Cough Flashcards
Cough is
an important defense
mechanism that allows the clearance of
secretions and foreign particles.
three phases to a cough:
- Deep inspiration. 2. Glottic closure and buildup of intrathoracic pressure. 3. Opening of the glottis with rapid release of pressure.
a wide variety of stimuli can trigger the cough reflex, including:
• Upper respiratory tract infection • Lower respiratory tract infection • Environmental pollutants Mechanical irritation • Chemical irritation
• Chronic inflammatory states
• Drugs
Upper Respiratory Tract Infection (generally viral)
• Pharyngitis • Sinusitis (via persistent nasal secretions into the pharynx—“postnasal drip”) -
• Tracheitis
Lower Respiratory Tract Infection
• Bronchitis • Pneumonia • Tu b e r c u l o s i s
Environmental Pollutants :
• Dust • Pollen, animal dander, and other allergens • Cigarette smoke
Mechanical Irritation (of upper or lower respiratory tract)
• Tumor
• Aortic aneurysm
• Cerumen
• Pulmonary edema
Chronic Inflammatory States
• Asthma
• Chronic bronchitis (chronic obstructive
pulmonary
disease [COPD])
• Chronic aspiration
• Gastroesophageal reflux disease
• Sarcoidosis
Acute cough
duration <21 days, is usually related to
respiratory infection, aspiration, or inhalation of respiratory irritants.
Subacute cough
(present for 3–8 weeks) is often related to persistent
inflammation from a tracheobronchitis episode.
Chronic cough
(>8 weeks in duration) can be caused by many pulmonary and
cardiac diseases.
Pharynx
Post-nasal drip
History of chronic rhinitis
Larynx
Laryngitis, tumour, whooping cough, croup
Voice or swallowing altered,
harsh or painful cough
Paroxysms of cough,
often associated with stridor
Trachea
Tracheitis
Raw retrosternal pain with cough
Bronchi
-Bronchitis (acute) and chronic obstructive pulmonary
disease (COPD)
Dry or productive, worse in mornings
-Asthma
Usually dry, worse at night
-Eosinophilic bronchitis
Features similar to asthma but airway hyper-reactivity
absent
-Lung cancer
Persistent (often with haemoptysis)
Lung parenchyma
-Tuberculosis
Productive (often with haemoptysis)
-Pneumonia
Dry initially, productive later
-Bronchiectasis
Productive, changes in posture induce sputum
production
-Pulmonary oedema
Often at night (may be productive of pink, frothy sputum)
-Interstitial fibrosis
Dry and distressing
important historical features
• Is the cough acute (less than 3 weeks in duration) or chronic?
• Does the patient smoke, and if so, is there any history of obstructive airway
disease?
• Is there sputum production? (If so, what color is it? Is there any blood?)
• Are there any environmental exposures (e.g., dust, fumes, animal dander)?
• Are there any associated constitutional symptoms (e.g., fever, weight loss)?
“red-flag” symptoms
hemoptysis
weight loss
physical examination
• Sinus tenderness (sinusitis)
• Conjunctival injection, rhinitis (upper respiratory infection [URI])
• Tympanic membrane erythema (otitis)
• Oropharyngeal “cobblestoning” (chronic sinusitis)
• Loose rhonchi (infection, i.e., bronchitis or pneumonia)
• Consolidation (pneumonia)
• Fine crackles (pulmonary edema)
• Focal wheezing (local obstructing lesion, i.e., tumor or foreign body)
• End-expiratory wheezing (obstructive airways disease, i.e., asthma/COPD)
dry, irritant, nonproductive cough
secondary to ACE inhibitors
productive early morning cough
chronic bronchitis
radiography can reveal
infiltrate, mass, or pulmonary edema
A clear chest radiograph
tracheobronchitis,
asthma, or environmental exposure
Purulent sputum
many white blood cells suggests bronchitis or
pneumonia
Pulmonary function testing
may reveal chronic obstruction or reactive
airways disease.
Computed tomography
may reveal anatomic lesions such
as extrinsic compression, bronchiectasis, or parenchymal masses
Purified protein derivative testing
is indicated if tuberculosis is
suspected
Antitussives suppress the cough reflex
either by anesthetizing
the peripheral irritant receptors or increasing the threshold of
the central cough center
Peripheral anesthetics include
• Benzonatate
• Phenol preparations
• Menthol preparations
