Test 2

Question 1

chronic cough

Answer 1

lasting more than 8 weeks

Question 2

antitussives

Answer 2

However, because patients should be encouraged to expectorate during the day, these drugs have a limited role and should only be used on a short-term basis and only at night.

Nonnarcotic agents such as dextromethorphan or pseudoephedrine/brompheniramine/dextromethorphan combination therapy may be used every 3 to 4 hours as needed.

In addition, benzonatate (Tessalon) may be effective.

When sleep or eating is interrupted by persistent cough, the preferred choice is codeine, 8 to 30 mg every 3 to 4 hours, but only on a short-term basis.

Question 3

antihistamines for cough

Answer 3

Antihistamines are useful for those who have allergic upper airway disease but should usually avoided in asthmatic individuals because they may thicken secretions and inhibit expectoration. Intranasal corticosteroid sprays or aerosols, such as beclomethasone (Beconase), fluticasone (Flonase), and mometasone (Nasonex), may also be useful when used on a consistent basis.

Question 4

expectorants for cough

Answer 4

Although expectorants may work in some cases, increasing the patient’s water intake to 3 to 4 L/day is the most cost-effective means of helping to liquefy secretions, as long as the patient can manage the fluid volume and does not have heart failure or other disorder in which increased fluid intake could compromise health. Guaifenesin (Mucinex), which is available OTC, helps to break up mucus. Patients must be reminded to drink plenty of fluids when taking guaifenesin. Some clinicians prefer to give an expectorant during the day and a cough suppressant at night, so that the patient may sleep.

Question 5

AHI

Answer 5

The apnea-hypopnea index (AHI) may be used to define and quantify the severity of OSA.

The AHI is obtained by dividing the total number of events (the number of apnea episodes plus the number of hypopnea episodes) throughout the entire night by the total sleep time in hours.

Question 6

RDI

Answer 6

The respiratory disturbance index (RDI), another commonly cited parameter, is defined as the AHI plus the average number of snoring-related arousals per hour.

Question 7

OSA diagnosis

Answer 7

• AHI or RDI greater than or equal to 5 and less than 14 if comorbid factors such as excessive daytime sleepiness, hypertension, stroke, or heart failure are present, or
• AHI or RDI greater than or equal to 15 in the absence of comorbid factors.