Cough and expectoration

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Cough and expectoration. zhengcuixia. Concept. cough. A protective reflex act clean excessive secretion & foreign material Initiated by miscellaneous stimuli or by voluntary exertion. The most common respiratory symptom. Severe cough is a serious clinical problem. Cough reflex. - PowerPoint PPT Presentation

Text of Cough and expectoration

  • Cough and expectorationzhengcuixia

  • Concept

    A protective reflex act clean excessive secretion & foreign materialInitiated by miscellaneous stimuli or by voluntary exertion.The most common respiratory symptom.Severe cough is a serious clinical problem.

  • Cough reflexAfferent inform.from: larynx, trachea, bifurcation of the bronchi Irritant type: mechanical, chemical, inflammationAfferent fibers are in the vague nerve cough center.

  • Cough reflexEfferent signals larynx, muscles of diaphragm, chest wall, abdomen A coordinated series of movement complete the cough. Deep inspiration expiration effort with glottis closed- glottis open abruptly high volocity of airflow brings out screations from airways.

  • Influencing factorsSuppressed afferent or efferent nerve function Failed glottis function (laryngopharynx dis)Diminished muscle forceObstructed airway seen in severe COPDTrachea intubationChest or abdominal pain limit cough movement

  • Causes

    Airway stimulation by chemicals & foreign material (smoker & occupational exposure)Airway infection & inflammationLung parenchyma disordersPleural & chest wall disordersCardiovascular abnormalitiesOther causes Psychiatric cough

  • classifyNon production ( dry cough )Production (with sputum)

    Acute Chronic or acute on chronic

  • Clinical appearance in common diseasesAcute respiratory infection or excesobation of chronic infectious illnesssNeoplasmsPleural diseaseCardiovascular diseasesGeneral disease affecting the respiratory systemChronic cough: postualnasal drip syndrom, cough type asthma, smoker, occupational exposure

  • Accompanied abnormalitiesFeverChest pain Dyspnea & wheezeSputum production

  • Accompanied CXF abnormalitiesNeoplasmEfussionalinterstinal

    MediastinumCardiovascularPleural or chest wall

  • complicationCough syncope syndromFatigueFractures due to severe persistent cough Pneumomediastinum, pneumothorax, and subcutaneous emphysema due to high intrathoracic pressure during cough.

  • InvestigationGeneral condition of the patientTime specialtiesVoice specialtiesProductive or notIn relation with postureAccompany with chest pain; with dyspnea, or other complications

  • Sputum production(expectoration)

  • Characters: mucoid, tenasious, purulent, blood stained, with special odor, rusty, serousVolume: Accompanied manifestation

  • Laboratory examinationRutineMicrobiologic test ( including culture )Cellular

  • hemoptysisBleeding below the level of the larynx that being coughed out Degrees: from blood-tinged sputum to massive gross blood, even leading to airway occlusion (apnea ) & shock. The latter is much less seen.

  • Common causes

    Infectious respiratory disease: TB, bronchiactesis, bronchitisNeoplasm:Cardiovascular disease: MS, PE, PAH, deformity of blood vessleOther less seen disease leading to hemoptysis.

  • ClacificationSmall ModerateMassive

  • Differentiating from hematemesis

  • Differentiating from upper airway bleedingPost nasal bleedingMouth and farynxil membrane bleedingby intenssive investigation and examination

  • Investigation

    If coughed out or vomitted outVolume: how muchTime durationAny accompanied appearances