential
29
Q
A
30
Q

treatment of cough with dextromethorphan

dose

adverse effects

drug interactions

comments

A
  • Dose
    • Adults & chidlren >12:
      • 10-20 mg Q4H PO OR 30mg Q6-8H
      • max 120mg/day
    • Children 6-11
      • 5-10 mg Q4H or 15 mg Q6-8H
      • Max 60 mg.day
  • Adverse efects
    • generally well tolerated
    • occasional diziness, drowsiness, nausea
  • Drug interactions
    • modulators of serotonin: risk or serotonin sydrone
      • ex: SSRIs
    • CYP2D6 inhibitors
  • Comments
    • causes less sedation then codeine and other opioids
    • has ben abused bc of euphoric effects
31
Q

treatment of cough with honey

dose

adverse reactions

interactions

comments

A
  • Dose
    • Adults: 15 mL dailt TID
    • Children 1-18: 2.5-10 mL HS
  • Side efects
    • rare: nervousness, insomnia, hyperactivity
  • Interactions
    • none known
  • Comments
    • use pasteuized due to botulism risk
    • avoid in children <1 or immunocompromized patients
    • avodi if allergic to pollen
32
Q

treatment of cough with guaifenesin

dose

side effect

interactions

A
  • Dose
    • adults and children >12
      • 200-400mg Q4H
      • Max 2.4 g/day
    • Children >6
      • 12mg/kg/day
      • divided doses Q4H
      • max 1.2g/day
  • Side effects
    • rare: dizziness, drowsiness, headache, nausea and vomiting (reported at high doses)
  • Interactions
    • none known

130: Professional Practice 2 (30 decks)

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