Cough and SOB

Question 1

Cough

Answer 1

Tussive reflex: irritation -> medulla -> inspiration -> closed glottis -> contraction -> expulsion
Protection: aspiration and clearance
Can be problematic: oedema or rib fracture
Causes acute: irritation/infection
Causes chronic: medications/asthma/rhinitis/oesophageal reflux/cancer

Question 2

Sputum and haemoptysis

Answer 2

sputum: quantity, colour, smell, blood
haemoptysis: bright red, dark or frothy and pink

Question 3

Dyspnoea

Answer 3

Red flag
Obstructive vs restrictive
Acute: trauma & obstruction/infection/PTX/PE/panic
Chronic: anaemia/HF/metabolic/COPD, asthma, fibrosis/cancer
Treatment: ABCs, syrups and linctus, avoidance, quarantine, antibiotics, inhalers

Question 4

Dyspnoea considerations

Answer 4

Nasal and naso-pharyngeal considerations: rhinosinusitis- acute and chronic, post nasal drip; viral upper respiratory tract infection
Tracheo-bronchial considerations: asthma; COPD (usually associated with smoking); bronchiectasis (scarring from previous infection or as part of other conditions - CF), dilation of smaller airways forming potential space for mucous pooling, stagnation and infection, lower threshold for antibiotics, and longer course, consideration of colonisation; cancer (bronchogenic carcinoma, SCLC small cell lung carcinoma, usually environmental)

Question 5

Breathlessness and Hyperventilation

Answer 5

Breathlessness: causes are often multi-factorial (cardiac failures arise as complication of COPD, asthmatics may get pneumothorax)
Hyperventilation: significant proportion of chronic SOB, management includes reassurance, rebreathing and relaxation

Question 6

SOB

Answer 6

Considerations from history:
Duration
Associated symptoms
Precipitating circumstances and triggers
Previous episodes, smoking occupation
Inhaled foreign body/pneumothorax/PE - causes of sudden SOB