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Flashcards in Assessment of chronic cough Deck (13):
1

Define subacute and chronic cough

Subacute= 3-8 weeks
Chronic= >8 weeks

2

Differential for cough- common and uncommon

Common
Upper airway cough syndrome (postnasal drip)
Asthma
Gastro-oesophageal reflux disease (GORD)
Non-asthmatic eosinophilic bronchitis (NAEB)
Chronic bronchitis
Angiotensin-converting enzyme inhibitor (ACE inhibitor) Pneumonia
Post-infectious cough
Bordetella pertussis infection

Uncommon
Lung cancer
Bronchiectasis and chronic suppurative lung disease
Interstitial pulmonary fibrosis
Sarcoidosis
Tuberculosis
Foreign body
Hypersensitivity pneumonitis
Bronchiolitis
Recurrent aspiration
Tropical filarial pulmonary eosinophilia
Psychogenic cough

3

Causes of productive cough

Bronchitis
Bronchiectasis
Pneumonia
Asthma
Foreign body
Bronchial Ca
Lung abscess
TB (when cavitating)

4

Red flags

Red flags

Asthma
Pneumonia
Bordetella pertussis infection
Lung cancer
Interstitial pulmonary fibrosis
Tuberculosis
Foreign body
Recurrent aspiration

5

History

• How would you describe the cough?
• How long has the cough been present?
• Do you cough up sputum?
• Describe the sputum, especially its colour.
• Is there any blood in the sputum?
• How much sputum do you produce—a teaspoonful,
an eggcupful or more?
• Is there a burning sensation in your throat or chest
when you cough?
• Have you noticed any other symptoms?
• What about chest pain or fever, shivers or sweats?
• Do you have a wheeze?
• Have you had previous attacks of wheezing or hay
fever?
• Is there a history of asthma in your family?
• Have you lost weight?
• Has anyone in the family had TB or a persistent cough?
• How much do you smoke?
• Are you exposed to any smoke or fumes?
• What kind of work do you do?
• Where have you worked in the past?
• Is there a chance you have been exposed to asbestos?
• Do you keep birds at home?
• Do you have any birds nesting outside your bedroom?
• Is there a possibility of a foreign body such as a peanut
‘having gone down the wrong way’?
• Have you had an operation recently or been confi ned
to bed?
• Have you noticed any swelling of your legs?
• Have you been exposed to birds such as pigeons?

6

What do fine crackles vs course crackles indicate

Fine crackles
on auscultation indicate pulmonary oedema of heart
failure, interstitial pulmonary fi brosis and early lobar
pneumonia, while coarse crackles indicate resolving
pneumonia, bronchiectasis and TB

7

Initial investigations

• haemoglobin, blood fi lm and white cell count
• sputum cytology and culture
• ESR (elevated with bacterial infection, bronchiectasis,
TB, lung abscess and bronchial carcinoma)
• respiratory function tests
• radiology:
— plain chest X-ray (shows many problems)

8

Causes of nocturnal cough

Asthma
LVF
PND
Chronic bronchitis
WHooping cough

9

Causes of waking cough

Bronchiectasis
Chronic bronchitis
GORD

10

Character of sputum and causes

• Clear white (mucoid) → normal or uninfected bronchitis
• Yellow or green (purulent) → due to cellular material
(neutrophils or eosinophil granulocytes)
— ± infection (not necessarily bacterial infection)
— asthma due to eosinophils
— bronchiectasis (copious quantities)
• Rusty → lobar pneumonia (S. pneumoniae): due to
blood
• Thick and sticky → asthma
• Profuse, watery → alveolar cell carcinoma
• Thin, clear mucoid → viral infection
• Redcurrant jelly → bronchial carcinoma
• Profuse and offensive → bronchiectasis; lung abscess
• Thick plugs (cast-like) → allergic bronchopulmonary
Aspergillus; bronchial carcinoma
• Pink frothy sputum → pulmonary oedema

11

Commonest causes of hemoptysis

URTI
Acute bronchitis

12

Other causes of hemoptysis

Chronic bronchitis
Bronchiectasis
Lobar pneumonia
Neoplasm
Pulmonary infarction/PE

LVF
Mitral stenosis

Anticoagulant

13

Cause of solitary pulmonary nodule on Xray

Bronchial carcinoma
Solitary metastasis
Granuloma (TB)
Hemartoma