Chronic Cough

Question 1

When completing a physical exam for a coughing patient, what should you check for?

Answer 1

• Presence of nasal and/or ocular discharge
• Cough elicited by gentle tracheal or thoracic palpation
• Auscultation over the larynx and trachea (stridor or clicks)
• Thoracic auscultation (crackles, wheezes, absence of lung sounds)

Question 2

This is defined as a high pitched continuous musical sound (air movement through very narrowed airways)

Answer 2

Wheeze

Question 3

This is defined as discontinuous popping sounds (air bubbling through fluid)

Answer 3

Crackles/rales

Question 4

This is defined as prevention of transmission of lung sounds

Answer 4

Decreased to absent lung sounds

Question 5

These are present throughout the upper respiratory tract extending into the bronchioles

Answer 5

Cough receptors

Question 6

What are the anatomical categories when considering chronic cough?

Answer 6

Airways, pulmonary parenchyma, and pleural space

Question 7

What exam findings would suggest an upper airway disease - nasal disease causing post nasal drip?

Answer 7

Nasal discharge, sneezing, reverse sneezing, stertor, facial deformity, open-mouth breathing

Question 8

What exam findings suggest pleural space disease?

Answer 8

• Pleural effusions and pleural space mass —> Tachypnea (rapid shallow breathing) and muffled heart/lung sounds

Question 9

If you suspected a patient to have laryngeal disease - LARPAR, what would you find on your exam?

Answer 9

• Noisy, stridorous inspiratory respiration
• Exercise intolerance
• Voice change
• Cyanosis and resp distress

Question 10

If you suspect tracheal disease - tracheal collapse in a chronic cough case, what would you expect to find on exam?

Answer 10

• Honking/goose honk, harsh cough
• mild to severe panting
• exercise intolerance
• cyanosis in severe cases

Question 11

What diagnostics would you run to differentiate lower airway versus pulmonary parenchymal disease?

Answer 11

• CBC/chem, 4DX, thoracic rads (MOST IMPORTANT)

Question 12

What are some differentials for bronchial disease?

Answer 12

• Chronic bronchitis
• Eosinophilic bronchopneumopathy
• Parasitic
• Bronchopneumonia

Question 13

What are the 3 diagnostic criteria for chronic bronchitis?

Answer 13

1. Chronic cough
2. Evidence of excessive mucus production
3. Exclusion of other chronic cardiopulmonary diseases

Question 14

Name 3 airway parasites

Answer 14

Crenosoma vulpis, Oslerus osleri, Eucoleus aerophilus

Question 15

How do you treat chronic bronchitis?

Answer 15

• Glucocorticoids (prednisone)
• Cough suppressants
• Other considerations: elimination of environmental irritants, control of body weight, use of harness in place of collar

Question 16

How long does a cough have to last in order to be considered chronic?

Answer 16

> 8 weeks