cough and shortness of breath

Question 1

what are the signs of the symptom shortness of breath? 2

Answer 1

• increased RR

- decreased SaO2

Question 2

what are the signs of the symptom of tight chest? 2

Answer 2

• decreased PEFR

- wheeze

Question 3

what is a cough? 3

Answer 3

• tussive reflex (stimulation of sensory nerves) irritation/ medulla/ inspiration/ closed glottis/ contraction/ expulsion
• Protective: aspiration, clearance
• Can be problematic oedema, rib fractures, affects sleep, affects partner, affects throat, stress incontinence, cough syncope

Question 4

what are the causes of cough? 2

Answer 4

• Acute irritation, infection

- Chronic medications, asthma, rhinitis, oesophageal reflux, cancer

Question 5

what do we need to know about the history of a cough? 9

Answer 5

• Duration
• Time of day
• Type of cough
• Triggers
• Sputum
• SOB
• Sound
• Nature of onset
• Where does it get worse, is there a relationship with food

Question 6

what signs do we need to know about sputum? 4

Answer 6

• Quantity
• Colour
• Smell
• Blood

Question 7

what signs do we need to know about haemoptysis? 3

Answer 7

• Frothy and pink
• Bright red
• Dark (altered)

Question 8

explain nasal and naso-pharyngeal considerations for cough and breathlessness? 2

Answer 8

• Rhino-sinusitis: acute and chronic, postnasal drip- combination of cough, postnasal drip, need to clear throat, nasal congestion, nasal discharge, hoarseness need appropriate therapy for rhinitis which can lead to resolution of cough
• Common things: viral upper respiratory tract infections

Question 9

explain trachea-bronchail considerations for cough and breathlessness? 4

Answer 9

• Asthma most common cause of chronic cough in childhood, many children have viral induced wheeze but do not go on to develop asthma, cough is indicative of poor control
• COPD
• Bronchiectasis scarring from previous infection or as part of other conditions, dilation of smaller airways forming potential space for mucous pooling, stagnation and infection, Lower threshold for antibiotics, often a longer course, Consideration of consolidation with specific pathogens
• Cancer bronchogenic carcinoma, SCLC, usually environmental

Question 10

how can we treat a cough? 7

Answer 10

• ABCs
• Syrups and linctus?
• Avoidance
• Quarantine
• Antibiotics?
• Inhalers
• Catch it, bin it, kill it