Coughs in adults Flashcards
Probability diagnosis
Upper respiratory infection
Postnasal drip/ sinusitis/rhinitis
Smoking
Inhaled irritants
Acute bronchitis
Chronic bronchitis/COPD
Serious disorders not to be missed
Cardiovascular:
- left ventricular failure
- Cancer:
- lung cancer
- larynx
Infection:
- tuberculosis
- pneumonia
- influenza
- lung abscess
- HIV infection
- SARS (coronavirus)
Other:
- asthma
- cystic fibrosis
- foreign body
- pneumothorax
Pitfalls (often missed)
Atypical pneumonias
Gastro-oesophageal reflux (nocturnal)
Smoking (children/adolescents)
Bronchiectasis
Whooping cough (pertussis)
Interstitial lung disorders (e.g. idiopathic pulmonary fibrosis)
Sarcoidosis
General pitfalls
Attributing cough due to bronchial carcinoma in a smoker to ‘smoker’s cough’
Overlooking TB, esp. in the elderly, by equating symptoms to old age, bronchitis or even smoking
Overlooking the fact that bronchial carcinoma can develop in a patient with other pulmonary conditions such as chronic bronchitis
Being slow to order a chest X-ray
Masquerades checklist
Drugs e.g.
- ACE inhibitors
- beta blockers
- inhaled steroids
- sulfasalazine
Is the patient trying to tell me something?
Anxiety and habit.
Key history
Determine the nature of the cough & associated symptoms such as;
- the nature of the sputum, breathlessness
- wheezing
- constitutional symptoms.
Haemoptysis
Hx of smoking habits, past and present
Occupational history
PMHx esp respiratory and drug intake.
Key examination
General exam including enlarged cervical or axillary glands
Careful exam of lungs and CVS with inspection of sputum
Key investigations
More applicable if haemoptysis
- FBE/ESR/CRP
- Sputum cytology and culture
- Respiratory function tests
- Plain CXR
Other tests as appropriate according to clinical findings e.g.
- CT
- bronchoscopy
- ECG
- echocardiogram
- ventilation/perfusion scan
- CT pulmonary angiogram
Diagnostic tips
Postnasal drip is the commonest cause of a persistent or chronic cough esp at night.
Cough may persist for many weeks following a URTI.
Cough is the cardinal feature of chronic bronchitis.
Unexplained cough >50 years is bronchial carcinoma until proved otherwise (esp. if a hx of smoking).
Red flag pointers for cough
- age >50 yrs
- smoking history
- history of asbestos exposure
- persistent cough
- overseas travel
- TB exposure
- haemoptysis
- unexplained weight loss
- dyspnoea
- fever
