Cough Flashcards
Describe a cough
A sudden, forceful release of air from the lungs
- Reflex triggered by irritation or obstruction
- Clears the lung passages via a rush of air
What is the cough reflex?
Step 1: Airway sensory nerves respond to pro-tussive stimulus
Step 2: Impulse travels along the VAGUS NERVE to the medulla
- The cough control center
Step 3: Medullary center sends message to respiratory pattern generator, eliciting cough response
Describe an Acute Cough:
Lasts less than 3 weeks
Usually associated with viral upper respiratory infections
List possible causes of acute cough.
- Possibly pneumonia
- Acute L ventricular failure due to stretching caused by fluid backing into lungs
- Asthma
- Foreign body aspiration
Describe a Subacute Cough:
Describe a Subacute Cough:
Lasts 3 to 8 weeks
- 3 to 4 weeks in kiddos
List possible causes of a subacute cough
- Post-infectious cough
- Bacterial sinusitis
- Asthma
Describe a Chronic Cough:
Lasting over 8 weeks in adults
- >4 weeks in kiddos
List causes of a chronic cough in non-smokers:
- Upper Airway Cough Syndrome (UACS)
- AKA Post Nasal Drip - Asthma
- GERD due to acid irritation
- CHF
- Aspiration (commonly pneumonia)
- Lung Disorders
- ACE Inhibitors (>20% of pts)
- B-blockers in patients with COPD and asthma
- Even eye drops can cause effects
What are the major causes of cough in children?
- Viral/bacterial respiratory infection
- Heart disease
- Foreign body aspiration
- Poor coordination of sucking and swallowing reflexes
- Esophageal motility disorders
What are symptoms and signs of a productive cough?
Wet or “chesty” cough
- Expels secretions from the lower respiratory tract
- Retention of secretions can cause impaired ventilation and decreases the lungs ability to resist infection
Patient presents with a productive cough and has been diagnosed with an anaerobic infection? Describe the secretions the patient may cough up.
Malodorous = foul-smelling
Patient coughs up yellow secretions. What is the possible cause?
yellow = inflammation (WBCs present)
Patient coughs up red/pink secretions. What is the possible cause?
hemoptysis - blood that initially came from lower respiratory tract
Patient coughs up clear secretions. What is the possible cause?
bronchitis
Describe the signs/symptoms of a patient who has a dry cough and what can cause this?
"Hacking" cough that serves no physiological purpose Causes: Viral respiratory tract infections Atypical bacterial infections GERD Cardiac disease Medications: ACE inhibitors
What are the concerning complications of a patient who has a persistent cough?
Exhaustion, insomnia, muscle pain, hoarseness, sweating, urinary incontinence
- Some may induce vomiting, cardiac dysrhythmias, syncope, stroke, rib fractures due to intensity
When should you refer a patient to a physician for a cough?
Child under 4 years old
Cough lasting > 7 days
Violent cough, night sweats - May be Pneumonia or TB
Coughing up blood or non-clear sputum
SOB - may sound like barking or whooping
Fever ≥ 103° in adults or ≥ 102° in children
Abdominal swelling
Unintentional weight loss
Hx of chronic lung disease
Foreign object aspiration
Suspected drug-induced cough
Cough is unresponsive/worsening with self-treatment
What are the top 3 causes of chronic cough in adults?
#1 UACS - Post nasal drip #2 Asthma #3 GERD
When should you recommend a patient use Hydrocodone for a cough? What should you counsel the patient on?
Antitussive = non-producitve cough
Adults who no history of substance abuse disorders (CII)
Children 6+ years old
What is the role of antitussives in cough treatment?
Control or eliminate cough by increasing the cough threshold for non-productive coughs
What is the role of protrussives in cough treatment?
Decrease sputum viscosity, increase sputum volume and facilitate its removal for productive coughs with thick mucous
What age is safe for children to use cough drops?
> 6 years old according to the Academy of Pediatrics
What are the guidelines for giving children honey to relieve chronic cough?
DO NOT USE UNDER AGE 1
1 to 6 y.o. = Give dark honey or corn syrup
> 6 y.o. = can use cough drops/honey products
What can you recommend for a cough due to URI or chronic bronchitis?
ipratropium
What can you recommend for postinfectious cough?
#1 Ipratropium #2 Inhaled glucocorticoids #3 Short course of Oral GCs if severe #4 Central acting antitussive
What products are not recommend for a cough due to a common cold?
