18. Cough Flashcards
(22 cards)
Chez les patients qui consultent pour une toux aiguë
* Inclure dans votre diagnostic différentiel certaines causes graves (p. ex., pneumothorax, embolie pulmonaire).
* Pour poser un diagnostic d’infection virale, obtenez une anamnèse appropriée.
* Ne prescrivez pas d’antibiothérapie pour traiter une infection virale. (Lorsqu’approprié, considérez plutôt une thérapie antivirale).
Chez les enfants qui consultent pour une toux persistante (ou récidivante), élaborez un bon diagnostic différentiel.
Nommez des examples
- RGO
- Asthme
- Rhinite
- Présence d’un corps étranger
- Coqueluche
Lorsque la toux persiste (p. ex. pendant des semaine), incluez dans votre diagnostic différentiel quoi?
Causes extrapulmonaires
* RGO
* Insuffisance cardiaque congestive
* Rhinite
Causes plus graves
* Cancer
* Embolie pulmonaire
In smokers with persistent cough, assess for what?
for chronic bronchitis (chronic obstructive pulmonary disease) and make a positive diagnosis when it is present. (Do not just diagnose a smoker’s cough.)
Name COMMON DDX of cough (6)
- Post infectious (URTI/pneumonia/sinusitis/bronchitis)
- Upper Airway Cough Syndrome (UACS, previously Postnasal Drip)
- Asthma
- COPD
- GERD
- Medication - ACE-inhibitor
What to always consider in DDX of cough? (11)
Respirology
* Pneumothorax
* Pulmonary Embolism
* Tuberculosis
* Pneumonia
* Lung cancer or mets
* Aspiration/Foreign body
* Interstitial lung disease
* Workplace exposure
* Obstructive sleep apnea
_
* Heart failure
* Complicated GERD
Describe : Chronic cough management (6)
- Smoking cessation
- Consider ACE-inhibitor
- Consider Post-infectious cough (3w-8w after acute respiratory infection)
- CXR (2-view) if >8w, r/o tuberculosis or lung mass (malignancy, sarcoidosis)
- If normal CXR, no ACE-i, no exposure to irritants (smoking/occupational), consider Syndrome de toux des voies respiratoires supérieures, asthma and GERD = Sequential treatment
- If all failed, diagnose syndrome d’hypersensibilité à la toux (idiopathic, refractory cough)
Describe tx : Post-infectious cough (3)
- Self-limited will resolve spontaneously
- Trial of inhaled ipratropium (Atrovent)
- Trial of combined inhaled ipratropium with inhaled corticosteroids
Describe : UACS (previously “post-nasal drip syndrome”) (2)
- Sensation of secretions/irritation of back of the throat, nasal congestion and discharge, throat clearing
- Allergic rhnitis, non-allergic rhinitis
Describe tx : Allergic rhinitis (4)
- Allergen avoidance
- Nasal corticosteroids
- Second generation antihistamines
- Combination corticosteroid/antihistamine inhaler and/or cromolyn
Describe tx : Non-Allergic rhinitis (4)
- First-generation antihistamine plus decongestant (care in hypertension), glaucoma
- Atrovent
Describe prise en charge : Asthma (cough-variant) (2)
- Spirométrie, ajouter un test de provocation à la méthacholine si non diagnostique
- Corticoïdes inhalés
Describe tx : GERD (4)
- Dietary modifications
- PPI twice daily
- Addition of prokinetic if no response
- If failed, objective testing for GERD (barium esophagography, upper endoscopy, 24h esophageal pH)
If sequential treatment fails (UACS, Asthma, GERD), what to do? (5)
Diagnose cough sensitivity syndrome (idiopathic, refractory cough)
* Speech pathology treatment
* Neuromodulating medication (Gabapentin, Pregabalin)
* CT scan if suspect lung cancer, bronchiectasis or ILD
* Referral to specialty
Name DDX INFECTION of cough in peds (6)
- Bordetella Pertussis
- URTI / Pneumonia
- Recurrent viral infection (infants and toddlers)
- Bacterial bronchitis or rhinosinusitis (Productive/wet cough)
- Bronchiectasis/Cystic fibrosis (wet productive cough, weight loss)
- Croup (Barky night time cough)
Describe : Bordetella Pertussis (3)
- paroxysms of coughing
- post-tussive vomiting/whoop
- age 8-11yo
Name DDX of cough in peds (6)
- Infectious
- Lung
- Cardiac (heart failure)
- Allergy
- GI
- Congenital anomalies (neonatal onset)
Name DDX LUNG of cough in peds (2)
- Physical/Chemical irritants
- Asthma (nighttime, wheeze)
Name DDX GI of cough in peds (2)
- Foreign Body (new onset after choking, age 0-2yo, diminished breath sounds)
- GERD (after meals)
Name DDX CONGENITAL ANOMALIES (neonatal onset) of cough in peds (2)
- Fistule trachéo-œsophagienne (étouffement avec les aliments)
- Laryngotrachéomalacie
Describe prise en charge cough in peds (4)
- Empiric approach for treatment not used first-line unless conditions present
- If inhaled corticosteroids are used, trial of therapy should be limited
- CXR and spirometry (if age appropriate)
- Consider watch and wait if suspect post-viral cough
Describe : Evaluation Of Persistent Chronic Cough In Healthy Adults (Algorithm)
