Resp Flashcards
What is chronic cough?
> 4-8 weeks
Natural history of viral cough
Persistenceofcough after viral infection: – 10 days: 50% – 16 days: 25% – 25 days: 90%
Chronic cough differential
- Frequent viral respiratory tract infections
- Postviral cough
- Pertussis/Pertussis like cough
- Cough variant Asthma
- Chronic Rhinitis
- Persistent Bronchitis
- GERD
- Psychogenic Cough
- Non-specific Isolated Chronic Cough
- Cystic Fibrosis
- Immunodeficiency
- Primary Ciliary Dyskenesia
- Foreign Body Aspiration
- Recurrent Pulmonary Aspirations
- Tuberculosis
- Anatomic Disorder
- Interstitial Lung Diseases
Red flags for chronic wet cough
Concerningfeatures – Year round – Starting at early age – Not responsive to therapies – Specific pointers to other illnesses
Clinical Presentations of CF
in infancy
• Failure to thrive * Meconium ileus • Recurrent respiratory symptoms – Wheeze, cough, bronchiolitis *Hyponatremic, hypochloremic metabolic alkalsosis • Prolonged Jaundice • Severe pneumonia
Clinical Presentations of CF
in infancy
- Recurrent respiratory symptoms: Cough, pneuomonia, wheeze poorly controlled asthma etc..
- Failure to thrive
- Recurrent rectal prolapse
- Clubbing
- Bronchiectasis
- Nasal polyps/sinus disease
- Chronic Pseudomonas aeroginosa colonization
Genetic testing for CF
- can miss 5% of classic CF
- implications for treatment
Prognostic factors for CF
Prognostic factors: – Male>female – Lung disease • FEV1 • Burkohderia Cepacia • Pneumothorax – Nutritional status • Weight/height • Diabetes
Risk factors for recurrent aspirations
– Choking/coughing with feeds, especially liquids
– Neurologic abnormalities
– Previous intubations
– Syndromes associated with anatomic malformations (VACTRL)
Differential for asthma
• Asthma/Transient Wheezing • Cystic fibrosis • Large airway obstruction – Extrinsic, Intrinsic, Wall abnormality • Foreign Body Aspiration • Chronic Aspiration • Primary Ciliary Dyskinesia • Infectious adenopathy – Tuberculosis, fungal infection • Chronic Lung Disease of Prematurity • Rare Interstitial Lung Disease • Congestive Heart Failure • GERD
Asthma Control Criteria
- Daytime Symptoms: <4 days/week
- Nighttime Symptoms: <1 night/week
- Physical Activity: Normal
- Exacerbations: Mild, Infrequent
- Absence from work/school: None
- Fast acting B-agonist use: <4 doses/week*
- FEV1 or PEF: ≥90% personal best
Diagnosis of Asthma
• Clinical symptoms + • Objective evidence – Spirometry: obstruction (↓FEV1/FVC) + bronchodilator response (↑FEV1 by ≥12%) – Peak Flow: increase by ≥20% following bronchodilator – Methacholine Challenge • +ve: <4 mg/mL • Borderline: 4-16 mg/mL • Negative: >16mg/mL
Modified Asthma Predictive index
1MajorCriteria
– Parental Asthma
– Doctor Diagnosed Eczema
– Sensitization to aeroallergen
• 2MinorCriteria – Wheezing in between episodes – Peripheral eosinophilia – Sensitization to aeroallergens
> 3 wheezing episodes –> Predicts who will continue to wheeze into school age
Recurrent pneumonia in the same location
• Anatomic abnormality – External airway compression (ie – lymphadenopathy, vascular abnormality) – Intrinsic airway abnormality • Congenital malformation – CPAM – Pulmonary sequestration – Bronchogenic Cyst • Foreign Body • Right Middle Lobe syndrome • Bronchiectasis • Persistent Infection (ie TB)
Recurrent pneumonia in multiple locations
Multiple locations • Immune deficiency • Cystic Fibrosis • Primary Ciliary Dyskinesia • Recurrent aspirations – Anatomical – Swallowing disorder – Neurologic impairment
