Cough and expectorationzhengcuixia
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
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
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.
Infectious respiratory disease: TB, bronchiactesis, bronchitisNeoplasm:Cardiovascular disease: MS, PE, PAH, deformity of blood vessleOther less seen disease leading to hemoptysis.
Differentiating from hematemesis
Differentiating from upper airway bleedingPost nasal bleedingMouth and farynxil membrane bleedingby intenssive investigation and examination
If coughed out or vomitted outVolume: how muchTime durationAny accompanied appearances