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Cough
• Definition:
‘A Cough is a forced expulsive manoeuvre, usually against a closed glottis and which is associated with a characteristic sound’
It is caused by stimulation of sensory nerves
in the mucosa of the pharynx, larynx, trachea and bronchi.
Cough is the single most common respiratory complaint for which patients seek care
Acute Cough <3 weeks
Differential Diagnosis(CAUSES)
• Upper Respiratory Tract infections(URTI):
Viral syndromes, sinusitis , pertussis
• URTI triggering exacerbations of Chronic LungDisease eg Asthma/ COPD
• Pneumonia
• Left Ventricular Heart Failure
• Foreign Body Aspiration
COPD
1. Chronic Bronchitis :
defined clinically as Productive cough (cough with sputum expectoration ) in a chronic smoker for at least 3 months a year during a period of 2 consecutive years with exclusion of other causes of productive cough .
2. Emphysema :
defined pathologically as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls without obvious fibrosis.
• Gastroesophageal reflux disease (GERD) refers to
acid reflux, or backward flow, of stomach acid and other contents into the esophagus. If stomach acid moves backward up the esophagus, reflexes result in spasm of the airways that can cause shortness of breath and coughing. In some individuals, no sensation of heartburn is felt and their only symptom may be cough.
Diagnostic tests:
• 24-hour esophageal pH probe (best)
• OGD – Esophagogastrodudenoscope
Therapeutic trial: gastric acid suppression with proton pump
inhibitor (e.g. omeprazole) for ≥ 2 months, combined with diet andlifestyle modification
History
1-Onset and Duration :
Acute : < 3weeks
Chronic : > 8 weeks
2-Character :Bovine with Hoarsness----Left recurrent laryngeal nerve palsy
causing left vocal cord paralysis due to CA Lung
Barking with Hoarsness and Stridor -----Acute Epiglottitis,
Laryngitis , CA Larynx
Wheezy ------COPD , Asthma
2-Amount of Sputum
How much sputum is coughed up each day ? Is it a small(a teaspoonful) or large (a teacupful) amount?
Bronchiectasis-------- a long history of large amount of purulent
sputum to be coughed up mainly in morning on changing posture .
Pulmonary Oedema ------ Large volumes of watery frothy sputum with a pink tinge in an acutely dyspnic patient .
Hemoptysis
• Coughing up blood, irrespective of the amount, is an alarming
symptom and patients nearly always seek medical advice. A
history should be taken to establish that it is true hemoptysis
and not hematemesis, or gum or nose bleeding.
• Hemoptysis must always be assumed to have a serious cause until this is excluded .
• Massive Hemoptysis:
It is coughing of about 600ml blood/24 h
History• A history of repeated small haemoptysis is highly suggestive of
bronchial carcinoma.
• Fever, night sweats and weight loss suggest tuberculosis.
• Pneumococcal pneumonia often causes 'rusty'-coloured
sputum but can cause frank haemoptysis, as can all suppurative pneumonic infections including lung abscess.
• Bronchiectasis can cause catastrophic bronchial
haemorrhage,
• pulmonary thromboembolism is a common cause of
haemoptysis and should always be considered.