Respiratory System Flashcards
Cough
A cough is a reflex action of the body described as a forced expulsive maneuver
Productive: phlegm is produced
Dry: no phlegm production
Most commonly associated with upper respiratory tract infection which is usually mild and self-limiting. Acute coughs resolve in around 2 weeks.
Danger symptoms of cough
- Very high temperatures and shortness of breath with cough could indicate more serious infections such as Pneumonia. It is most common in people over 65 or under 2 as well as smokers and drinkers. Refer urgently.
- Chest pain with cough
- Coughing up blood could indicate tuberculosis or cardiovascular cause such as pulmonary edema. Urgent referral is advised.
- A cough that lasts longer than 21 days should be a referral for a routine GP appointment
Differential diagnosis of cough
- In asthmatics, coughs are an indication of poorly controlled asthma so it is good to check their understanding of their condition
- A persistent nighttime cough in children requires a routine referral to investigate the possibility of asthma
Practical tips for cough
- Smoking cessation will help reduce cough symptoms and complications of upper respiratory tract infection or exacerbations of COPD
- Ensure adequate fluid
- Simple home remedies such as honey and lemon
Treatment options for cough
- Demulcants such as simple linctus contain soothing ingredients such as syrup and glycerol to suppress the voluntary cough mechanism to reduce frequency of the coughs
- Expectorants such as ipecacuanha, ammonium chloride produce expulsion of bronchial secretions. There is very little evidence
- Anti-tussive containing codeine or opioid should be avoided in children and also not recommended in adolescents. Also not preferred in adults due to adverse effects such as constipation and dependence.
- Pholcodine has fewer side effects than codeine.
- Dextromethorphan (a non-opioid) and menthol are both effective at suppressing coughs however, not to be used in productive coughs as clearance of phlegm and mucus is required
- Anti-histamines such as diphenhydramine suppress the cough and cause drowsiness. Useful in noctural cough.
Coup in children
- Starts with a cold and has a barking cough. Trachea becomes swollen and thick mucus is produced. This makes it difficult to breathe.
- Symptoms often worse during the first 3 days and worsen at night. May last for a further week.
- No medical treatment is needed, antipyretic may help with the fever
- Sit the child upright to help them breathe easily
- Drink lots of fluid
- Call 999 if needed when difficulty breathing (ribcage being pulled upwards and inwards) , rate of breathing is fast, child appears agitated and pale
Common cold
- Acute, mild and self-limiting
- The most common symptoms are nasal discharge, nasal obstruction, sore or scratchy throat, headache and cough
- Hoarseness, loss of taste and smell, mild burning of the eyes, pressure in the ears or sinuses and muscosal swelling
Danger symptoms of cold
Children under two years of age have an increased risk of contracting pneumonia and appears more unwell than normal i.e. fever, fast breathing, difficulty breathing, nasal flaring, shortness of breath, anxiety, cyanosis requires urgent referral
Treatment options for cold
- Paracetamol is first line choice as anti-pyretic and anti analgesic
- Saline nasal drops for stuffy nose
- Topical nasal decongestants i.e. ephedrine, oxymetazoline, xylometazoline
- Oral decongestants i.e. pseudoephedrine not to be given to children under the age of six and children between 6-12 should not use for more than 5 days
Practical tips for cold
- Reassure that colds are self-limiting
- Adequate fluid intake
- Promote uptake of flu vaccine
- Smoking cessation
Hayfever (Seasonal allergic rhinitis)
Symptoms will typically consist of seasonal sneezing, nasal itching, nasal blockage, and watery nasal discharge.
Eye symptoms: Red, itchy, watery eyes
- Cough, wheeze and shortness of breath
Systemic symptoms: Tiredness, fever, pressure sensation in head and itch
Treatment options
- Oral antihistamines
- Intranasal corticosteroids
- Sodium cromoglicate
- Oral decongestants
Oral antihistamines
- Improve general symptoms of hayfever such as sneezing
- Sedating: chlorphenamine, promethazine
- Non-sedating: Loratidine, Cetirizine and acrivastine
Intranasal corticosteroids
If rhinitis is the main symptom, this is the first line
- Slow onset of action (12 hours)
- Begin treatment two or three weeks before hayfever season
- Beclometasone, Fluticasone, Budesonide
- For adults over the age of 18
- Max period of use is 3 months
Sodium cromoglicate
- Available as eye drop and nasal spray
- First choice in children
