Cough Flashcards
What type of pathology is suggested by a dry cough with prolonged expiratory phase?
Narrowing of the small-sized to moderate sized airways
What type of pathology is suggested by an barking cough?
Tracheal inflammation, narrowing or collapse
What type of pathology is suggested by a moist cough?
Increased mucus secretion or infection in the lower airway
What are episodes of cough most commonly due to in children?
Common cold viruses
What organism causes whooping cough (pertussis)?
Bordetella pertussis
Describe the phases of pertussis?
- Catarrhal phase - roughly a week of coryzal symptoms; child most infectious at this point
- Paroxysmal phase - characteristic paroxysmal or spasmodic cough; lasts up to 3mths
- Convalescent phase - symptoms gradually decrease but may persist for many months
List the characteristics of the paroxysmal cough
- Worse at night
- May culminate in vomiting
- Child goes red or blue in the face
- Mucus flows from nose and mouth
- Whoop in older children; apnoea in infants
- Epistaxis and subconjunctival haemorrhages can occur after vigorous coughing
List the complications of pertussis
- Pneumonia
- Seizures
- Bronchiectasis
- Significant mortality
Are antibiotics useful in the management of pertussis?
Although macrolide antibiotics eradicate the organism, they only reduce symptoms if started in the catarrhal phase
How can we manage pertussis?
- Admit infants and young children with severe spasms of cough or cyanotic attacks
- Isolate from other children
- Supportive treatment
- Macrolide prophylaxis for close contacts
- Unimmunised infant contacts should be vaccinated
List the causes of persistent or recurring cough
- Recurrent respiratory infections
- Following specific respiratory infections (pertussis, RSV, Mycoplasma)
- Asthma
- Persistent lobar collapse following pneumonia
- Suppurative lung diseases (CF, ciliary dyskinesia, immune deficiency)
- Recurrent aspiration
- Persistent bacterial bronchitis
- Inhaled foreign body
- Cigarette smoking (active or passive)
- TB
- Habit cough
- Airway anomalies (trachea-bronchomalacia; tracheo-oesophageal fistula)
Define persistent cough
A cough that lasts more than 8wks or one that has not improved after 3-4wks in the absence of recurrent URTI
Causes of persistent cough after acute infection
- Unresolved lobar collapse
- Persistent bacterial bronchitis
- Suppurative lung disease
What character of the cough indicates need for further investigation?
If the cough is wet or productive
What is the most common cause of a persistent cough with wheeze and breathlessness?
Asthma
List the characteristics of habit cough
- Barking
- Unproductive
- Post-infection
- Disappears during sleep
- Dry
List the most common pathogens to cause pneumonia in a newborn
- Organisms from mother’s genital tract
- GBS
- Gram negative enterococci and bacilli
List the most common pathogens to cause pneumonia in infants and young children
- Respiratory viruses (RSV)
- Streptococcus pneumoniae
- H. influenza
- Bordetella pertussis
- Chlamydia trachomatis
- Staphylococcus aureus
List the most common pathogens to cause pneumonia in children >5yrs of age
- Mycoplasma pneumoniae
- Streptococcus pneumoniae
- Chlamydia pneumoniae
What are the clinical features of pneumonia?
- Fever
- Cough
- Rapid breathing
- Lethargy
- Poor feeding
- ‘Unwell’ child
- Localised chest, abdominal or neck pain - pleural irritation
What signs are present on examination of a child with pneumonia?
- Tachypnoea (most sensitive clinical sign)
- Nasal flaring
- Chest recession
- End-inspiratory coarse crackles
- Dullness of percussion
- Decreased breath sounds
- Bronchial breathing over affected area
- Decreased O2 sats
(5,6,7 often absent in young children)
What investigations are done if pneumonia is suspected?
- CXR
- FBC
- CRP
What are the indications for admission in pneumonia?
- O2 sats <92%
- Recurrent apnoea
- Grunting
- Inability to maintain adequate fluid/feed intake
How can pneumonia be managed?
- General supportive care - oxygen for hypoxia, analgesia for pain
- IV fluids to correct dehydration and maintain adequate hydration and sodium balance
- Antibiotics - determined by age and severity of illness
What antibiotics do we give to children with pneumonia?
Newborns - broad spectrum IV
Older infants - oral amoxicillin; co-amoxiclav reserved for complicated or unresponsive cases
>5yrs - either amoxicillin or an oral macrolide (e.g. Erythromycin)
Define persistent bacterial bronchitis
Persistent inflammation of the lower airways driven by chronic infection
Common organisms associated with persistent bronchitis
- Haemophilus influenzae
2. Moraxella catarrhalis
What is the management of persistent bronchitis?
- High dose antibiotic (co-amoxiclav)
2. Physiotherapy
List the causes of generalised bronchiectasis
- CF
- Primary ciliary dyskinesia
- Immunodeficiency
- Chronic aspiration
List the causes of focal bronchiectasis
- Previous severe pneumonia
- Congenital lung abnormality
- Obstruction by a foreign body
What is your differential diagnosis for acute cough?
- Upper airway disease:
- Common cold
- Infection
- Allergy
- Vocal cord dysfunction - Lower airway disease:
- Asthma
- Infection (RSV bronchiolitis, bronchitis) - Lung parenchymal disease:
- Infection (pneumonia, empyema)
- Atypical pneumonia
