Cough Flashcards
How long do acute coughs last?
<2 weeks
How long do prolonged acute coughs last (children)?
2-4 weeks
how long do chronic coughs last (children)?
> 4 weeks
How long do chronic coughs last (adults)?
> 8 weeks
Things to consider when patient present with a cough
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
Who is affected by coughs?
Anyone
Protective reflex to expel irritant, symptoms of other condition not diagnosed
Describe a productive cough
heavy, chesty, wet, phlegmy, feel it on their chest
Describe a non-productive cough
dry, tight, tickly
What are some causes of acute cough?
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
What are some causes of chronic cough?
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
What are some drugs that induce cough?
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
What are the most likely causes of coughs?
viral infection = sudden onset, worse at night, fever.
Minimal sputum/mucous and associated cold (7-10 days)
What are the likely causes of a cough?
upper airway cough syndrome, acute bronchitis
What are the unlikely causes of a cough?
croup, chronic bronchitis, asthma, ACEI cough, pneumonia
What are the very unlikely causes of a cough?
HF, TB, cancer, pneumothorax, lung abscess, GORD
Alarm symptoms associated with cough
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)
What are some differential diagnoses for a cough?
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
What do we aim to do when managing a cough?
Manage symptoms and rest (acute cough)
prevent spread of infection, recognise risk of complications (chronic cough)
refer appropriately (chronic cough)
What are the drug classes used to treat coughs?
cough suppressants/antitussives
Expectorants
Demulcents
Mucolytic
Sedating antihistamines
List some cough suppressant drugs
codeine, dextromethorphan, dihydrocodeine, diphenhydramine
When would cough suppressants be used?
Use in non-productive cough, supress cough reflex
List some expectorant drugs used to treat coughing
gauifenesin, ammonium salts, senega
When would expectorants be used?
Promote expectoration of bronchial secretions in productive cough
Helps loosen up mucus
List some demulcents used in cough treatment
glycerol, sucrose
What are demulcents used for in coughs?
form a protective layer over sensory receptors in the pharynx
List some mucolytics used to treat coughing
bromhexine, acetylcysteine
When would mucolytics be used to treat a cough
Inc sputum volume and reduce mucous viscosity, aid in expectoration
Bromhexine = breakdown mucolytic fibre, enhance ciliary activity, inc exocrine secretion
List some sedating antihistamines used in cough treatment
promethazine, chlorpheniramine
When would antihistamines be used in cough treatment?
Act like drying agent to dry up mucous/nasal secretion to reduce coughing
What are the guidelines to giving cough medicine to children?
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
What are non-pharm methods of treating cough?
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)
