Respiratory Disease Flashcards
(37 cards)
What is a cough
Cough is a reflex response to airway irritation triggered by stimulation of airway cough receptors by irritants e.g. secretions or by conditions that cause airway distortion. Cough is often defined according to its duration.
Acute cough
when present for up to 3-4 weeks
Sub acute cough
when present for 3-8 weeks
chronic cough
when present for greater than 8 weeks
Cough referral
- Haemoptysis
- Hoarseness
- Peripheral oedema with weight gain
- Prominent dyspnoea, especially at rest or at night
- Smokers aged over 45 years with a new cough, change in cough , or coexisiting voice disturbance, and smokers aged 55-80 yrs who have 30 pck year smoking history and currently smoke or who have quit within the past 15 yrs
- Systemic symptoms, such as fever or weight loss
- Trouble swallowing
- Vomiting
A cough that persists longer than three weeks or recurs on a regular basis suggests there is a chronic nature to the cough and further investigation is necessary
When an acute cough is caused by a RTI advise the following
- Acute cough usually persists for up to 3 to 4 weeks
- How to manage symptoms:
- Use paracetamol or ibuprofen
- Honey 1+
- Guaifenisin
Cough suppressants
cough referral to A&E
- A respiratory rate >30 bpm
- Tachycardia >130 beats per minutes
- Systolic blood pressure <90mmHg
- Oxygen saturation <92%
- PEV <33%
- Altered level of cosciousness
Use of accessory muscles
Demulcents
Contain soothing substances such as syrup or glycerol and may be used to relieve dry irritating cough. Simplest and cheapest option may be honey and lemon.
Expectorants
E.g. guaifenesin are claimed to promote expulsion of bronchial secretions but there is no evidence that any drug can specifically facilitate expectoration
Suppressants
Suitable when theres no identifiable cause- useful for when its disturbing sleep. They may cause sputum retention and this may be harmful in patients with chronic bronchitis and bronchiectasis.
Croup
Characterised by the sudden onset of a seal like barking cough, which may be accompanied by voice hoarseness. Symptoms are typically worse at night
Croup Treatment
- Paracetamol or ibuprofen for fever
*Corticosteroids
What is a cold
The common cold is the conventional term used to describe a mild, self-limiting, viral, upper RTI characterised by nasal stuffiness and discharge, sneezing, sore throat and cough9. The first symptom is often a sore or irritated throat9. Nasal discharge is normally profuse and clear at first, becoming thicker and darker as the infection progresses, although this does not usually indicate that a bacterial infection is present9. Cough develops in about 30% of colds, typically after nasal symptoms have cleared9. In adults and older children symptoms usually last around 1 week and typically 10–14 days in younger children9.
What is the most common cause of cold
Rhinovirus is the most common cause of cold9. About half of all colds are associated with this virus, although this proportion can increase to 80% in autumn months9. Other common viral pathogens include coronaviruses, parainfluenza, respiratory syncytial virus and adenovirus9. The viruses are transmitted via airborne droplets or by direct contact with infectious secretions
Cold referral
- infants less than three months old as they are susceptible to secondary bacterial infection; you should also refer infants if they are having difficulty feeding
- any infant or older person who appears significantly more unwell than would be expected for a common cold or influenza; you may suspect pneumonia and should also ask questions to rule out meningitis and septicaemia
- children who may have a foreign body in their nose; purulent discharge, usually from only one side of the nose and without other cold symptoms is strongly suggestive of this
- acute sinus involvement at any age
ear pain originating from the middle ear at any age
Practical Advice Antibiotics
Antibiotics do not work in viral infections and they cause adverse effects; they also increase the risk of bacterial resistance in the community, which may affect the treatment of other diseases
Practical Advice Hydration
Adequate fluid should be taken during the course of the illness. Very little evidence supports increased fluid intake in the management of common cold. It is important to maintain normal hydration as fluid loss is likely to be greater when fever and nasal discharge are present. it is therefore pragmatic to recommend that people should drink enough fluid to compensate for any increased fluid loss
Practical Advice Nutrition
Nutritious food is recommended but no specific diet is necessary; reassure parents that it is common for children to lose their appetite for a few days when they have a cold but this is not a serious concern, and children with colds should eat only when they are hungry
Practical Advice Rest
Adequate rest is advised but there is no recommendation on when a person should stay off work or school; in general, people should use how they feel as an indicator of how active they should remain. Normal activity will not prolong illness.
Paracetamol
Paracetamol is a suitable first-line choice for most patients9. The use of paracetamol is based mainly on historical evidence9, as a Cochrane review has concluded that further large-scale, well-designed trials are needed to determine whether this intervention is beneficial in the treatment of adults with the common cold12.
Care must be taken to avoid duplication of doses of paracetamol as it is contained in many prescribed and OTC preparations. Patients, or their parents, or carers should be counselled on the maximum dose and total daily dose of paracetamol depending on their age and other risk factors.
Ibuprofen
Ibuprofen may be recommended as an alternative first-line treatment to paracetamol9. The choice between these two agents should be made considering the medical history and preferences of the patient.
Ibuprofen is contra-indicated in patients:
* who have previously shown hypersensitivity reactions in response to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
* who have an active or previous peptic ulcer
* who have active or a history of upper gastro-intestinal bleeding or perforation related to NSAID therapy
* who have severe hepatic failure, renal failure or heart failure.
* varicella infection
Patients who are pregnant should be advised to avoid use of NSAIDs available without prescription from week 20 of pregnancy unless advised by their healthcare professionals. NSAIDs should not be taken during the third trimester of pregnancy (after 28 weeks of pregnancy) as they can in some cases cause labour to be delayed or last longer than expected. It can also have potential effects on the unborn baby’s kidneys and heart
steam
Steam inhalation may help to relieve congestion although care should be taken to avoid scalding. Sitting in the bathroom with a running hot shower is a safe option.
saline
Saline nose drops (0.9% w/v) may ease nasal stuffiness by helping to liquefy mucous secretions, although there is little evidence to support their effectiveness9.
Saline nasal irrigation may relieve the symptoms of nasal congestion; however, more robust research is required. Nasal saline is safe but can cause minor adverse effects, such as irritation or a burning sensation, particularly with products using higher flows or concentrations9.
Gargling with salt water may help to relieve sore throat or nasal congestion; however, their recommended use is generally based on anecdotal evidence
Menthol
Menthol lozenges and menthol vapour rubs are marketed for the relief of nasal congestion.
Menthol lozenges have little effect on nasal congestion using objective measurements; however, they may create the sensation of improved airflow and as a result patients may feel there is an improvement9.
Vapour rubs have been shown to be beneficial in children with bronchitis but evidence for their efficacy in the common cold is lacking. However, some children like the sensation of the rub and may experience symptom relief
