Cough

Question 1

How long do acute coughs last?

Answer 1

<2 weeks

Question 2

How long do prolonged acute coughs last (children)?

Answer 2

2-4 weeks

Question 3

how long do chronic coughs last (children)?

Answer 3

> 4 weeks

Question 4

How long do chronic coughs last (adults)?

Answer 4

> 8 weeks

Question 5

Things to consider when patient present with a cough

Answer 5

Age = children (Dry cough), elderly (greater risk of cough due to serious conditions)

pregnancy/breastfeeding

Allergy/ADR, drug interactions/other meds

Symptoms severity and duration

Whether symptoms are recurrent

Other health conditions = asthma, COPD

Smoking status = chronic bronchitis

Immunisation status

Question 6

Who is affected by coughs?

Answer 6

Anyone

Protective reflex to expel irritant, symptoms of other condition not diagnosed

Question 7

Describe a productive cough

Answer 7

heavy, chesty, wet, phlegmy, feel it on their chest

Question 8

Describe a non-productive cough

Answer 8

dry, tight, tickly

Question 9

What are some causes of acute cough?

Answer 9

Acute bronchitis = associated with common cold, fever, sputum (minimal), sore throat, 7-10 days

Drug induced = commo with ACE inhibitors, beta-blockers

Croup = viral infection (babies/children), harsh barking cough, noisy breathing, self-limiting (2-5 days)m prednisolone (mild-moderate cases)

Upper airway cough syndrome = sinus or nasal discharge entering pharynx, caused by allergy or sinus infection, sneezing, itchy throat, nasal discharge

pneumonia = dry, painful cough

Question 10

What are some causes of chronic cough?

Answer 10

Chronic bronchitis = productive cough every day for 3 months >2 year, seen in heavy smokers

Asthma = connected to allergic reaction or trigger, wheezing, shortness of breath, cough worse at night, no productive

Pertussis (whooping cough) = DTP vaccine prevents

Pneumonia, TB

Question 11

What are some drugs that induce cough?

Answer 11

ACE inhibitors = not dose related, timeframe of onset is variable from hours to years, resolution is to remove drug (1-4 wks), can switch to other drug class if applicable ‘

NSAIDs = aspirin use in asthmatics

Beta-2 selective blockers (atenolol, metoprolol) may produce less bronchospasm

Question 12

What are the most likely causes of coughs?

Answer 12

viral infection = sudden onset, worse at night, fever.

Minimal sputum/mucous and associated cold (7-10 days)

Question 13

What are the likely causes of a cough?

Answer 13

upper airway cough syndrome, acute bronchitis

Question 14

What are the unlikely causes of a cough?

Answer 14

croup, chronic bronchitis, asthma, ACEI cough, pneumonia

Question 15

What are the very unlikely causes of a cough?

Answer 15

HF, TB, cancer, pneumothorax, lung abscess, GORD

Question 16

Alarm symptoms associated with cough

Answer 16

Children <6, unexplained cough >2wks (1wk in children), vulnerable patients (>65, children, chronic lung disease, asthma, immunosuppressed)

Recurrent productive cough in child (esp at night), blood in sputum

Difficulty breathing/wheeze/difficulty feeding, pain on inspiration, persistent hoarseness, respiratory noises

Debilitating symptoms, particularly elderly

Other symptoms (weight loss, chest pain, fever), new changed cough in smoker >45 y/o, overseas travel (TB)

Question 17

What are some differential diagnoses for a cough?

Answer 17

upper airway cough syndrome (UACS) = clearing throat, swallowing mucous, can be associated with allergies, treat cause not just cough

Allergies = non-productive, worse at night, other allergy symptoms (itchy oral cavity, blocked nose, conjunctivitis)

Acute bronchitis = common in autumn and winter, wheeze, feel breathless, 7-10 days can last up to 3 weeks, dry productive cough

Croup = peaks between 1-2 years old, late evening with barking cough, resolves in 48hrs, treated with corticosteroids

Pneumonia = chest pain, difficulty breathing, fever, chills, nausea, vomiting, confusion (elderly). Initially non-productive cough, becomes productive with red-stained mucous, worse at night, headache, pleuritic pain, high fever

Chronic bronchitis = coughing up sputum most days, 3 months, history of recurrent bronchitis, smoking is primary factor (non-smoker = UACS, asthma, GORD)

Asthma = cough, wheeze, tight chest, SOB, worse at night, associated with triggers, Atopy family history, children have non-productive cough

Question 18

What do we aim to do when managing a cough?

Answer 18

Manage symptoms and rest (acute cough)

prevent spread of infection, recognise risk of complications (chronic cough)

refer appropriately (chronic cough)

Question 19

What are the drug classes used to treat coughs?

Answer 19

cough suppressants/antitussives

Expectorants

Demulcents

Mucolytic

Sedating antihistamines

Question 20

List some cough suppressant drugs

Answer 20

codeine, dextromethorphan, dihydrocodeine, diphenhydramine

Question 21

When would cough suppressants be used?

Answer 21

Use in non-productive cough, supress cough reflex

Question 22

List some expectorant drugs used to treat coughing

Answer 22

gauifenesin, ammonium salts, senega

Question 23

When would expectorants be used?

Answer 23

Promote expectoration of bronchial secretions in productive cough

Helps loosen up mucus

Question 24

List some demulcents used in cough treatment

Answer 24

glycerol, sucrose

Question 25

What are demulcents used for in coughs?

Answer 25

form a protective layer over sensory receptors in the pharynx

Question 26

List some mucolytics used to treat coughing

Answer 26

bromhexine, acetylcysteine

Question 27

When would mucolytics be used to treat a cough

Answer 27

Inc sputum volume and reduce mucous viscosity, aid in expectoration

Bromhexine = breakdown mucolytic fibre, enhance ciliary activity, inc exocrine secretion

Question 28

List some sedating antihistamines used in cough treatment

Answer 28

promethazine, chlorpheniramine

Question 29

When would antihistamines be used in cough treatment?

Answer 29

Act like drying agent to dry up mucous/nasal secretion to reduce coughing

Question 30

What are the guidelines to giving cough medicine to children?

Answer 30

Children <2 = prescription only S4

Children 2-6 yrs = not to be give

Children 6-11yrs = use only on advice of doctor, pharmacist, or nurse practitioner

Question 31

What are non-pharm methods of treating cough?

Answer 31

Drinking warm drinks, plenty of water

Avoid exposure to cold air, irritants, smoke

Eat regular, healthy meals limited in high fat, sugar, salt

Hard candies, other lozenge

Honey, lemon, glycerin

Vaporisers/humidifiers = inc humidity (Soothe irritated airways, dec cough)