Pharmaceutical Management of Cough

Question 1

What is a cough?

Answer 1

Protective reflex action caused when airway is irritated or obstructed

Question 2

What is an acute cough?

Answer 2

<3 weeks

Question 3

What is a subacute cough?

Answer 3

3-8 weeks

Question 4

What is a chronic cough?

Answer 4

> 8 weeks

Question 5

Where is an acute cough from?

Answer 5

Viral upper respiratory tract

Question 6

How does a chronic cough present?

Answer 6

Dry/minimally productive cough

Question 7

What are common causes of chronic cough?

Answer 7

GORD
Asthma syndromes
Rhinitis
Drugs
Environment - eg. dust

Question 8

What do you consider when assessing a cough?

Answer 8

Age, sex
Cough characteristics
Exacerbating features
Where?
Acute/chronic?
Worse morning, midday or night?

Question 9

What are the specific cough syndromes?

Answer 9

Cough variant asthma
GORD
Upper airway disease
Treatment of cough due to other respiratory diseases

Question 10

Describe cough variant asthma

Answer 10

Isolated cough in patient without objective evidence of asthma

Question 11

What are the clinical indicators of cough variant asthma?

Answer 11

Nocturnal
Started when young
After exercise
Allergen exposure

Question 12

How do you treat cough variant asthma?

Answer 12

Eliminate allergen
Bet-2-agontists
Antihistamines
Steroids
TAKE MEDICATION IN EVENING

Question 13

Describe GORD

Answer 13

Patients with GORD have increased cough reflex sensitivity which improves anti-reflux therapy

Question 14

How do you treat GORD?

Answer 14

PPI or H2 antagonist
Eliminate causative medications
Lifestyle advice

Question 15

What is the problem with long term use of PPIs?

Answer 15

Increase pH of stomach = more likely to get an infection
Osteoporosis

Question 16

Describe upper airways disease + cough?

Answer 16

Accompanied by nasal stuffiness, sinusitis
= secretions drain into posterior pharynx

Question 16

Describe upper airways disease + cough?

Answer 16

Accompanied by nasal stuffiness, sinusitis
= secretions drain into posterior pharynx

Question 16

Describe upper airways disease + cough?

Answer 16

Accompanied by nasal stuffiness, sinusitis
= secretions drain into posterior pharynx

Question 17

What is the treatment for upper airways disease + cough?

Answer 17

Antihistamines - limited efficacy
Trial of corticosteroid = ONLY IF PROMINENT

Question 18

When do you refer someone?

Answer 18

> 3 weeks
Sign of infection
Shortness of breath
Whooping cough in children
Recurrent nocturnal cough in kids
Adverse drug reaction
Failed medication

Question 19

What are CO2 retainers?

Answer 19

People with COPD have lower O2 saturation = giving them too much O2 dangerous

Question 20

What are things you can get OTC?

Answer 20

Expectorants
Suppressants
Demulcents

Question 21

What are examples of suppressants?

Answer 21

Codeine, pholcodine + dextromethorphan

Question 22

What are examples of expectorants?

Answer 22

Guaifenesin
Ipecacuanha

Question 23

What are suppressants?

Answer 23

Where no underlying cause May be useful if sleep disturbed

Question 24

What are expectorants?

Answer 24

Apparent promotion of expulsion of bronchial secretions

Question 25

What are demulcents?

Answer 25

Soothing actions Harmless + inexpensive

Question 26

Describe use of antihistamines

Answer 26

Allergy type cough Avoid patients who are taking phenothiazines + tricyclic antidepressants Avoid alcohol Can make drowsy

Question 27

Describe use of sympathomimetics

Answer 27

Bronchodilator + decongestant Care in high BP, diabetics, coronary artery disease Interactions with beta blockers, tricyclic antidepressants

Question 28

Describe use of theophylline

Answer 28

Bronchodilation GI irritation, palpitations, insomnia + headaches Side effects = toxicity

Question 29

Describe use of mucolytics

Answer 29

Break mucus apart Inhaled, oral Relief after 60 seconds after inspiration

Question 30

What is CRP?

Answer 30

Measure of inflammation Increased = bacterial infection Should be less than 5

Question 31

What are some non-pharmacological actions?

Answer 31

Fluids Paracetamol/ibuprofen = associated fever + pain Lemon + honey Steam Simple linctus cough mixture

Question 32

Who are the medications for?

Answer 32

ONLY children over 6