Cough and SOB Flashcards
What is a Cough and what causes it?
- what muscles and organs does it effect
- a sudden forceful release of air from the lungs
- Tussive Reflex: stimulation (irritant, e.g. particulate, or obstructive, e.g. mucous) of sensory nerves (epithelium of pharynx, larynx, trachea and bronchi – carina of trachea = greatest concentration)
–> cough centre in medulla –> expiratory muscles contract (internal intercostals, rectus abdominus, external and internal obliques, transversus abdominus)
What is the benefit of coughing?
o Prevents aspiration
o Supplements clearance mechanisms (mucociliary escalator) when baseline overwhelmed or inadequate
- be very cautious and judicious in antitussives (cough suppressant drugs)
What are problematic results of a cough
- affects sleep
- pain in ribs: can get associated rib fractures
- pain in throat: can get associated vocal cord oedema, affecting the voice
- stress incontinence
- cough syncope
all of these can reduce QoL
What features should be gathered in the history?
o Duration: acute: 8 weeks
o Pattern: time of day [e.g. nocturnal in asthma], post-exertional, environmental [e.g. only at work – baker’s cough = most common occupational lung disease].
o Sound: e.g. ‘inspiratory whooping’ – droplet spread of Bordetella pertussis, incubation 7- 10d, followed by catarrhal phase, then a paroxysmal phase of cough 3-6m, vaccinated [HiB]; ‘bovine cough’ = loss of explosive character due to vocal cord paralysis, rare – when seen often caused by bronchial carcinoma and indicates infiltration of the recurrent laryngeal nerve
o Triggers: e.g. cold air, smoke
o Sputum: volume, colour, consistency, presence of blood
o Nature of onset
What do the different types of haemoptysis indicate?
o Bright red blood: seen in pulmonary infarction (rarer), but also in rupture of superficial capillaries of the pharynx
o Rusty colour: seen in pneumonia
o Pink and frothy: seen in heart failure or other causes of pulmonary oedema
What are the common causes of haemoptysis?
- Acute infection
- Bronchial carcinoma
- TB
- Pulmonary infarcation
What are occasional causes of haemoptysis?
- Trauma
- Vascular abnormalities: AV malformations
- Bleeding disorders: can be iatrogenic
What are rare causes of haemoptysis?
- Associated with SLE (Systemic lupus erythematosus)
- Aspergillosis
- Goodpasture’s syndrome: autoimmune disease, body mistakenly produces antibodies against collagen in the lungs and kidneys
What are some Nasal and Naso-pharyngeal causes of cough?
What is the treatment?
- Rhinosinusitis: acute and chronic, postnasal drip
o Combination of cough, postnasal drip, need to clear throat, tickle, nasal congestion, nasal discharge, hoarseness
o Therapy: antihistamines, intra-nasal corticosteroids, and sparing / v. limited use of some decongestants
- Common causes: viral upper respiratory tract infections (rhinovirus, coronavirus, picornaviridae families = >200)
What are some Tracheao-bronchial causes of cough?
What is the treatment?
- Asthma: many children have viral-induced recurrent viral coughs, but do not go on to develop asthma
- COPD:
- usually associated with significant smokers history
- seen in younger age groups when significant Hx of cannabinoid smoking
- seen in the absence of smoking with alpha-1-antitrypsin deficiency
- Bronchiectasis
- Dilation of smaller airways (bronchioles) forming potential space for mucous pooling, stagnation and infection
- Lower threshold for antibiotics, and often longer course
- Consideration of ‘colonisation’ with specific pathogens (e.g. pseudomonas)
- Cancer
- Bronchogenic carcinoma (trachea / bronchi / bronchioles)
- SCLC (small cell lung carcinoma) of parenchyma
- Usually environmental (cigarette, industrial pollutants)
- Infection
What are other causes of a cough?
- GORD: Gastro-oesophageal reflux disease
- can cause coughing through aspiration, trachea oesophageal fistula (TOF)
- triggered by cough receptors in the oesophagus
- treat with proton pump inhibitors as they have a faster effect than H2 antagonists
- Can be due to something given to the patient
- ACE cough: ramipril
- not dose-dependent, often stars several months of taking ACEi
- can be seen in beta-blockers (much less likely), would be contraindicated in people with asthma
What does Acute shortness of breath present like in Asthma?
- Bilateral wheeze
- may produce purulent phlegm
What does Acute shortness of breath present like in Heart failure
- may hear Bilateral wheeze
- Bilateral Fine crackles
What does Acute shortness of breath present like in Exacerbation of COPD?
- Purulent phlegm
- Coarse crackles
- Bilateral wheeze
- may hear bilateral fine crackles
What does Acute shortness of breath present like in Pneumonia?
- Purulent phlegm
- Coarse crackles
- Focal reduced Air Entry
