Cough
Definition
• An explosive expiration that provides a normal protective mechanism for clearing the
tracheobronchial tree of secretions and foreign material
• Acute cough: <3 weeks
• Chronic cough: >3 weeks
Symptoms & Signs
History
• Valuable clues for etiology
o Acute or chronic?
o Symptoms of respiratory infection at onset?
o Seasonal? Wheezing?
o Symptoms of postnasal drip?
Nasal discharge
Frequent throat clearing
"Tickle in the throat"
o Symptoms of gastroesophageal reflux?
Heartburn or sensation of regurgitation
o Fever or sputum? If sputum present, what is its volume, character?
o Hemoptysis?
o Associated diseases or risk factors?
Cigarette smoking
HIV
Environmental exposures (e.g., asbestos)
o Angiotensin-converting enzyme (ACE) inhibitor?
Physical examination
• Signs of postnasal drip may be present.
o Oropharyngeal mucus or erythema
o "Cobblestone" appearance to mucosa
• Auscultation of the chest may demonstrate:
o Inspiratory stridor (upper airway disease)
o Rhonchi or expiratory wheezing (lower airway disease)
o Inspiratory crackles (process involving pulmonary parenchyma—e.g., interstitial lung
disease, pneumonia, or pulmonary edema)
• Temperature
o Fever suggests infection (bronchitis, pneumonia).
• Check for systemic or nonpulmonary causes.
o Heart failure
o Primary nonpulmonary neoplasm
o AIDS
Treatment Approach
• Definitive treatment
o Dependent on determining underlying cause
• Specific considerations
o Elimination of exogenous inciting agent (cigarette smoke, ACE inhibitor) or
endogenous trigger (postnasal drip, gastroesophageal reflux)
Usually effective if precipitant can be identified
o Treat specific respiratory tract infections.
o Bronchodilators for potentially reversible airflow obstruction
o Inhaled glucocorticoids for eosinophilic bronchitis
o Chest physiotherapy and other methods to clear secretions in bronchiectasis
o Treatment of endobronchial tumors or interstitial lung disease if therapy availableand appropriate.
No comments:
Post a Comment