Cough Flashcards
Facts about cough?
• Cough is a very common complaint that leads patients to seek medical attention. • The CDC estimates cough is the reason for greater than 30 million patient visits annually. • It is important to remember that cough is a symptom, not a disease. • Cough is primarily a protective mechanism in response to various forms of irritation. • The force of a cough is felt to depend upon the magnitude and type of airway irritation, along with the individual’s vital capacity.
Explain the cough reflex?
The cough reflex is caused by irritation of cough receptors, increase Afferent signals, go to Medulla and higher cortical centers, then get Efferent signals to Effector muscles This reflex aids in clearing the airways
Where are the cough receptors? What are the afferent nerves? efferent? what are the efferent muscles?
Explain the specific afferents, efferents, and muscles in different areas of the lung?
Explain the timeline of acute, subacute and chronic cough?
Acute <3weeks
Subactute 3-8 weeks
Chronic: 8 weeks or more
Questions to ask a patient who has a chronic cough?
- How long have you had the cough?
- Was the cough preceded by and upper respiratory infection?
- Is the cough productive or non-productive (dry)?
- If productive, what are the sputum characteristics? The amount of phlegm Copious thick bronchiectasis The color of the sputum *Remember thick yellow or green sputum indicates the presence of either numerous neutrophils or eosinophils Have you seen blood in the sputum? Is there an odor to the sputum? Foul-smelling, think bronchiectasis*
- When does the cough occur? With exercise Primarily at night After meals Seasonal
- Are there associated symptoms? Weight loss Chills, fever, night sweats Shortness of breath Heartburn Post nasal drip Wheezing Chest tightness Hoarseness
- Are you a current or former smoker? If you attribute your cough to smoking has there been a recent change in its character
- What current medications are you taking?
- Do you have a pet or around pets? A dog, cat, bird
- What is your work environment like?
- How do you heat your home? eg, wood burning stove, fireplace
- What seems to make your cough better or worse?
Airway irritants that can cause cough?
- Inhaled smoke, dusts, fumes
- Aspiration: Gastric contents • Oral secretions • Foreign bodies
- Postnasal drip (upper airway cough syndrome)
Airway diseases that can cause cough?
•Upper respiratory tract infection •Postinfectious cough •Acute or chronic bronchitis •Eosinophilic bronchitis •Bronchiectasis •Neoplasm •External compression by node or mass lesion •Reactive airways disease (asthma)
Parenchymal diseases that can cause a cough?
- Pneumonia and other lower respiratory tract infections (e.g., tuberculosis)
- Lung abscess
- Interstitial lung disease
Two other things that cause cough?
CONGESTIVE HEART FAILURE
MISCELLANEOUS: Drug-induced (angiotensin-converting enzyme inhibitors)
Acute cough differential?
Commonly viral
Other causes: pneumonia, allergic rhinitis, acute tracheobronchitis, aspiration or foreign body, medication (ACE I), PE, pulmonary edema
Chronic cough differential?
Top three in a non-smoker: upper airway cough syndrome, GERD, asthma
Next three most common: chronic bronchitis, bronchiectasis, Non-asthmatic eosinophilic bronchitis
explain the cough flow chart?
Chronic Cough is more common in? Occurs when? Can last how long?
More common in women than men
Commonly occurs in the fifth and sixth decades of life
Can persist for months to years
Can be very disabling
Can cause substantial physical, social, and physiologic effects
Evaluation of Chronic Cough?
