Cough Flashcards
Give the different types of coughs and explain the terms that classify it.
Productive (chesty, sputum production)
Non-productive (dry, tickly, irritating)
Classified by duration
- Chronic - longer than 8 weeks
- Subacute - lasting between 3-8 weeks
- Acute - lasting >3 weeks
What are some causes for a chronic cough
Upper airway cough syndrome, GORD ACE inhibitors Sitagliptin Asthma, bronchiectasis, bronchitis, COPD Non-asthmatic eosinophilic bronchitis Congestive heart failure Interstitial lung disease Lung cancer Tuberculosis
What are some causes for a subacute cough
Post-infectious cough (whooping cough – pertussis)
Pneumonia
New onset or acute exacerbation of asthma, COPD, bronchiectasis, bronchitis, GORD
What are some causes for a acute cough
URTI (colds & flu are most common) COVID-19 New onset or acute exacerbation of asthma, COPD, bronchiectasis and upper airway cough syndrome Pulmonary embolism Pneumonia Pneumothorax Acute bronchitis Croup Irritant exposure Inhaled foreign body
Referral symptoms
SOB Chest pain Pain on inspiration Cough lasting more than 2 weeks Wheezing Recurrent nocturnal cough Hoarseness longer than 2 weeks Haemoptysis Sputum -- rust colored (pneumococcal pneumonia) -- blood stained/haemoptysis (lung cancer, TB, pulmonary oedema -- pink. frothy (pulmonary oedema) -- yellow or green (bronchiectasis (foul smelling), pneumonia)
Questions to ask
Who it is (adult, child, elderly) Onset (acute, chronic, subacute) -- referral for coughs lasting more than 2 weeks Can you cough for me or describe it Travel history (long flight or TB risk area) Other symptoms involved? Red flags or urgent care symptoms Smoking history Substance misuse DHx -- ACEi Nocturnal coughing -- asthma Occupation Hx -- COPD PMH -- exacerbation of prev. condi? Sputum color (if any)
Demulcents: indication, examples, MoA, age, price?
Indication
- Symptomatic relief of coughs
Examples
- Paediatric simple linctus/standard simple linctus
- Glycerin
- Lemon and honey linctus
MoA
- [PHARMACOLOGICALLY INERT AND USED AS A PLACEBO]
- Coat and soothe the back of the throat
Ages
Safe for children, pregnant and elderly
Price
Cheap
Anti-tussives: indication, examples, MoA, age, counselling?
Indication
- Symptomatic relief of dry, tickly, or irritating coughs
Examples
- Codeine & pholcodine = opioid cough suppressants
- Dextromethorphan = non-opioid
All carry abuse potential, but dextromethorphan and pholcodine believed to carry less potential
MoA
- Generally, reduction in the nerve impulses from the area of the brain responsible for coughing
Age
- Codeine based products not to be used in under 18s
- Pholcodine and dextromethorphan not to be used in under 6
Counselling
- Drowsiness may occur with these drugs – no driving if this happens
- Constipation may occur with codeine
Expectorants: indications, examples, MoA, age, counselling
Indication
- Symptomatic relief of productive coughs
Examples
- Guaifenesin
- Ammonium chloride
- Ipecacuanha
- Squill
MoA
- Understood to act as a placebo
Age
- Guaifenesin and ipecacuanha not to be used in under 6
Counselling
- Guaifenesin doesn’t have clinically sig. interactions
Antihistamines: indications, examples, MoA, age, counselling
Indication
- Symptomatic relief from rhinorrhoea and sneezing
Examples
- Diphenhydramine
- Promethazine
- Triprolidine
MoA
- Dry up the excessive secretions from the bronchial and nasal passages
Age
None of these should be used in under 6 unless recommended by a HCP
Counselling
- First gen antihistamines, so they may cause sedation
- Anticholingeric side effects: dry mouth, constipation, blurry vision, urinary retention, exacerbation of narrow/closed angle glaucoma
- Not to be used in narrow/closed angle glaucoma and BPH
What are some other general counselling points?
Products containing sodium
- Check sodium levels, and appropriateness (low sodium diet, renal impairment, CVD)
Products containing alcohol
- Hx of alcohol abuse, interactions, intended age treatment
Products containing sugar
- Recommend SF alternatives to diabetics or children
Be logical with suggestions
- Not expectorant and antitussive
Age appropriate
General self-care tips
Keep well hydrated
Plenty of rest
Boiled sweets or lozenges may soothe the cough
Warm water with lemon and honey may soothe the cough
Steam inhalation
Diabetics should monitor their glucose levels well
Smoking cessation
