Cough Flashcards
if a patient develops a cough and explains that its dry but feels it in their chest, is this a dry cough or chesty cough?
Chesty cough and should be treated as a chesty cough
How are acute and chronic coughs classified?
Acute cough - a cough that lasts less than 3 weeks
Chronic cough - lasts more than 8 weeks
What type of cough is it if it has lasted more than 3 weeks but less than 8 weeks?
difficult to define as this type of cough falls within the ‘grey area’ as all chronic coughs develop from an acute cough - so best to refer for further investigation
what is the main cause of an acute cough?
viral infection
What are the clinical features of a acute cough?
presents with sudden onset and associated fever. Sputum is minimal and symptoms are often worse in the evening
Cold symptoms usually last 7-10 days.
What are the likely causes of a cough? What is it characterised by?
Upper airway coughs syndrome (UACS)- postnasal drip, rhinosinusitis
a nasal discharge that flows behind the nose and into the throat.
AND
Acute bronchitis - dyspnoea, wheeze - viral but if bacterial - antibiotic tx is necessary
What should you ask patient if they have symptoms of UACS?
Are they swallowing mucous or notice that they are clearing their throat more than usual
What causes UACS?
allergies are the main cause which are usually non-productive and worse at night
What symptoms are usually associated with UACS?
sneezing, nasal discharge/blockage, conjunctivitis, itchy oral cavity
How would you treat UACS?
antihistamines, decongestants
What can trigger croup? Who does it affect? What are the symptoms? How would you treat?
Recent infection with parainfluenza virus
Affects infants aged 3 months and 6 years
symptoms: severe and violent like ‘barking’ (seal-like) quality, in between coughs pt is breathless and struggles to breathe properly, worse at night
treat with IM dexamethasone, nebuliser budesonide
How can you identify an asthmatic cough?
What drugs should an asthmatic not take and why?
wheezing, coughing, chest tightness and SOB, can be intermittent, worse at night and provoked by triggers
Do not take NSAIDS, BB are also not recommended
What causes pneumonia?
What are the symptoms of the cough?
What other symptoms will the patient experience?
streptococcus penumoniae
non-productive and painful (24-48 hours), rapidly becomes productive, with sputum being stained RED, worse at night
pt will
pt will be unwell, with high fever, malaise, headache and breathlessness, pleuritic pain that worsens on inspiration - urgent referral to the doctor
What drugs can cause a cough?
ACE inhibitors - cough ceases after withdrawal but can take 3-4 weeks to resolve
NSAIDS
BB
When HF progresses, what type of cough develops in pts?
productive, frothy cough with a pink-tinged sputum
What type of cough do patients with TB present and what symptoms are associated with it?
chronic in nature and sputum production can vary from mild to severe
accompanied with weight loss, night sweats, fever, malaise
What are 7 questions you would ask a pt about their cough?
sputum colour nature of sputum onset of cough duration of cough periodicity Age of pt Smoking hx
If a pt presents with a mucoid colour sputum what does this suggest?
no infection present
If a pt presents with a yellow/green/brown colour sputum what does this suggest?
infection
mucopurulent sputum is caused by viral infection and does not require automatic referral
If a pt presents with haemopytsis what does this suggest?
pneumonia
If a pt presents with pink tinged colour sputum what does this suggest?
left ventricular failure
If a pt presents with dark red colour sputum what does this suggest?
carcinoma
If a pt presents with a thin and frothy sputum, what does this suggest?
left ventricular failure
if a pt presents with a thick, mucoid sputum, what does this suggest?
ashtma
if a pt presents with an offensive foul-smelling sputum, what does this suggest
either bronchoiecasis or lung abscess
if a cough is worse in the morning, what does this suggest?
upper airways cough syndrome, bronchiectasis or chronic bronchitis
If a cough lasts for 3 days 3 weeks 3 months what can this suggest?
- URTI
- acute or chronic bronchitis
- chronic bronchitis, TB, carcinoma
If a pt DOES present with green-yellow or brown sputum, when would it be considered a bacterial infection?
if the cough has persisted for more than 7-10days - could be possible it went from an initial viral infection and has become a secondary infection
What are expectorants and what are they used for?
Expectorants are used to help expectoration - promotes secretion of sputum
used for productive cough
Name the expectorants used.
Guaifenesin (thought to stimulate secretion of respiratory tract fluid, increasing sputum volume, decreasing viscosity), ammonium salts, ipecacuanha, creosote, squill
What is given for dry irritating cough?
Codeine, pholcodeine, dextromethorphan and sometimes antihistamines are given ex diphenhydramine
How do antitussive drugs work?
they act directly on the cough centre to depress the cough reflex
Which pts would you not give a cough suppressant to?
pts with productive coughs as it may lead to accumulation in the lungs and this results in a higher chance of infection
What is the purpose of demulcents?
they are pharmacologically inert but reduce irritation by coating the pharynx to prevent coughing, soothes the throat
Name some demulcents
simple linctus, honey, glycerin
What age can you prescribe a child and what dose should be given?
- guaifenesin
- Codeine
- Pholcodeine
- Dextromethorphan
- Diphenhydramine
- Simple linctus
- > 6 years 100mg QDS (but for adults and children over 12 take 200mg QDS)
- > 18 years - 5ml TDS/QDS
- > 6 years 5-10ml TDS/QDS
- > 12 years 10ml QDS
- > 6 years
- > 1 month TDS/QDS
What are the likely side effects of:
- guaifenesin
- Codeine
- Pholcodeine
- Dextromethorphan
- Diphenhydramine
- Simple linctus
- NONE
- sedation, constipation
- possible seadtion
- ””
- dry mouth, sedation, constipation
- NONE
What drugs can interact with the following:
- guaifenesin
- Codeine
- Pholcodeine
- Dextromethorphan
- Diphenhydramine
- Simple linctus
- NONE
- increased sedation with alcohol, opioid analgesics, anxiolytics, hypnotics, antidepressants
- ””
- ””
- ””
- NONE
which patients must be careful when taking the following and why?
- guaifenesin
- Codeine
- Pholcodeine
- Dextromethorphan
- Diphenhydramine
- Simple linctus
- NONE
- asthmatics - cough suppressants can cause respiratory depression - but rarely occurs so can still give it
- ””
- ””
- glaucoma, prostate enlargement - increases intraocular pressure and precipitation of urinary retention
- NONE
can the following be given in pregnancy and BF?
- OK
- avoid in 3rd trimester, short periods okay in BF
- ””
- ”” and cause drowsiness and poor feeding in the baby
- ok but some say avoid, BF ok as small amounts secreted however may reduce milk supply
- OK
Why are antihistamines used as a cough suppressant?
the sedative effects allow pts to have an uninterrupted nights sleep
their MOA is thought to be through anticholinergic-like drying action on the mucous membranes and not via histamine
What extra advice could you give for the tx of a child under 6?
extra fluid consumption as well as the use of a demulcent
what advice would you give to a insulin-dependent diabetic?
check their glucose more frequently because insulin requirements increase during acute infections
if a pt is taking theophylline and has a cough, what advice would you give?
can cause GI upset, nausea, palpitations, best avoided
what advice would you give if a pt wanted to take illogical combinations?
avoid them - these are combinations of expectorants and suppressants
When would you refer? (9)
- cough lasting longer than 3 weeks
- coloured sputum
- haemoptysis
- Persistent harsh barking cough - croup or laryngotracheitis
- difficulty breathing
- chest pain
- whooping cough
- recurrent night-time cough - asthma
- 2-10% of pts taking ACEI
