cough Flashcards
when would a cough require an urgent referal?
: clinical features of suspected PE (dry and blood in cough), pneumothorax or sepsis (productive cough)
signs of serious illness:
- Resp rate >30
- Tachycardia >130bpm
- Systolic bp <90 or diastolic <60
- Oxygen sats of <92% or central cyanosis – if person has no history of chronic hypercapnia
- Peak expiratory rate of less than 33% of predicted
- Altered level of consciousness
- Use of accessory muscles of resp (esp if becoming exhausted)
- Features of foreign body aspiration – stridor (haemodynamically unstable)
define an acute cough
<3 weeks
define sub-acute cough
3-8weeks
what is chronic cough?
> 8weeks
what can cause an acute cough?
Acute cough causes: URTI, foreign body aspiration. PE, pneumothorax, acute bronchitis, pneumonia, acute asthma, exacerbation of COPD, whooping cough, lung cancer
Non resp causes of acute cough: ACEi, aortic aneurysm, cardiac failure – pulmonary oedema, GORD
what would a sudden acute cough indicate?
aspiration, foreign body, pneumothorax
what is important to cover in cough history taking?
Acute cough history:
- Sudden: aspiration, foreign body, pneumonthorax
- Triggers: asthma?
- When do you cough: asthma? (diurnal)
- Exertion?
- Breathlessness when coughing?
- Phlegm? – productive
- Blood – PE, lung cancer
- Red flag questions – any unintentional weight loss?
- High temp – fever – TB, sepsis
- Any contact with TB?
- Smoker or not? – lung cancer?
- Current of past occupation? – asbestosis
- Any new meds – ACEi
- Travel/ hotels? – TB, legionella pneumonia
- Pets? – psttaci pneumonia
what can cause an acute cough if it is an upper resp tract infection?
Acute causes: sinusitis, rhinitis, pharyngitis, laryngitis
what can foreign body aspiration lead to?
Foreign body aspiration: vary from life threatening and death to non-specific symptoms of cough, wheezing, fever, haemoptysis or dyspnoea
- Large objects may completely occlude the trachea and result in asphyxiation and death
- Small objects may lodge in lower lobar airways and cause wheezing and coughing – atelectasis (partial lobe collapse) , post obstructive pneumonia, bronchiectasis, lung abscess
- Right lower lobe is more likely to have foreign body: right bronchus is wider and steeper
who is most at risk of foreign body aspiration?
- At risk groups: children, >70yrs, stroke patients, dementia, impaired cough reflex – medications, alcohol, drugs
- swallowing impairments
what tests can be find foreign body aspiration?
Investigations- CXR
- Non specific – aspiration has caused atelectasis, pneumonia, air trapping and pneumomediastinum.
- Normal CXR does not rule out foreign body aspiration – CT/ bronchoscopy may needed to confirm
- CT – more sensitive, non-invasive
- Bronchoscopy – flexible for stable
can acute bronchitis lead to a cough?
yes Pneumonia progresses goes lung parenchyma hence shows consolidation
- Infections causing inflammation in bronchial airways, increased mucus production and oedema of bronchus
- Productive cough is hallmark of LRTI
- Pneumonia denotes infection in lung parenchyma resulting in consolidation of affected segment or lobe
what is common in pertussis?
post infectious cough
can be dry or productive
what are the stages of pertussis?
- Three stages: catarrhal ( build of mucus in nose/ throat), paroxysmal (sudden) and convalescent (recovering from illness) and may persist for several months
- Initial symptoms: similar to cold, rhinoorhoea and lacrimination, dry cough followed by episodes of severe coughing – fever may be absent or low grade
if whooping cough occurs in childhood what is patient at risk of in future?
bronchiectasis - widening of bronchi
