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Module 1 > Cough: Clinical Perspectives and Therapy > Flashcards

Cough: Clinical Perspectives and Therapy Flashcards

1
Q

Describe the classic cough patient

A

Female, ≥50

Hypersensitive to aerosols

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2
Q

What are the aims of treating cough symptoms

A

↓Intensity

↓Frequency

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3
Q

What are the top three causes of cough

A

GORD

Rhinosinusitis (postnasal drip)

Asthma

Infection, COPD, Drugs, ILD

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4
Q

What causes the cough in ILD?

A

Traction of tissue irritates vagal nerve endings

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5
Q

What is the mechanism for cough in GORD

A

Vagus nerve innervation by acid in lower oesophagus

Acid in the laryngeal area which stimulates superior laryngeal nerves

Microaspirations

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6
Q

Presenting complaints of GORD

A

Early morning cough

Indigestion

Waterbrash

Cough

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7
Q

What are some diagnositc investigations for GORD

A

Oesophageal Impedence (paried channels down the oesophagus, records any break of the current and pH)

Manometry (measures pressures in oesophagus)

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8
Q

What are the treatments for GORD

A
  1. PPI + Anti-histamines
  2. Alginates (Gaviscon - coats oesophagus)
  3. Motility agents (to keep acid down)
  4. Nissen’s fundoplication (imitates sphincter) - not many studies at the moment for GORD cough

PPI is first line hoever, Cochrane review showed it was ineffective at ↓cough severity

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9
Q

Name tools used to assess cough severity

A

Leicester Cough Questionnaire

Visual cough Scale

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10
Q

What are the mechanisms of cough in asthma (3)

A
  1. Inflammation -> Nerve ending stimulation
  2. Constrictor stimuli -> Bronchoconstriction induced cough
  3. Mucus -> clearnce and stimlui of nerve endings?
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11
Q

Apart from asthma, what are some other eosinophilic airway diseases?

A

Cogh Variant Asthma

Atopic Cough

Eosinophilic Bronchitis

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12
Q

Why might an asthmatic patient still have a cough even though on treatment?

A

Poor Compliance

Other cough-disease (post-nasal drip, GORD)

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13
Q

Name some uncommon causes of cough

A

OSA

Chronic tonsillar enlargement

Arnold’s Reflex

Tracheobronchopathia osteochondroplastica

Drugs (Indacaterol B2 agonist, 20% cough SE)

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14
Q

What is the mechanism of cough in patients with obstructive sleep apnoa

A
  • Airway trauma sa a result of snoring and collapsed larynx.
    • Airway inflammation
    • Irritation of nerve endings
  • Apnoea
    • ↑Effort to ventilate
    • ↑Trans-diaphragmatic pressure
    • ↓sphincter tone
    • Cough
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15
Q

Tracheobronchopathia osteochodroplastica can cause cough. What is this

A

Benign, submucosal nodules growing from submucosal layer in airways

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16
Q

Describe the manifestation of cough from Anrold’s reflex

A

Auricular branch of the vagus nerve gets stimulated by ear wax

Induces cough through vagus nerve

Good hygeine will stop this

17
Q

Charactersitics of Holmes-Adie Syndrome and link with cough

A

Aniscoria (unequal eye pulis, ankle tendon areflexia)

Loss of myelination of lung afferents -> ↑hypersensitivity of secondary neurons in the nucleus solitarius

18
Q

40% of patients have idiopathic cough. What are some reasons for the increased cough (mechanisms of cough) in this context (5)

A
  • ↑Airway Nerve Sensitivity
    • ↑Capsaicin sensitivity and C-fibre activation
    • ↑Density of nerve fibres (↑CGRP nerves)
  • ↑TRPV1 receptors
  • ↑Sensitivity of laryngeal glotic closure reflex
    • General vocal cord dysfunction
  • Airway Inflammation
    • Mediators (histamine, PGE2, LTs)
    • Cells (neutrophils)
  • Goblet Cell hyperplasia
    • Cause or consequence
19
Q

Current treatments for idiopathic cough

A

Morphine - reduces cough severity, central mechanism of action, risk of SE and dependence

Codeine - chronic COPD cough - not effective

20
Q

Novel therapy for anti-tussives

A

P2X3 receptor ?antagonist

Promising data in animal and in vitro modls - untested in humans

21
Q

Effect of theobromine on cough

A

Reduces sensitivity to capsaicin (theobromine leads to more concentrations of capsaicin to induce cough)

22
Q

What is the mechanism of action of theobromine?

A

Adenosine 1 receptor antagonist and PDE inhibitor

Leads to ↑cAMP

Theobromine = theophyline = methylxanthine

23
Q

What are some non-licensed therapies ofr cough

A

Cloves, hot ginger with honey, steam inhalation of Vick Vaporub

LAMA

Low dose Gabapentin

Low dose opiate

Mucolytics (carbocisteine)

Module 1 (16 decks)

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