Cough and Hemoptysis Flashcards
A cationic channel found on rapidly adapting receptors and C-fibers, which is the receptor for capsaicin; its expression is increased in patients with chronic cough
Type-1 vanilloid receptor
This afferent nerve is also known as the Arnold nerve
Auricular branch of the vagus nerve
Sensory signals from the respiratory tract travel through these nerves (2) to a region of the brainstem in the nucleus tractus solitarius, vaguely identified as the “cough center”
Vagus and superior laryngeal nerves
Surrogate marker for cough strength
Peak expiratory flow or maximal expiratory pressure at the mouth
Subacute cough is defined as lasting for this duration
3-8 weeks
acute if less than 3 weeks, chronic if more than 8 weeks
Most common causes of chronic cough (4) when initial assessment with chest examinatio and radiograph is normal
Cough-variant asthma, GERD, nasopharyngeal drainage, and medications (ACE inhibitors)
Diagnosis: characteristic inspiratory whoop after a paroxysm of coughing
Pertussis
Irritation of the tympanic membrane can result in cough by stimulation of this nerve
Arnold’s nerve
Mechanism of ACE inhibitor cough may involve sensitization of sensory nerve endings due to accumulation of this peptide
Bradykinin
Cough due to asthma in the absence of wheezing, shortness of breath, and chest tightness
Cough-variant asthma
In a patient capable of making reliable measurements, this can be used as a cost-effective method to support or discount a diagnosis of asthma
Home expiratory peak flow monitoring
Chronic eosinophilic bronchitis causes chronic cough with a normal CXR and is characterized by absence of airflow obstruction or bronchial hyperresponsiveness and sputum eosinophilia in excess of this percentage
3%
Treatment for chronic eosinophilic bronchitis
Inhaled glucocorticoids
Most effective drugs for chronic idiopathic cough
Narcotic cough suppressants (e.g., codeine or hydrocodone)
An over-the-counter, centrally acting cough suppressant with fewer side effects and less efficacy than narcotic cough suppressants
Dextromethorphan
This cough suppressant is thought to inhibit neural activity of sensory nerves in the cough-reflex pathway and is generally free of side effects; however, its effectiveness is variable and unpredictable
Benzonatate
Most common etiology of hemoptysis
Infection of the medium-sized airways
Most common cause of hemoptysis worldwide
Tuberculous infection
Diagnosis: sudden-onset dyspnea with hemoptysis and hypoxemia in the first 100 days after a bone marrow transplant
Diffuse alveolar hemorrhage
Most common cause of noninflammatory alveolar hemorrhage
Direct inhalational injury (thermal injury, illicit substances, toxic chemicals)
Pneumonia due to these organisms (2) are more likely to cause necrotizing lung infections and, thus, are more often associated with hemoptysis
Staphylococcus aureus and gram-negative rods (e.g., Klebsiella pneumoniae)
Risk factors (2) that would warrant chest CT scan in a patient with mild hemoptysis
Smoking, age >40
Management for patients with massive hemoptysis and continuous bleeding after securing the airway
Embolization or resection
Diagnosis: monthly hemoptysis in a woman
Catamenial hemoptysis from pulmonary endometriosis
Definition of massive hemoptysis
> 200-600 cc in 24 h
