Cough and breathlessness Flashcards
Signs and symptoms
Symptoms:
Felt by the patient, usually subjective.
Example: pain, fatigue, nausea.
Signs:
Things observed usually by the clinician.
Includes:
Haemoptysis, hypertension, hypoxaemia etc.
Cough reflex pathway
Irritation of the airway/alveoli—-> Inspiration —-> Compression of thorax —-> Expulsion of air from thorax caused by contraction of expiratory musculature.
Cough initiated from medulla control- prevents aspiration
Stimulated by sensory nerve (irritant receptors) in: Epithelium of pharynx Larynx Trachea Bronchi
Purpose of cough reflex
Prevents aspiration- drawing in of breath.
Supplement clearance mechanism for when mucociliary clearance is no functioning properly.
Acute cough
Cough that only lasts for up to 2 weeks.
Persistent/ prolonged/ sub-acute cough
Cough lasting 2-8 weeks long
Chronic cough
Cough lasting up to 8 weeks.
Common causes:
Rhinitis
Asthma
Reflux oesophagitis
Common causes of cough ( 6)
Common cold
Lower respiratory tract infection- pneumonia
COPD
Rhinitis
Oesophageal reflux
Smoking
Uncommon causes of cough (7)
Passive smoking
Lung tumour
Heart failure
ACE inhibitors
Occupational exposure
TB
Psychological
7 types of cough
Dry
Smoker’s
Bovine
Productive
Whooping
Croup
Chronic
Dry cough
Occurs when there is irritation in the throat and airways.
Nothing is expelled from the cough
Causes: Irritants Allergies Common cold Asthma
Smoker’s cough
Chronic cough- lasting for 8 or more weeks.
Usually in the morning
Produces little sputum.
Productive cough
Cough that expels material.
If sputum is infected= purulent.
Not normally suppressed by drugs
Antitussives
Drugs that stop coughing.
Describing sputum
Colour
Quantity and quality
Smell
Haemoptysis- from lungs.
(Haematemesis, from GI)
Haemoptysis
Sputum that contains blood.
Bright red blood indicates:
PE
Malignancy
TB
Rusty colour:
Acute pneumonia
Pink and frothy:
Pulmonary oedema + LVF
Bovine cough
Cough that lacks explosive character
Cause:
Vocal cord paralysis
Damage from thyroid surgery
Carcinoma of bronchus compressing L recurrent laryngeal nerve.
Whooping cough
Cough caused by bacterial infection of Bordetella pertussis- presence of an inspiratory ‘whoop’
Spreads via droplets
Incubation period: 7-10 days
Catarrhal to paroxysmal phase.
Croup cough
Cough characterised by a ‘barking’ like sound- associated with stridor
Due to mainly viral infections but can also be due to diptheria.
Infection causes swelling of inside the trachea.
Viral infections include:
Respiratory syncytial virus
Influenza
Cough history
Clarifications need to be made to help diagnosis:
- How long the cough has been happening.
- The time of the day coughing happens.
- Type of cough.
- The triggers
- Sputum?
- SOB?
Systemic symptoms related to cough
Malaise
Fever
Weight loss
Breathlessness
Other respiratory symptoms associated with cough
Nasal discharge and other nasal symptoms.
Phlegm
Wheeze
Dyspnoea
Management of cough
Fluid
Smoking cessation
Avoid smoky places
1 tsp honey + hot water.
Stay in warm, humid environments.
Stridor
High-pitched breath sound due to turbulent airflow in larynx or lower bronchial tree.
Can be to respiratory tract obstruction.
Can be seen in croup
Causes of sudden onset of breathlessness
Pneumothorax
Inhalation of a foreign body.
PE
Hyperventilation
Causes of breathlessness with onset lasting hours
Asthma
Laryngeal oedema
Heart failure
pneumonia
Diabetic keto-acidosis
Cause of breathlessness that lasts days/ weeks
Pneumonia
Heart failure
Cause of breathlessness that lasts for months/ years
Tumours
Pulmonary fibrosis
Muscle weakness
Chronic airway obstruction (i.e COPD)
Chest wall disorder.
