Cough

Question 1

What does a dry cough suggest?
Barking cough?
Moist cough?

Answer 1

Dry - prolonged expiratory phase - narrowing of small sized to moderate sized airways
Barking cough - tracheal inflammation, narrowing or collapse
Moist - increased mucus secretion or infection in lower airway

Question 2

What is the function of the cough reflex?

Answer 2

Expel unwanted material from the airway below the glottis

Question 3

What is whooping cough?

Answer 3

Pertussis

Highly contagious respiratory infection caused by Bordatella pertussis

Question 4

How does whooping cough present?

Answer 4

A week of coryza (catarrhal phase)
Child develops paroxysmal or spasmodic cough followed by characteristic inspiratory whoop (paroxysmal phase)

Spasms of cough often worse at night and may culminate in vomiting.
Child goes red/blue in the face and mucus flows from nose and mouth

Epistaxis and subconjunctival haemorrhages can occur

In infants apnoea is common

Lasts up to 3 months

Symptoms gradually decrease (convalescent phase)

Question 5

What are complications of whooping cough?

Answer 5

Pneumonia
SEizures
Bronchiectasis

Question 6

What investigations in whooping cough?

Answer 6

Pernasal swab to culture and identify organism
PCR

Marked lymphocytosis

Question 7

What is management/prevention of whooping cough?

Answer 7

Macrolide eradicate organism however decrease symptoms only if started during catarrhal phase.
Close contacts should receive macrolide prophylaxis

Vaccination reduces risk fo developing pertussis and severity
This does not guaruntee protection
Immunisation of mothers dragon pregnancy reduces risk of pertussis in infant

Question 8

Common cause of chronic cough?

Answer 8

Recurrent respiratory infections
Following pertussis,RSV
ASthma
Persistent lobar collapse following pneumonia
CF
Recurrent aspiration and GORD
Smoking

Question 9

What should you consider in severe persistent cough?

Answer 9

Tuberculosis