Cough Flashcards
In patients with chronic cough who are non-smokers, aren’t taking ACEIs, and have a normal CXR, what are the four diagnoses on which you should focus your diagnostic approach?
Upper airway cough syndrome (UACS),
Asthma,
Non-asthmatic eosinophilic bronchitis (NAEB)
GERD
(CHEST Guideline, 2012)
What is the empiric treatment for UACS?
First-generation antihistamines + oral decongestants or nasal ipratropium
Describe the diagnostic approach in someone presenting with chronic cough.
- History + Physical + CXR
- If smoking or using ACEI, discontinue and R/A
- If a cause is suggested, investigate and/or empirically treat
- If none of the above is suggestive or impactful, begin investigation +/- treatment of UACS, asthma, NAEB, and GERD, in that order.
What four criteria, if absent, effectively eliminate the need for a CXR to rule out pneumonia in a patient presenting with acute cough?
- HR >100
- RR >24
- T >38
- Focal chest examination findings of consolidation, egophany, or fremitus
What factors are concerning for pertussis and how would you confirm the diagnosis?
When a patient has a cough lasting for > 2
weeks without another apparent cause and it is
accompanied by paroxysms of coughing, posttussive vomiting, and/or an inspiratory whooping sound.
To make a definitive
diagnosis order a nasopharyngeal aspirate or
polymer (Dacron; INVISTA; Wichita, KS) swab
of the nasopharynx for culture to confirm the
presence of B pertussis. Isolation of the bacteria
is the only certain way to make the diagnosis.
What is the diagnostic approach to subacute cough?
- Determine whether it is a post-infectious cough
or not. - If it is post-infectious, determine whether
it is a result of UACS, transient bronchial hyper-responsiveness, asthma, pertussis, or an
acute exacerbation of chronic bronchitis. - If it is
noninfectious, manage the cough the same way
as chronic cough.
