Assessment of chronic cough Flashcards
Define subacute and chronic cough
Subacute= 3-8 weeks Chronic= >8 weeks
Differential for cough- common and uncommon
Common
Upper airway cough syndrome (postnasal drip)
Asthma
Gastro-oesophageal reflux disease (GORD)
Non-asthmatic eosinophilic bronchitis (NAEB)
Chronic bronchitis
Angiotensin-converting enzyme inhibitor (ACE inhibitor) Pneumonia
Post-infectious cough
Bordetella pertussis infection
Uncommon Lung cancer Bronchiectasis and chronic suppurative lung disease Interstitial pulmonary fibrosis Sarcoidosis Tuberculosis Foreign body Hypersensitivity pneumonitis Bronchiolitis Recurrent aspiration Tropical filarial pulmonary eosinophilia Psychogenic cough
Causes of productive cough
Bronchitis Bronchiectasis Pneumonia Asthma Foreign body Bronchial Ca Lung abscess TB (when cavitating)
Red flags
Red flags
Asthma Pneumonia Bordetella pertussis infection Lung cancer Interstitial pulmonary fibrosis Tuberculosis Foreign body Recurrent aspiration
History
• How would you describe the cough?
• How long has the cough been present?
• Do you cough up sputum?
• Describe the sputum, especially its colour.
• Is there any blood in the sputum?
• How much sputum do you produce—a teaspoonful,
an eggcupful or more?
• Is there a burning sensation in your throat or chest
when you cough?
• Have you noticed any other symptoms?
• What about chest pain or fever, shivers or sweats?
• Do you have a wheeze?
• Have you had previous attacks of wheezing or hay
fever?
• Is there a history of asthma in your family?
• Have you lost weight?
• Has anyone in the family had TB or a persistent cough?
• How much do you smoke?
• Are you exposed to any smoke or fumes?
• What kind of work do you do?
• Where have you worked in the past?
• Is there a chance you have been exposed to asbestos?
• Do you keep birds at home?
• Do you have any birds nesting outside your bedroom?
• Is there a possibility of a foreign body such as a peanut
‘having gone down the wrong way’?
• Have you had an operation recently or been confi ned
to bed?
• Have you noticed any swelling of your legs?
• Have you been exposed to birds such as pigeons?
What do fine crackles vs course crackles indicate
Fine crackles
on auscultation indicate pulmonary oedema of heart
failure, interstitial pulmonary fi brosis and early lobar
pneumonia, while coarse crackles indicate resolving
pneumonia, bronchiectasis and TB
Initial investigations
• haemoglobin, blood fi lm and white cell count
• sputum cytology and culture
• ESR (elevated with bacterial infection, bronchiectasis,
TB, lung abscess and bronchial carcinoma)
• respiratory function tests
• radiology:
— plain chest X-ray (shows many problems)
Causes of nocturnal cough
Asthma LVF PND Chronic bronchitis WHooping cough
Causes of waking cough
Bronchiectasis
Chronic bronchitis
GORD
Character of sputum and causes
• Clear white (mucoid) → normal or uninfected bronchitis
• Yellow or green (purulent) → due to cellular material
(neutrophils or eosinophil granulocytes)
— ± infection (not necessarily bacterial infection)
— asthma due to eosinophils
— bronchiectasis (copious quantities)
• Rusty → lobar pneumonia (S. pneumoniae): due to
blood
• Thick and sticky → asthma
• Profuse, watery → alveolar cell carcinoma
• Thin, clear mucoid → viral infection
• Redcurrant jelly → bronchial carcinoma
• Profuse and offensive → bronchiectasis; lung abscess
• Thick plugs (cast-like) → allergic bronchopulmonary
Aspergillus; bronchial carcinoma
• Pink frothy sputum → pulmonary oedema
Commonest causes of hemoptysis
URTI
Acute bronchitis
Other causes of hemoptysis
Chronic bronchitis Bronchiectasis Lobar pneumonia Neoplasm Pulmonary infarction/PE
LVF
Mitral stenosis
Anticoagulant
Cause of solitary pulmonary nodule on Xray
Bronchial carcinoma
Solitary metastasis
Granuloma (TB)
Hemartoma
