CARDIOPULMO - Chronic Cough Flashcards
Cough differentials
- Atypical Pneumonia
- ACE induced
- Asthma
- Tuberculosis
Probability diagnosis Upper respiratory infection Postnasal drip/sinusitis/rhinitis Smoking Inhaled irritants Acute bronchitis Chronic bronchitis/COPD
Serious disorders not to be missed
Cardiovascular:
•left ventricular failure
Cancer:
•lung cancer
•larynx
Infection: •tuberculosis •pneumonia •influenza •lung abscess •HIV infection •SARS (coronavirus)
Other: •asthma •cystic fibrosis •foreign body •pneumothorax
Pitfalls (often missed) Atypical pneumonias Gastro-oesophageal reflux (nocturnal) Smoking (children/adolescents) Bronchiectasis Whooping cough (pertussis) Interstitial lung disorders (e.g. idiopathic pulmonary fibrosis) Sarcoidosis
Masquerades checklist
Drugs (e.g. ACE inhibitors, beta blockers, inhaled steroids, sulfasalazine)
Is the patient trying to tell me something?
Anxiety and habit.
Cough - Key history
Key history
Determine the nature of the cough, especially associated symptoms such as the nature of the sputum, breathlessness, wheezing and constitutional symptoms. Haemoptysis See ‘Haemoptysis (in adults)’. History of smoking habits, past and present, and occupational history are essential.
Past history, especially respiratory and drug intake.
Cough - Key PE
Key examination
- General examination including a search for enlarged cervical or axillary glands
- Careful examination of the lungs and cardiovascular system with inspection of sputum
Cough - Key Investigations
Key investigations
More applicable if haemoptysis •FBE/ESR/CRP •Sputum cytology and culture •Respiratory function tests •Plain CXR and others as appropriate
Cough - Diagnostic Tips
Diagnostic tips
- Postnasal drip is the commonest cause of a persistent or chronic cough especially at night.
- Cough may persist for many weeks following a URTI.
- Cough is the cardinal feature of chronic bronchitis.
- Unexplained cough >50 years is bronchial carcinoma until proved otherwise (esp. if a history of smoking)
