Cough

Question 1

Chronic Cough

Answer 1

• Cough lasting longer than 8 weeks

- Not an infection

Question 2

Acute cough

Answer 2

• Lasting less than 8 weeks
• Usually self limiting
• Usually due to acute infection of post-infection

Question 3

Paroxysm

Answer 3

• Spell/sudden onset of rapid succession cough
• Progressively decreased lung volumes
• Can lead to emesis

Question 4

Post-tussive emesis

Answer 4

• severe cough causing vomiting

- associated w/ pertussis

Question 5

Post nasal drip

Answer 5

• PND
• Oozing of secretions down nasopharynx
• Due to nasal/sinus inflammation

Question 6

Upper Airway Cough Syndrome

Answer 6

• UACS

- Same and PND

Question 7

Gastro esophageal reflux disease

Answer 7

• GERD
• Gastric contents reflux into esophagus
  
  • Cause cough w/ or w/o aspiration into lungs
  • Heartburn, indigestion, vocal cord erythema

Question 8

Eosinophilic Bronchitis

Answer 8

• Eosinophils infiltrate airways causing cough
• Detect eosinophils in sputum
• Tx w/ steroids

Question 9

Anatomy behind a cough

Answer 9

• Irritate cough receptors
• Transmit to afferent nerves of medullary cough center
  
  • Nucleus tractus soliarius
• Efferent nerves connect cough center to expiratory respiratory muscles and cause the cough
• Receptors are located in the larynx, trachea, ear canal, bronchi, pleura, stomach, nose, sinus, pharynx, pericordium, and diaphragm

Question 10

Physiology of a Cough

Answer 10

• Inspiratory phase: deep inspiration to high lung volume
  
  • Straighten and lengthen airways
• Compressive phase: expiratory muscles contract against glottis
  
  • High intrathoracic pressure
• Expiratory phase: glottis opens & rapid release of air
  
  • Diaphragm relaxes to transmit abdominal pressure
• Airway narrows to increase high flow rates
  
  • Pushes foreign material and mucus forward
  • Vibrations loosens adherent mucus

Question 11

Cough Causes: irritants

Answer 11

• Smoking

- occupational exposure

Question 12

Cough causes: infection

Answer 12

• Bronchitis
• Pneumonia
• Aspiration pneumonia
• Pertussis
• Post-infections

Question 13

Cough causes: Lung disease

Answer 13

• Airway disease: COPD, asthma, PND, vocal cord dysfunction

- Parenchymal disease: Interstitial lung disease/Fibrosis

Question 14

Cough cause: Cardiovascular

Answer 14

• HF
• Pulmonary infarct
• aortic aneurysm

Question 15

Cough Causes: Tumors

Answer 15

• Bronchogenic
• Meatastatic
• Benign and malignant masses in the airway

Question 16

Cough causes: Drugs

Answer 16

• ACE inhibitors

- Beta blockers

Question 17

Other causes of Cough

Answer 17

• GERD
• Thyroid disease
• Irritation of external auditory canal
• Psychogenic cough

Question 18

Approach to Chronic cough

Answer 18

1. Consider iatrogenic causes
   
   • Beta blockers and ACE inhibitors
2. If there is a clear etiology then treat that
3. If no clear etiology, then use empiric treatment

Question 19

Empiric treatment for cough

Answer 19

1. Treat most common of the likely conditions 1st and then add
2. Cannot be sure of Dx until responds to appropriate Tx
3. Can take weeks or months to work
4. Step down or stop treating some things as getting better

Question 20

Most common causes of cough

Answer 20

1. UACS
   - Rhinitis: tx w/ nasal steroids and antihistamines+decongestant
   - Sinusitis: Tx w/ antibiotics
2. Asthma
   - Dx w/ challenge test (methacholine or exercise)
   - Tx w/ inhaler
3. GERD: dx w/ 24h pH probe
   - Presumptive tx w/ lifestyle change and proton pump inhibitors
4. IF no response to anything then do bronchoscopy
5. Psychogenic cough is diagnosis of exclusion