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Cough and Hemoptysis DR.Bilal Natiq Nuaman,MD C.A.B.M. ,F.I.B.M.S. ,D.I.M. ,M.B.Ch.B. 2017

L 8 .approach to cough and hemoptysis

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Cough and

Hemoptysis

DR.Bilal Natiq Nuaman,MD

C.A.B.M. ,F.I.B.M.S. ,D.I.M. ,M.B.Ch.B.

2017

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

Classification of Cough

• Acute Cough = < 3 Weeks Duration

• Chronic Cough > 8 Weeks Duration

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.

Post nasal drip PND(upper airway cough syndrome UACS )

• 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.

Thank you