Approach to cough Flashcards
Most probable causes of cough
URTI Postnasal drip Smoking Acute Bronchitis Chronic Bronchitis (COPD)
Serious Disorders not to be missed
LV HF Lung Cancer --> Bronchial carcinoma presents w/ worsening cough Severe infections: TB Pneumonia Influenza Lung Abscess HIV Infection
Asthma
Cystic Fibrosis
Fireign Body
Pneumothorax
Cough: Commonly missed diagnoses
Atypical Pneumonias GORD (nocturnal cough) Smoking (in children/adolescents) Bronchiectasis Whooping Cough (Pertussis) Interstitial Lung Disorders Sarcoidosis
Drugs
Common causes of non-productive cough
URTI LRTI --> Viral or mycoplasma Inhaled Irritants --> Smoke, dust, fumes Drugs --> e.g. ACEI Bronchial Neoplasm --> gradually worsening, 'bovine' cough without explosiveness due to carcinoma infiltration of recurrent laryngeal nerve Pleurisy Interstitial Lung Disorders: Fibrosing Alveolitis, Allergic Alveolitis, Pneumoconosis, Sarcoidosis TB --> Non-cavitating stage LV HF (especially nocturnal cough) Whooping Cough (pertussis) GORD (esp nocturnal) Hiatus Hernia Postnasal Drip
Common Causes of Productive Cough
Chronic Bronchitis Bronchiectasis Pneumonia Asthma Foreign body (later response) Bronchial Carcinoma (dry or loose) Lung Abscess TB --> in Cavitating stage
Investigations of chronic cough
And when should investigations be done?
If cause of cough not apparent, or if unresolved after initial treatment
CXR: first line
Next step in chronic cough if CXR normal
Spirometry
Consider sinus xray
Gastroscopy
Oesophageal pH monitoring
Possible diagnoses = Asthma, GORD, Chronic Bronchitis, Postnasal drip
Next step in chronic cough if diffuse opacity on CXR
Exclude Pulmonary Odema
Spirometry –> Total lung capacity and diffusion concentration to rule out CO
Bronchoscopy –> alveolar lavage or transbronchial biopsy
Possible Diagnoses = LV HF, Diffuse Pneumonic Process, Interstitial Lung Diseases, Opportunistic infection
Next step in chronic cough if localized opacity on CXR
Sputum: cultures, microscopy, cytology
Bronchoscopy
Thorax CT scan
Possible Diagnoses = Pneumonia, Lung Neoplasms, Inhaled foreign body, Bronchiectasis
Clear white mucoid sputum?
Normal or uninfected bronchitis
Yellow / green (purulent) sputum?
Usually infection but not necessarily bacterial
Asthma
Bronchiectasis (copious amounts)
Rusty coloured sputum
Pneumonia
Thick and sticky sputum
Asthma
Profuse, watery sputum
Alveolar cell carcinoma
Thin, clear mucoid sputum
Viral infection
Redcurrent Jelly sputum
Bronchial carcinoma
Profuse and offensive sputum
Lung Abscess
Bronchiectasis
Thick plugs - cast like - sputum
Allergic bronchopulmonary aspergilius
Bronchial Carcinoma
Pink Frothy Sputum
Pulmonary Odema (usually LV HF)
What must you consider if blood-stained sputum?
Always consider TB and malignancy
Consider anticoagulants*
Acute bronchitis - produces streaky haemoptysis (common cause)
URTI - another common cause
Lobar pneumonia - rusty coloured sputum
How is cough classified into acute, persistent and chronic cough. What does this mean for their management?
Cough associated with viral infection should last no longer than 2 weeks
If lasting >2 weeks = persistent
If lasting > 2 months = chronic
Coughs lasting more than 3-4 weeks require scrutiny
What is the rule about unexplained chronic cough in patients >50yo
Bronchial cancer until proven otherwise
When should you consider TB?
In presence of unusual cough +/- wheeze
Bright red haemoptysis in young person –> could be initial symptom
If a CXR is normal, what is essential to disprove presence of bronchial carcinoma?
Bronchoscopy
Large haemoptysises are usually due to which pathologies?
TB or bronchiectasis
