Cough and Wheeze Flashcards
What is an acute cough?
50% recovery by day 10
90% recovery by day 25
What are differentials for an acute cough?
Viral URTI
Foreign body
Croup
Allergy
Asthma
Pneumonia
Bronchiolitis
Pertussis
What are investigations for an acute cough?
Nothing - consider CXR if history suggestive of foreign body inhaled
What is usually the cause of acute cough?
Viral (normal to have 7-10/year)
What are the features of croup?
Barking cough
Respiratory stridor
Hoarse voice
What is the respiratory rate for <2 months?
<60
What is the respiratory rate for 2-12 months?
<50
What is the respiratory rate for 1-5yrs?
<40
What is the respiratory rate for 6-8yrs?
<30
What is the respiratory rate for 9-12yrs?
<20
What is the treatment of acute cough?
OTC remedies = placebo
Abx not effective or recommended
Pertussis - macrolides (within 1-2wks)
Antihistamines - allergic cough in pollen season
Honey for nocturnal cough
What is a chronic cough?
11 coughs/day (up to 30)
Cough longer than 4-6wks
What are differentials for a chronic cough?
Non-specific isolated cough
Protracted bacterial bronchitis
Cystic fibrosis
Bronchiectasis
Asthma
Aspiration
What is first line investigation for chronic cough >4wks in children?
CXR
Spirometry with reversibility (>5yrs)
Sputum/cough swab for micro
What is treatment of protracted bacterial bronchitis?
Prolonged course of antibiotics +/- physio
Usually co-amoxiclav (4-8wks treatment)
What is protracted bacterial bronchitis?
Bacterial biofilm formation possibly following damage to respiratory epithelia caused by previous infection
Resistant to abx and host immune response
What are features of protracted bacterial bronchitis?
Chronic moist wet cough
What are second line investigations for chronic cough?
Sweat test (born before 2007)
Immunoglobulins and vaccine response
Allergy testing
Ciliary studies
What are the types of wheeze?
Monophonic (single note)
Polyphonic (multiple notes)
During inspiration or expiration
What are causes of acute wheeze?
Asthma
Infection - bronchiolitis, bacterial tracheitis, mycoplasma pneumonia, retropharyngeal abscess
Foreign body
What are causes of recurrent wheeze?
Asthma
Abnormalities of tracheobronchial tree
CVD - compress bronchi
Mediastinal masses
CF
BPD - bronchopulmonary dysplasia
Aspiration syndromes
What are the presenting features of asthma in children?
Wheeze
Dry cough
Breathlessness
Noisy breathing
What are features of diagnosis of asthma in children?
Increased nasal secretions/mucosal swelling
Hyper-expansion, chest deformity, accessory muscles
Wheezing during normal breathing or prolonged expiratory phase
Atopic dermatitis/eczema
What is the indication of asthma with spirometry?
FEV1 <80%
FEV1/FVC <80% (obstruction picture due to reduced FEV1 but normal FVC)
What is the treatment of asthma?
Preventers - LABA and ICS
Relievers - SABA, Ipratropium bromide
