Cough & Breathlessness Flashcards
Cough
A sudden, forceful release of air from the lungs
Cough Reflex Pathway
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
Acute cough def
2 weeks
Persistent, prolonged or sub-acute def
2-8 weeks
Chronic cough
More than 8 weeks
Rhinitis (34%) - Post-nasal drip - Nasal steroid drops may help Asthma (25%) - Think of with nocturnal cough Reflux oesophagitis (20%)
Prevalence of cough
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%
Cough differential diagnosis - common
- Common cold
- LRTI ‘pneumonia’
- asthma / COPD
- Rhinitis (‘post-nasal drip’)
- Oesophageal reflux
- Smoking
Cough differential diagnosis - less common
Passive smoking Lung tumours Heart failure ACE inhibitor drugs Occupational exposure TB Psychological cough
Cough in GP
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!
Types of cough
Dry Smoker’s Bovine Productive Whooping Croup Chronic
Dry cough
Irritation in the throat and airways
Nothing expelled
Smoker’s cough
Chronic
Morning cough
Little sputum
Productive Cough
Expelling material
infected sputum (“purulent”)
‘Helpful’ cough
Should not normally be suppressed by drugs
Coughs which stop coughing = antitussives
Describe Sputum
Always best to inspect! Colour Quantity Quality Smell Presence of blood “Haemoptysis” - Not “haematemesis”
Haemoptysis
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
Other types of sputum
Clear, white (mucoid) or purulent (pus)
Can examine microscopically for bacteria, pus cells, eosinophils and malignant cells
Bovine Cough
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
Children - Whooping cough
Bordatella pertussis Droplet infection spread Incubation 7- 10 days Catarrhal phase followed by paroxysmal phase Inspiratory whoop
Children - croup
Barking cough (associated with stridor – see later)
Once mainly due to diphtheria
Now viral e.g. Respiratory Syncitial Virus
Exclude foreign body
Cough history
Use patient’s own language, with clarifications:
Duration Time of day Type of cough Triggers Sputum SOB
Cough related symptoms
Other Symptoms: Nasal symptoms Phlegm Wheeze Dyspnoea
Systemic factors Unwell Fever Weight loss Breathless
Lifestyle: Smoking Occupation/ dust exposure Travel Foreign body inhalation Pets
Cough management
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/steroidsShortness of breath
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)
SOB history
Age
Character of breathing (Wheeze or Stridor)
Previous episodes Smoking Occupation, e.g. - Asbestos (causes mesothelioma) - Flintknappers (causes fibrosis)
