Cough and Wheeze

Question 1

What is an acute cough?

Answer 1

50% recovery by day 10
90% recovery by day 25

Question 2

What are differentials for an acute cough?

Answer 2

Viral URTI
Foreign body
Croup
Allergy
Asthma
Pneumonia
Bronchiolitis
Pertussis

Question 3

What are investigations for an acute cough?

Answer 3

Nothing - consider CXR if history suggestive of foreign body inhaled

Question 4

What is usually the cause of acute cough?

Answer 4

Viral (normal to have 7-10/year)

Question 5

What are the features of croup?

Answer 5

Barking cough
Respiratory stridor
Hoarse voice

Question 6

What is the respiratory rate for <2 months?

Answer 6

<60

Question 7

What is the respiratory rate for 2-12 months?

Answer 7

<50

Question 8

What is the respiratory rate for 1-5yrs?

Answer 8

<40

Question 9

What is the respiratory rate for 6-8yrs?

Answer 9

<30

Question 10

What is the respiratory rate for 9-12yrs?

Answer 10

<20

Question 11

What is the treatment of acute cough?

Answer 11

OTC remedies = placebo
Abx not effective or recommended
Pertussis - macrolides (within 1-2wks)
Antihistamines - allergic cough in pollen season
Honey for nocturnal cough

Question 12

What is a chronic cough?

Answer 12

11 coughs/day (up to 30)
Cough longer than 4-6wks

Question 13

What are differentials for a chronic cough?

Answer 13

Non-specific isolated cough
Protracted bacterial bronchitis
Cystic fibrosis
Bronchiectasis
Asthma
Aspiration

Question 14

What is first line investigation for chronic cough >4wks in children?

Answer 14

CXR

Spirometry with reversibility (>5yrs)
Sputum/cough swab for micro

Question 15

What is treatment of protracted bacterial bronchitis?

Answer 15

Prolonged course of antibiotics +/- physio
Usually co-amoxiclav (4-8wks treatment)

Question 16

What is protracted bacterial bronchitis?

Answer 16

Bacterial biofilm formation possibly following damage to respiratory epithelia caused by previous infection

Resistant to abx and host immune response

Question 17

What are features of protracted bacterial bronchitis?

Answer 17

Chronic moist wet cough

Question 18

What are second line investigations for chronic cough?

Answer 18

Sweat test (born before 2007)
Immunoglobulins and vaccine response
Allergy testing
Ciliary studies

Question 19

What are the types of wheeze?

Answer 19

Monophonic (single note)
Polyphonic (multiple notes)
During inspiration or expiration

Question 20

What are causes of acute wheeze?

Answer 20

Asthma

Infection - bronchiolitis, bacterial tracheitis, mycoplasma pneumonia, retropharyngeal abscess

Foreign body

Question 21

What are causes of recurrent wheeze?

Answer 21

Asthma
Abnormalities of tracheobronchial tree
CVD - compress bronchi
Mediastinal masses
CF
BPD - bronchopulmonary dysplasia
Aspiration syndromes

Question 22

What are the presenting features of asthma in children?

Answer 22

Wheeze
Dry cough
Breathlessness
Noisy breathing

Question 23

What are features of diagnosis of asthma in children?

Answer 23

Increased nasal secretions/mucosal swelling
Hyper-expansion, chest deformity, accessory muscles
Wheezing during normal breathing or prolonged expiratory phase
Atopic dermatitis/eczema

Question 24

What is the indication of asthma with spirometry?

Answer 24

FEV1 <80%
FEV1/FVC <80% (obstruction picture due to reduced FEV1 but normal FVC)

Question 25

What is the treatment of asthma?

Answer 25

Preventers - LABA and ICS
Relievers - SABA, Ipratropium bromide