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Theme 4 > Cough & Breathlessness > Flashcards

Cough & Breathlessness Flashcards

1
Q

Cough

A

A sudden, forceful release of air from the lungs

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2
Q

Cough Reflex Pathway

A

Initiated by stimulation of sensory nerves (epithelium of pharynx, larynx, trachea, bronchi)
Cough centre in medulla

Expiratory musculature contracts creating strong rush of air to clear material from breathing passages

Prevent aspiration
Supplements clearance mechanisms when the normal mucociliary clearance is inadequate or overwhelmed
Can get swelling, e.g. laryngeal oedema

Irritation - inspiration - compression - expulsion

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3
Q

Acute cough def

A

2 weeks

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4
Q

Persistent, prolonged or sub-acute def

A

2-8 weeks

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5
Q

Chronic cough

A

More than 8 weeks

Rhinitis (34%)
- Post-nasal drip
- Nasal steroid drops may help
Asthma (25%)
- Think of with nocturnal cough
Reflux oesophagitis (20%)
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6
Q

Prevalence of cough

A

In GP cough is common, e.g. 10%

14-23% non smoking adults in community have a cough

Estimates of chronic cough range from 3%-40%

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7
Q

Cough differential diagnosis - common

A
  • Common cold
  • LRTI ‘pneumonia’
  • asthma / COPD
  • Rhinitis (‘post-nasal drip’)
  • Oesophageal reflux
  • Smoking
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8
Q

Cough differential diagnosis - less common

A 
Passive smoking
Lung tumours
Heart failure
ACE inhibitor drugs
Occupational exposure
TB
Psychological cough
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9
Q

Cough in GP

A

GPs do do tests - chest xrays/ Spirometry

Need to know how to manage mild/early symptoms: not just severe ones!
Intermediate cases often hardest to manage!

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10
Q

Types of cough

A 
Dry
Smoker’s
Bovine 
Productive
Whooping 
Croup
Chronic
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11
Q

Dry cough

A

Irritation in the throat and airways

Nothing expelled

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12
Q

Smoker’s cough

A

Chronic
Morning cough
Little sputum

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13
Q

Productive Cough

A

Expelling material
infected sputum (“purulent”)
‘Helpful’ cough
Should not normally be suppressed by drugs
Coughs which stop coughing = antitussives

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14
Q

Describe Sputum

A 
Always best to inspect!
Colour
Quantity
Quality
Smell
Presence of blood
“Haemoptysis” - Not “haematemesis”
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15
Q

Haemoptysis

A 
May contain blood (“haemoptysis”)
Bright red 
- pulmonary infarction due to embolus
- Malignancy
- TB
Rusty colour (eg acute pneumonia)
Pink & frothy (eg pulmonary oedema & LVF)

Think about blood coming from other sites
Cut tongue
Bleeding nose
Bleeding gums

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16
Q

Other types of sputum

A

Clear, white (mucoid) or purulent (pus)

Can examine microscopically for bacteria, pus cells, eosinophils and malignant cells

17
Q

Bovine Cough

A

Loss of explosive character
Vocal cord paralysis

May be due to important causes:
carcinoma of the bronchus infiltrating L recurrent laryngeal nerve
Damage in thyroid surgery

18
Q

Children - Whooping cough

A 
Bordatella pertussis
Droplet infection spread
Incubation 7- 10 days
Catarrhal phase followed by paroxysmal phase
Inspiratory whoop
19
Q

Children - croup

A

Barking cough (associated with stridor – see later)
Once mainly due to diphtheria
Now viral e.g. Respiratory Syncitial Virus
Exclude foreign body

20
Q

Cough history

A

Use patient’s own language, with clarifications:

Duration
Time of day
Type of cough
Triggers
Sputum
SOB
21
Q

Cough related symptoms

A 
Other Symptoms:
Nasal symptoms
Phlegm
Wheeze
Dyspnoea 
Systemic factors
Unwell
Fever
Weight loss
Breathless
Lifestyle:
Smoking 
Occupation/ dust exposure
Travel
Foreign body inhalation
Pets
22
Q

Cough management

A 
Depends on cause and severity
Mild:  self-care
Take lots of fluid
Stop smoking
Avoid smoky places
1 tsp honey in small
    glass hot water
Stay in warm, humid environment
Sometimes antibiotics
If asthma, take bronchodilators/steroids
23
Q

Shortness of breath

A 
Shortness of breath = Dyspnoea
An important symptom (“red flag”)
Difficult, laboured breathing
Acute v chronic
Obstructive (e.g. COPD/asthma) or restrictive (e.g. fibrosis)
24
Q

SOB history

A

Age
Character of breathing (Wheeze or Stridor)

Previous episodes
Smoking
Occupation, e.g. 
- Asbestos (causes mesothelioma)
- Flintknappers (causes fibrosis)
25
Q

Stridor

A

high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree
i.e. respiratory tract obstruction

26
Q

Immediate onset of SOB

A

Pneumothorax
Inhalation of foreign body
Pulmonary embolism
Hyperventilation

27
Q

Time course of SOB

A

Hours

  • asthma
  • laryngeal oedema
  • heart failure
  • pneumonia
  • diabetic keto-acidosis

Days/ weeks

  • pneumonia
  • heart failure
  • pleural effusion
  • anaemia

Months/years

- tumours
- pulmonary fibrosis
- muscle weakness, eg motor neurone disease
- chronic airways obstruction
- pulmonary fibrosis
- chest wall disorders

Theme 4 (16 decks)

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