Unit 3 - Approach to the Coughing Patient Flashcards
The coughing mechanism is a _____ mechanism that works with the mucociliary apparatus.
protective
What medical history must you obtain when determining the cause of coughing?
Duration, progression, associations (time of day), triggers, character of cough, and other systemic signs
What are potential triggers for a cough?
the owner is a smoker, perfume/air fresheners, household cleaners, dusty kitty litter, and house construction
What environmental exposure can cause a cough?
boarding/grooming, obtained from a shelter, outdoors/travel history, walks, dog parks, show/agility competitor, heartworm prevention, other sick animals in the house
When determining the cause of a cough, what should you look for/do on the PE?
tracheal and cervical palpation, nasal discharge, changes in weight, fundic examination, skin lesions, cardiac abnormalities, lymphadenopathy, and rectal examination
What does a non-productive cough sound like?
usually loud, harsh, and paroxysmal
What is a goose-honk most commonly associated with?
upper airway disease - trachea and mainstem bronchi
What is a productive cough?
when sputum is expectorated from the lower airways
What is productive cough most commonly associated with?
lower airway disease or pulmonary parenchymal disease
How does a productive cough sound like?
it is typically softer in volume - a huff - can be confused with vomiting
Coughing is _____ in cats, so it should be persued ______.
uncommon, aggressively
What is coughing most commonly associated with in cats?
lower airway disease (asthma is the most common)
How do you know if a cough is cardiogenic in nature?
It is classically worse at night, there is exercise intolerance and tachypnea at rest, and there is perihilar edema on radiographs that is responsive to furosemide
What are the locations where non-cardiogenic coughs come from?
upper (large) airway, lower (small) airway, parenchymal, and less commonly pleural space
What are the infectious causes of upper airway coughs?
infectious tracheobronchitis, parasitic (filaroides), or hilar lymph node enlargement
Are upper airway coughs typically productive or non-productive?
non-productive
What are the non-infectious causes of upper airway coughs?
tracheal collapse, compressive masses, or foreign bodies
What can cause lower airway cough?
inflammatory airway disease or smoke/chemical irritant inhalation
What are the causes of inflammatory airway disease?
canine chronic bronchitis, feline lower airway disease, eosinophilic bronchopneumopathy
What are the infectious causes of parenchymal disease cough?
bacterial pneumonia, fungal disease, heartworm infection, parasitic, or Toxoplasma
What are the non-infectious causes of parenchymal disease cough?
neoplasia, lung lobe torsion, and non-cardiogenic pulmonary edema
What are the common ‘first tier’ tests for diagnosing underlying causes of cough?
CBC, throacic rads, fecal examination, heartworm testing, and cytology (skin lesions, nasal discharge, and lymph nodes)
What are common ‘second tier’ tests for diagnosing underlying causes of cough?
Cardiac evaluation, chemistry panel, urinalysis, airway sampling (for type of pneumonia), advanced imaging, lung aspirate/biopsy, bronchoscopy, and thoracotomy
What does TTW stand for?
transtracheal wash
What does ETW stand for?
endotracheal wash
When is TTW or ETW indicated?
for diffuse disease
How do you perform TTW or ETW?
Place a catheter to the level of the carina, insert saline (patient must be able to cough), recover the saline for cytology and culture
What is BAL and when is it indicated?
Bronchoalveolar lavage - indicated for localized disease - scope is used to perform this
If you decide to do empiric antibiotic therapy, what guidelines should you follow?
limit to one course, discontinue 1-2 weeks prior to sampling airways, informed client consent (may complicate future diagnosis/tx if unsuccessful)
What is an antitussive?
a drug used to prevent or relieve a cough
What are the most effective antitussives (general)?
opioids
What opoids can be used for antitussives?
butorphanol, hydrocodone, loperamide, diphenoxylate
What is combined with hydrocodone to prevent human abuse?
anti-cholinergics
When wouldn’t you use an antitussive?
the vast majority of lower airway coughs - contraindicated in causes of pneumonia
What condition do we use antitussives in?
collapsing trachea cases
What abnormal breath sound will you hear with a cardiogenic cough?
crackles
What other disease process, aside from CHF, can cause a cardiogenic cough?
advanced mitral valve disease, specifically causing cardiomegaly, that causes the left atrium to push on the mainstem bronchi