Zinc
Combo antihistamine-decongestants (2nd gen)
T/F: Codeine has been shown to provide significant benefit in reducing acute cough symptoms.
False; Dextromethorphan has been show while antihistamines and codeine have not show benefit
Why should you recommend licorice as an herbal treatment for cough?
TRICK You shouldn’t!
- Due to Adverse Drug Reactions of CV effects and HYPOkalemic rhabdomyolysis
Which alternative product should you avoid in diabetes for cough? Why?
Marshmallow; Induces hypoglycemia
List the FDA-approved topical antitussives. How do they work?
Camphor and menthol; Pts inhale the vapors to stimulate the sensory nerve ending in the nose to create a sense of improved air flow
- Eucalyptus is NOT FDA-approved
Guafenesin MOA + Side Effects
Expectorant
MOA: Loosens and thins lower respiratory tract secretions and makes minimally productive coughs more productive
SE: N/V, rash, diarrhea, headache
Diphenhydramine MOA + Side Effects
1st Gen Antihistamine
- FDA approved antitussive
MOA: Acts of the respiratory centers in the medulla to increase the cough threshold
SE: Drowsiness, Disturbed coordination, dry mouth, blurred vision, urinary retention
- Paradoxical excitement/hyperactivity in younger children may occur
Which patients should not receive diphenhydramine?
Narrow angle glaucoma CVD Asthma HTN Hyperthyroidism
Benzonatate MOA + Side Effects
Rx only Antitussive
MOA: Local anesthetic effect on respiratory passages, lung and pleural stretch receptors
SE: sedation, HA, nausea, rash, dizziness, numbness of chest
Do not use in children under 10 y.o.
Dextromethorphan MOA + Side Effects
Opioid-derived antitussive
MOA: acts on respiratory centers in the medulla to increase cough threshold
SE: dizziness, drowsiness, fatigue, drunk-like behavior with overdose
Dextromethrophan is found to be _________ with codeine.
equipotent
Hydrocodone MOA + Side Effects
CII Antitussive
MOA: Acts centrally on the respiratory center in the medulla to increase the cough threshold
SE: N/V, drowsiness and constipation
Codeine MOA + Side Effects
CV Antitussive (OTC in some states, like IA) MOA: Acts centrally on the respiratory center in the medulla to increase the cough threshold
SE: N/V, drowsiness and constipation
Chlophendianol MOA + Side Effects
MOA: Antihistamine with antitussive, anesthetic and mild anticholinergic effects
SE: dizziness, drowsiness, fatigue
Discuss the OTC product Coricidin HBP Cough and Cold.
“Triple C” - contains dextromethorphan + chlorpheniramine
- SE: May cause heart arrhythmias (chlorphen.)
Which drugs have the fastest on-set for antitussive activity?
15 to 30 minutes = dextromethorphan, hydrocodone, codeine
What medication history is important to ask about before recommending dextromethorphan?
MAOI use in the past 2 weeks: Fluoxetine, paroxetine
- Cause N/V, blurred vision, hallucinations or Serotonin syndrome
Serotonin Syndrome Signs
HTN, Hyperthermia, Myoclonus, Mental status changes
Dextromethorphan
- opioid derived antitussive
- no analgesic
- no sedative
- no respiratory depressant
- no addictive properties at therapeutic doses
MOA of dextromethorphan
Acts on respiratory centers in medulla to increase cough threshold
ADR dextromethorphan
- dizziness
- drowsiness
- fatigue
Abuse of dextromethorphan
- stupor/disorientation, euphoria, difficulty walking
- may cause seizures and be fatal
T/f codeine antitussives are the gold standard
False! Used to be, but current evidence suggests otherwise
- dextromethorphan preferred
What is the only FDA approved non-prescription expectorant?
Guaifenesin (mucinex)
Which expectorant should you always drink plenty of water with?
Guaifenesin
Non-pharmacologic treatment of coughs
- increase hydration best
- warm fluids
- hard candies & lozenges (>6 y/o)
- honey (avoid <1 y/o)
- cocoa
- vaporizers & humidifiers (may soothe irritated airways and decrease cough, cool mist preferred)
Treat post-infectious cough
- Inhaled ipratropium
- Inhaled glucocoritoids (GC)
- Short course of PO GC if severe
- Central acting antitussive
