Cough Flashcards

1
Q

Chronic Cough

A
  • Cough lasting longer than 8 weeks

- Not an infection

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2
Q

Acute cough

A
  • Lasting less than 8 weeks
  • Usually self limiting
  • Usually due to acute infection of post-infection
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3
Q

Paroxysm

A
  • Spell/sudden onset of rapid succession cough
  • Progressively decreased lung volumes
  • Can lead to emesis
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4
Q

Post-tussive emesis

A
  • severe cough causing vomiting

- associated w/ pertussis

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5
Q

Post nasal drip

A
  • PND
  • Oozing of secretions down nasopharynx
  • Due to nasal/sinus inflammation
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6
Q

Upper Airway Cough Syndrome

A
  • UACS

- Same and PND

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7
Q

Gastro esophageal reflux disease

A
  • GERD
  • Gastric contents reflux into esophagus
    • Cause cough w/ or w/o aspiration into lungs
    • Heartburn, indigestion, vocal cord erythema
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8
Q

Eosinophilic Bronchitis

A
  • Eosinophils infiltrate airways causing cough
  • Detect eosinophils in sputum
  • Tx w/ steroids
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9
Q

Anatomy behind a cough

A
  • 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
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10
Q

Physiology of a Cough

A
  • 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
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11
Q

Cough Causes: irritants

A
  • Smoking

- occupational exposure

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12
Q

Cough causes: infection

A
  • Bronchitis
  • Pneumonia
  • Aspiration pneumonia
  • Pertussis
  • Post-infections
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13
Q

Cough causes: Lung disease

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

- Parenchymal disease: Interstitial lung disease/Fibrosis

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14
Q

Cough cause: Cardiovascular

A
  • HF
  • Pulmonary infarct
  • aortic aneurysm
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15
Q

Cough Causes: Tumors

A
  • Bronchogenic
  • Meatastatic
  • Benign and malignant masses in the airway
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16
Q

Cough causes: Drugs

A
  • ACE inhibitors

- Beta blockers

17
Q

Other causes of Cough

A
  • GERD
  • Thyroid disease
  • Irritation of external auditory canal
  • Psychogenic cough
18
Q

Approach to Chronic cough

A
  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
19
Q

Empiric treatment for cough

A
  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
20
Q

Most common causes of cough

A
  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