Respiratory Flashcards
Specific questions to ask when a patient presents with a cough.
Sputum Colour Nature of Sputum Onset of cough Duration of cough Periodicity Age of patient Smoking history
What does sputum colour indicate in a cough?
Clear / White (Mucoid) - no infection present.
Yellow / Green / Brown - infection present, generally viral not requiring immediate referral.
Haemoptysis - rust coloured in pneumonia, pink in LV failure or dark red in carcinoma.
Includes bright red blood - usually a one-off due to force of coughing. Not serious and doesn’t require immediate referral.
What does the nature of the sputum indicate in a cough?
Thick & Frothy - LV failure.
Thick & Mucoid / Yellow - asthma.
Offensive foul-smelling sputum - bronchiectasis or lung abscess.
What does the onset of the cough indicate?
A cough that is worse in the morning may suggest upper airways cough syndrome, bronchiectasis or chronic bronchitis.
What does the duration of the cough indicate?
Upper respiratory tract infection (URTI) cough can linger for more than 3 weeks and is termed ‘postviral
cough’.
Coughs lasting longer than 3 weeks should be viewed with caution.
The most likely diagnoses of cough are as follows:
- At 3 days’ duration will be a URTI.
- At 3 weeks’ duration will be acute or chronic bronchitis.
- At 3 months’ duration conditions such as chronic bronchitis, tuberculosis and carcinoma become more likely.
What does periodicity of cough indicate?
Adult patients with recurrent cough might have chronic bronchitis, especially if they smoke.
Care should be exercised in children who present with recurrent cough and have a family history of eczema, asthma or hay fever. This might suggest asthma and referral would be required for further investigation.
What does the age of patient with a cough indicate?
Children will most likely be suffering from a URTI but asthma and croup should be considered.
With increasing age conditions such as bronchitis, pneumonia and carcinoma become more prevalent.
What does smoking history of a patient with a cough indicate?
Patients who smoke are more prone to chronic and recurrent cough. Over time this might develop in to chronic bronchitis and COPD.
What are the symptoms of croup?
Symptoms occur in the late evening and night. The cough can be severe and violent, and is described as having a barking (seal-like) quality. In between coughing episodes the child may be breathless and struggle to breathe properly. Typically, symptoms improve during the day and often recur again the following night, with the majority of children seeing symptoms resolve in 48 hours.
In what age group is croup most likely to be prevalent?
Infants between 3months-6years. Incidence is highest between 1-2years and is more common in boys.
What medicines may be related to a cough or wheeze?
ACE inhibitors - not dose related and may occur at any time during treatment.
NSAIDs
Beta-blockers
Cough referral symptoms.
Cough lasting >3 weeks SOB / breathlessness / wheeze Chest pain Pain on inspiration Hemoptysis Regularly recurring cough Debilitating symptoms Persistent nocturnal cough in children Purulent sputum lasting after 7-10 days (risk of secondary bacterial infection from initial viral infection) Any cough that does not improve with treatment
Treatment options for productive coughs.
Expectorants:
Guaifenesin: >6 years.
6-12 years = 100mg QDS >12 years = 200mg QDS
Antihistamines:
Diphenhydramine: >6 years. Generally in combination products.
Treatment options for non-productive coughs.
Suppressants: Codeine: >18 years - limit use due to risk of abuse. 5ml QDS Pholcodine: >6 years. 5-10ml TDS/QDS Dextromethorphan: >12 years. 10ml QDS
Antihistamines:
Diphenhydramine: >6 years. Generally in combination products.
Demulcents:
Simple Linctus: >1 month. No associated side-effects.
5-10ml TDS/QDS
Specific questions to ask when a patient presents with a cold.
Onset of symptoms.
Nature of symptoms.
Aggravating factors.
