what is the most common cause of cough?
Post nasal drip
GERD
asthma
90% of non smokers with a cough have one of these
what is a common presenting complaint to the doctor?
cough
what determines an acute cough?
<3weeks (commonly follows viral or bacterial infection)
what determines a subacute cough?
3-8 weeks
what determines a chronic cough?
> 8 weeks
what is the MCC of chronic cough?
chronic bronchitis secondary to smoking
what is the criteria for diagnosing chronic bronchitis?
3 mo of any given year for 2 consecutive yrs
what are common causes of acute cough?
common cold acute bacterial sinusitis allergic rhinitis environmental irritants COPD exacerbations
what are less common causes of acute cough?
pertussis
pneumonia
asthma
heart failure
what does the data say about using mucolytics, suppressants and antitussives for acute URI?
they don’t help
what do you have to be cautious about prescribing with pts with chronic cough?
codeine anti tussives
what are common causes of chronic cough?
chronic bronchitis asthma chronic rhinosinusitis (MCC in non smokers) ACE cough Post-infectious GERD
when can a pt have an ACE cough?
anytime during treatment
what are work up exams for pulmonary?
CXR
pulmonary function testing
staturations
what is a good question to identify dyspnea?
are you able to take a full deep breathe?
what part of the lungs has feeling?
pleura, vasculature
parenchyma has no feeling
what does wheezing mean?
obstruction
what are rales?
crackles
what do fine crackles indicate?
chronic interstitial lung disease problem
what do coarse crackles mean?
pneumonia
HF, pleural fluid
what do ronchi mean?
upper airway
bubbly, mucousy stuff
what FEV1/FVC is normal?
> 70%
how long do you have to remove ACE inhibitor to analyze chronic cough?
6 months
what is an important hx question for former smokers?
SOB with exertion
what is DLCO?
diffusion capacity
diminished in emphysema
what does alpha 1 antitypsin test indicate?
if pt has deficiency which leads to emphysema
what WBC characterize astham?
eosinophils
what WBC characterizes COPD?
macrophage
neutrophil
what CD is a/w asthma?
CD4
what CD is a/w COPD?
CD8
what do cigarettes do to lung function?
accelerate decline in lung function
release oxidants and free radicals
increase neutrophils
suppresses elastase-inhibitory activity
what are irreversible airflow limitations?
fibrosis and narrowing
loss of elastic recoil
destruction of alveoli
what are reversible airflow limitations?
inflammatory cell infiltration
smooth muscle contraction in peripheral and central airways
dynamic hyperinflation during exercise
what is a bullectomy?
remove a bullae or bleb to remove dead space and allow more expansion of good lung tissue
who should be tested for airflow limitations?
pts with chronic cough and sputum production with history of risk factors
what test is the gold standard for assessment of COPD?
spirometry
