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cough
M.A.zohal
pulmonologist
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inflammation, constriction, infiltration,
or compression of airways
Evaluation
full history
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Duration of cough
When it tends to occur
– nights or early morning, after exertion, on
exposure to dust, pollen or cold air (asthma),
– after meals or on sitting or bending over
(GERD),
– nocturnal (postnasal drip and asthma)
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hemoptysis
Evaluation
full history
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Associated symptoms
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Shortness of breath
Wheeze
Throat clearing
Sensation of postnasal drip
Chest pain
Ankle swelling
Orthopnoea/paroxysmal nocturnal dyspnoea
Dyspepsia
Evaluation
full history
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Previous respiratory disease, such as
childhood asthma, eczema, or hay fever
History of sinus disease or perennial rhinitis
History of severe respiratory infections, such
as whooping cough, that may have caused
bronchiectasis
Known cardiac disease or valvular heart
disease
Evaluation
full history
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Drug history ?ACE inhibitor
Occupation ?workplace irritants
Pets/birds
Smoker
Use of recreational drugs
Investigations
Initially
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Spirometry
Methacholine challenge test
Serial peak flow recording
Induced sputum examination
investigation
later
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Consider chest HRCT if any features suggestive
of lung cancer or interstitial lung disease, as a small
proportion may present with a normal CXR (central
tumour)
Consider ENT examination if predominantly upper
respiratory tract disease, resistant to treatment.
Consider sinus CT
Consider bronchoscopy if foreign body possible,
or history suggestive of malignancy, small
carcinoid, endobronchial disease. Perform after CT
to help guide bronchoscopist
Consider esophageal pH monitoring.
ACUTE COUGH
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Common cold
pneumonia,
congestive heart failure,
exacerbation of COPD
gastric aspiration
pulmonary embolism.
Chronic cough
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Asthma
GERD
postnasal drip (rhinosinusitis)
chronic bronchitis
bronchiectasis
Common cold
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postnasal drip,
throat-clearing,
irritation of the throat,
sore throat,
nasal obstruction,
nasal discharge
treatment
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Codeine was ineffective against the
acute cough of the common cold
Dextromethorphan may be
antibiotic therapy unless it persists for
more than 10 to 14 days.
Rhinosinusitis
(PND)
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throat-clearing
nasal quality to the voice
cobblestoning" appearance
presence of allergy to pollens
Treatment
PND
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corticosteroid drops
short course of oral steroids
anticholinergic spray
decongestant vasoconstrictor sprays
Antibiotic therapy
Asthma
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Often nocturnal
reversible airflow limitation
bronchial hyperresponsiveness
do not usually have an enhanced
cough reflex
Cough as the only presenting symptom of asthma
has been reported in up to 57% of patients
GE reflux
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laryngeal symptoms
– dysphonia
– hoarseness
– sore throat
– posterior vocal cord & laryngeal
inflammation
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esophageal dysmotility (heartburn, water
brash, and oral regurgitation )
Treatment
GERD
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avoiding caffeine,
wearing loose fitting clothes,
sleeping with an empty stomach
sleeping propped up
High dose omeprazole
H2 receptor blockers
pro-kinetics like metoclopramide
ACE inhibitor cough
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a tickly irritating sensation in the throat
It may appear within a few hours of taking
the drug or may become apparent only after
weeks or even months
The cough disappears within days or weeks
following withdrawal of the drug
POSTINFECTIOUS COUGH
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viral in nature
take weeks or months to resolve
spontaneously, although most settle
within 8 weeks.
pathogenesis
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persistent damage to the cough
receptors or persistent airway
inflammation induced initially by the
virus
Irritants may penetrate more readily
through the damaged epithelium
heightened cough reflex
Pathogenesis
(continue)
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Impaired mucociliary clearance
Mucus hypersecretion Inflammation in
upper airway such as rhinitis &
sinusitis
Gastro esophageal reflux
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Associated laryngospasm can occur,
which is a sudden hoarseness, with
associated stridulous inspiratory
efforts and a sensation of being
unable to breathe.
Other condition
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bronchogenic carcinoma
metastatic carcinoma
sarcoidosis
chronic aspiration
interstitial lung disease
left ventricular failure
Psychogenic or habit cough
Mediastinal tumor
Other causes of cough in
children
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congenital abnormalities (e.g., vascular rings,
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mediastinal tumors
tracheobronchomalacia, pulmonary sequestration)
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foreign bodies in the airway or esophagus
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aspiration
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heart disease.
Complication of cough
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Hoarseness
Tearing of muscle fiber
Rib fracture
Headache &back pain
Inguinal hernia & incontinence
codeine
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the methylether of morphine
centrally acting antitussive drug
ineffective against acute cough of the
common cold
Drowsiness
physical dependence
Dextromethorphan
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non-narcotic antitussive,
a synthetic derivative of morphine
no analgesic or sedative properties