Cough Group – 10

Outline Synopsis Epidemiology Anatomy Mechanism Red flags Risk factors Diagnosis Algorithm Physical examination Hypothetical case EBM

http://www.nhs.uk/conditions/cough/pages/introduction.aspx

SYNOPSIS A cough is a reflex action to clear your airways of

mucus and irritants such as dust or smoke. It's rarely a sign of anything serious.

A "dry cough" means it's tickly and doesn't produce any phlegm (thick mucus). A "chesty cough" means phlegm is produced to help clear your airways.

Classified as two types:i. Acute (Short term) coughii. Chronic (Persistent) cough

Synopsis Cough performs an essential

protective function for human airways and lungs.

Without an effective cough reflex, we are at risk for retained airway secretions and aspirated material predisposing to infection, atelectasis, and respiratory compromise.

Cough is often a clue to the presence of respiratory disease. In many instances, cough is an expected and accepted manifestation of disease, as in acute respiratory tract infection.

Excessive coughing complications:1. emesis, 2. syncope,3. muscular pain, 4. rib fractures & so can agregate

abdominal or inguinal hernias and urinary incontinence.

However, persistent cough in the absence of other respiratory symptoms commonly causes patients to seek medical attention.

Synopsis

Short Term Coughs(Acute)

An upper respiratory tract infection (URTI) that affects the throat, trachea or sinuses.

A lower respiratory tract infection (LRTI) that affects your lungs or lower airways 

An allergy, such as allergic rhinitis or hay fever A flare-up of a long-term condition such as asthma, chronic obstructive pulmonary disease (COPD) or chronic bronchitis

Inhaled dust or smoke  

Synopsis

Subacute Cough Postinfectious cough is the most common cause of subacute

cough. Pertussis

SynopsisPersistent coughs (chronic)

A persistent cough may be caused by: chronic bronchitis   asthma  an allergy smoking  bronchiectasis  postnasal drip  Gastro-oesophageal reflux disease (GERD)

Synopsis Different kinds of cough include:

1. Postnasal Drip2. Asthma3. GERD 4. COPD5. Medication-related cough6. Pneumonia7. Whooping Cough

http://news.health.com/2015/04/07/whats-causing-your-cough/

http://www.nhs.uk/conditions/cough/pages/introduction.aspx

Causes of coughs that are more common in children than adults include:

Bronchiolitis – a mild respiratory tract infection that usually causes cold-like symptoms

Croup – this causes a distinctive barking cough and a harsh sound known as stridor when the child breathes in

Whooping cough – look out for symptoms such as intense, hacking bouts of coughing, vomiting, and a "whoop" sound with each sharp intake of breath after coughing

EPIDEMIOLOGY

Spread occurs by direct contact or droplet infection during cough Infants less than one year of age constitute 50-70% of

diagnosed cases. Period of Communicability The disease occurs 3-12 days after exposure to an affected

individual The coughing stage lasts for approximately six weeks before

subsiding. In some countries, this disease is called the 100 days’ cough or cough of 100 days because of its length.

Epidemiology

ANATOMY & MECHANISM

MECHANISM special sensory proteins-

“receptors”- found on the surface of some cells that line the upper respiratory tract.

 Locations -throat,-trachea (windpipe), - upper bronchi

Receptors stimulated send a signal to sensory nerve fibers, such as those found in the vagus nerve.

 sensory fibers brain for interpretation.

The part of the brain that monitors the throat and upper airway region has been called the “cough center.” 

http://www.robitussin.com/

Mechanism cough center receives a signal

muscles in the throat and chest receive action signals that trigger the cough mechanism, which is a 3-part process:

First, a volume of air is inhaled. Second, the opening to the trachea

(the epiglottis) closes as the chest constricts, compressing the air within the lungs.

Third, the epiglottis opens, allowing a rapid burst of air to be expelled through the mouth.

http://www.robitussin.com/

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RED FLAGS

Persistent cough for more than three weeks Pleuritic chest pain Dyspnea Haemoptysis Persistent nocturnal cough Wheeze Recurrent chest infections Coughing up phlegm every morning for more than three months of the

year Unintentional weight loss

RISK FACTORS

The main risk factor for cough is being exposed to irritants, for example:

Smoke Noxious fumes Allergens such as pollen and dust Smog and other environmental pollutants

Exposure to viral and bacterial infections affecting the respiratory tract also increases the risk of cough.

Smoking is a major risk for serious conditions linked to chronic cough including lung cancer and chronic bronchitis.

DIAGNOSIS

Chest x-ray Sputum culture Breathing tests (also called pulmonary functions tests, PFTs,

or spirometry) Blood tests Chest CT scan Bronchoscopy

ALGORITHM

PHYSICAL EXAMINATION

Physical Examination: COUGH

1. Vital signs, including respiratory rate, temperature, and O2 saturation

2. General appearance: How sick does patient look?

3. Systemic exam if systemic symptoms indicate.

4. HEENT: Nasal passage, sinuses, throat, adenopathy, neck veins if considering cardiac problem.

5. Chest/lungs: Accessory muscle use, retractions, percussion, lung sounds.

6. Cardiovascular: PMI size and location, heart sounds (gallops, murmurs, or rubs).

7. Abdomen

8. Extremities

HYPOTHETICAL CASE

Hypothetical case

36 years old male, came in with a chief complaint of cough for 1 week, productive with yellowish sputum.

He was also noted to have fever, relieved by paracetamol intake.

No medications taken. He sought consult at the clinic due to persistent cough and

fever.

Hypothetical case

Chief complaint- cough for 1 week HPI- patient has cough with yellow sputum and noted to have

fever relieved by paracetamol. personal hx- no smoking ROS: unremarkable physical exam findings- BP-120/80 mm/hg

-RR-26 bpm-CR- 90 bpm- temp 38.5 degree celsius

Hypothetical case

Chest findings: symmetrical chest expansion, no retractions, (+) crackles r base Other findings were unremarkable.

Hypothetical case

Differentail diagnosis :-

viral rhinosinusitis acute bronchitis acute pneumonia

Hypothetical case

Final diagnosis: Acute pneumonia

EVIDENCE BASED MEDICINE

Population: 48 studies including 10,423 patient cases from January 1990 to March 2012 representing China, India, Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand and Vietnam.

Intervention: Systemtic Review Method: Descriptive Conclusion: These data have major implications for diagnostic

strategies and empirical treatment. Outcome: Narrow-spectrum antibiotics targeting S. pneumoniae

may be inappropriate in many Asian settings, and agents active against TB may lead to partial response and delayed TB diagnosis.

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