Cough Flashcards
What questions about the cough should you ask someone with a cough? (6)
Acute or chronic Constant or intermittent Productive or dry Blood Timing Character
What can whether a cough is acute or chronic tell you? And what defines chronic or acute?
The British Thoracic Society (BTS) defines acute as <3 weeks and chronic as >8 weeks. Between 3 and 8 weeks the cough may be due to recovering acute illness or developing chronic illness.
What can whether a cough is constant or intermittent tell you?
A cough that is intermittent may suggest an extrin- sic trigger (e.g. if the patient only coughs at work there may be an allergy to something in the workplace). A cough that is constant suggests an intrinsic cause.
What colour sputum in COPD?
White or clear
What can whether a cough has blood suggest? 3 forms of haemoptysis (2, 1 and 6
- Blood-streaked sputum? Suggests infection or bronchiectasis.
− Pink and frothy sputum? Suggests pulmonary oedema.
− Frank blood (haemoptysis)? Suggests tuberculosis (TB),
lung cancer, pulmonary embolus, bronchiectasis, or other rarer causes (e.g. Wegener’s granulomatosis, Goodpasture’s syndrome).
What can the timing of a cough tell you? (3)
Asthma is classically worse at night. Pulmonary oedema or gastro-oesophageal reflux disease (GORD) can also be worse at night due to the positional effects of lying flat. Patients often report sleeping propped up on pillows to mitigate these effects. Trigger factors such as pets, cold weather, or exercise indicate asthma, as does a worsening in spring/summer.
What can the character of a cough tell you? (5)
A wheezy cough suggests airway obstruction due to asthma or COPD. A bovine cough (breathy) is characteristic of vocal cord paralysis. A dry cough is suggestive of pulmonary fibrosis. A gurgling cough is sugges- tive of bronchiectasis. Pertussis infection causes a ‘whooping’ cough.
What are the 5 characters of cough?
Wheezy Bovine Dry Gurgling Pertussis
What colour sputum in bronchiectasis?
Green/rusty
What colour sputum in lung abscess?
Green/rusty
What does green/rusty sputum indicate?
Bronchiectasis or lung abscess
What colour sputum can asthmatics have
Clear or yellow
What does blood streaked sputum with cough indicate? (2)
Suggests infection or bronchiectasis.
What does pink and frothy sputum with cough suggest?
Pulmonary oedema (CHF)
What does frank blood with cough suggest? (6)
Suggests tuberculosis (TB), lung cancer, pulmonary embolus, bronchiectasis, or other rarer causes (e.g. Wegener’s granulomatosis, Goodpasture’s syndrome
What does a cough worse at night suggest?
Athma/GORD
What does a cough worse in summer/spring indicate?
Asthma
What topics of questions should you ask in someone presenting with cough?
First, ask open questions about the cough itself
Second, ask directed questions about factors that might be triggering the cough
Third, ask about factors that might be associated with the cough and give you clues about the underlying cause:
What should you inquire about secondly when someone presents with cough? (7)
What might be triggering the cough:
Smoking Asthma Allergies Recent rhinusitis/sinusitis History of GORD DHx (ACEi) Travel (TB)