Cough and breathlessness Flashcards
Describe the cough reflex pathway
Initiated by stimulation of sensory nerves in epithelium of pharynx, larynx, trachea and bronchi
The cough centre is in the medulla and its stimulated by irritant/obstruction
Expiratory muscualture contracts creating stronger rush of air to clear material from breathing passages
It prevents aspirations
Supplements clearance mechanisms the the normal mucocillary clearance is inadequate or overwhelmed
What would you describe as an acute, persistent and chronic cough?
Acute: <2 weeks
Persistent: 2-8 weeks
Chronic >8 weeks
Describe the prevalence of cough
Most commonly presents to GP (2nd most common presenting symptom in primary care)
Common in both smokers and non-smokers but more common in smokers
Suggest a common and uncommon differential diagnosis for a cough
COMMON Common cold LRTI: pneumonia Asthma Rhinitis Oesophageal reflux Smoking
UNCOMMON Passive smoking Lung tumours Heart failure ACE inhibitors Occupational exposure TB Psychological cough
What tests would a GP carry out on a patient presenting with cough?
CXR
Spirometry
Breathing rate, O2 sats, pulse, BP, temperature
Whats the difference between a dry and productive cough?
How does this differ to a smokers cough?
Dry cough is indicative of irritant in throat or airways
Productive coughs expel infected sputum “purulent” (pus containing)
Should not be suppressed by drugs
Smokers cough is chronic and produces little sputum, worse in morning.
Describe a bovine cough
Loss of explosive character
Vocal chord paralysis
May be due to bronchus infiltration in recurrent laryngeal nerve; damage in thyroid surgery
Describe whooping cough (children)
Caused by bordatella pertussis Droplet infection spread Incubation 7-10 days Catarrhal followed by paroxysmal phase Inspiratory whoop
Describe croup (children)
Barkign cough
Diptheria
Viral
What are the commonest causes of chronic cough?
Rhinitis
Asthma
Reflux oesophageal
What is stridor?
High pitched wheezing breath resulting from turbulent air flow over larynx (sounds like muffled horse)
Obstruction of central airway (wheezing is result of peripheral airway obstruction, typically bronchiole)
When might a person experience shortness of breath?
Suddenly in pneumothorax (on auscultation: no sound)
Asthma may cause SOB over hours as does laryngeal oedema, HF, pneumonia, diabetes
Pneumonia, HF, pleural effusion and anaemia causes SOB over days/weeks
