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Cough

Group 10

Outline

Synopsis
Epidemiology
Anatomy
Mechanism
Red flags
Risk factors
Diagnosis
Algorithm
Physical examination
Hypothetical case
EBM

SYNOPSIS

A cough is a reflex action to clear your airways of


mucus and irritants such as dust or smoke. It's rarely
a sign of anything serious.
A "dry cough" means it's tickly and doesn't produce any
phlegm (thick mucus). A "chesty cough" means phlegm is
produced to help clear your airways.
Classified as two types:
i.
ii.

Acute (Short term) cough


Chronic (Persistent) cough

http://www.nhs.uk/conditions/cough/pages/introduction.aspx

Synopsis

Cough performs an essential


protective function for human airways
and lungs.
Without an effective cough reflex, we
are at risk for retained airway
secretions and aspirated material
predisposing to infection, atelectasis,
and respiratory compromise.
Cough is often a clue to the presence
of respiratory disease. In many
instances, cough is an expected and
accepted manifestation of disease, as
in acute respiratory tract infection.

1.
2.
3.
4.

Excessive coughing complications:


emesis,
syncope,
muscular pain,
rib fractures & so can agregate
abdominal or inguinal hernias and
urinary incontinence.
However, persistent cough in the
absence of other respiratory
symptoms commonly causes
patients to seek medical attention.

Synopsis
Short Term Coughs(Acute)
An

upper respiratory tract infection (URTI) that affects the throat,


trachea or sinuses.
A lower respiratory tract infection (LRTI) that affects your lungs or
lower airways
An allergy, such as allergic rhinitis or hay fever
A flare-up of a long-term condition such as asthma, chronic
obstructive pulmonary disease (COPD) or chronic bronchitis
Inhaled dust or smoke

Synopsis

Subacute Cough
Postinfectious cough is the most common cause of subacute
cough.
Pertussis

Synopsis
Persistent coughs (chronic)
A persistent cough may be caused by:
chronic bronchitis
asthma
an allergy
smoking
bronchiectasis
postnasal drip
Gastro-oesophageal reflux disease (GERD)

Synopsis

Different kinds of cough include:


1.
2.
3.
4.
5.
6.
7.

Postnasal Drip
Asthma
GERD
COPD
Medication-related cough
Pneumonia
Whooping Cough

http://news.health.com/2015/04/07/whats-causing-your-cough/

Causes of coughs that are more common in children than


adults include:
Bronchiolitis a mild respiratory tract infection that
usually causes cold-like symptoms
Croup this causes a distinctive barking cough and a
harsh sound known as stridor when the child breathes in
Whooping cough look out for symptoms such as
intense, hacking bouts of coughing, vomiting, and
a "whoop" sound with each sharp intake of breath after
coughing

http://www.nhs.uk/conditions/cough/pages/introduction.aspx

EPIDEMIOLOGY

Spread occurs by direct contact or droplet infection during cough


Infants less than one year of age constitute 50-70% of
diagnosed cases.
Period of Communicability
The disease occurs 3-12 days after exposure to an affected
individual
The coughing stage lasts for approximately six weeks before
subsiding. In some countries, this disease is called the 100
days cough or cough of 100 days because of its length.

Epidemiology

ANATOMY & MECHANISM

MECHANISM

special sensory proteinsreceptors- found on the surface of


some cells that line the upper
respiratory tract.
Locations -throat,
-trachea (windpipe), - upper bronchi
Receptors stimulated send a
signal to sensory nerve fibers, such
as those found in the vagus nerve.
sensory fibers brain for
interpretation.
The part of the brain that monitors
the throat and upper airway region
has been called the cough
center.
http://www.robitussin.com/

Mechanism

cough center receives a signal


muscles in the throat and chest receive
action signals that trigger the cough
mechanism, which is a 3-part process:
First, a volume of air is inhaled.
Second, the opening to the trachea
(the epiglottis) closes as the chest
constricts, compressing the air within
the lungs.
Third, the epiglottis opens, allowing a
rapid burst of air to be expelled through
the mouth.
http://www.robitussin.com/

www.slideshare.net

RED FLAGS

Persistent cough for more than three weeks


Pleuritic chest pain
Dyspnea
Haemoptysis
Persistent nocturnal cough
Wheeze
Recurrent chest infections
Coughing up phlegm every morning for more than three months of the
year
Unintentional weight loss

RISK FACTORS
The main risk factor for cough is being exposed to irritants, for
example:
Smoke
Noxious fumes
Allergens such as pollen and dust
Smog and other environmental pollutants

Exposure to viral and bacterial infections affecting the


respiratory tract also increases the risk of cough.
Smoking is a major risk for serious conditions linked to
chronic cough including lung cancer and chronic bronchitis.

DIAGNOSIS

Chest x-ray
Sputum culture
Breathing tests (also called pulmonary functions tests, PFTs,
or spirometry)
Blood tests
Chest CT scan
Bronchoscopy

ALGORITHM

PHYSICAL EXAMINATION

Physical Examination:
COUGH
1. Vital signs, including respiratory rate, temperature, and O2 saturation
2. General appearance: How sick does patient look?
3. Systemic exam if systemic symptoms indicate.
4. HEENT: Nasal passage, sinuses, throat, adenopathy, neck veins if
considering cardiac problem.

5. Chest/lungs: Accessory muscle use, retractions, percussion,


lung sounds.
6. Cardiovascular: PMI size and location, heart sounds (gallops,
murmurs, or rubs).
7. Abdomen
8. Extremities

HYPOTHETICAL CASE

Hypothetical case

36 years old male, came in with a chief complaint of cough


for 1 week, productive with yellowish sputum.
He was also noted to have fever, relieved by paracetamol
intake.
No medications taken.
He sought consult at the clinic due to persistent cough and
fever.

Hypothetical case

Chief complaint- cough for 1 week


HPI- patient has cough with yellow sputum and noted to have
fever relieved by paracetamol.
personal hx- no smoking
ROS: unremarkable
physical exam findings- BP-120/80 mm/hg
-RR-26 bpm
-CR- 90 bpm
- temp 38.5 degree celsius

Hypothetical case

Chest findings: symmetrical chest expansion, no retractions,


(+) crackles r base Other findings were unremarkable.

Hypothetical case
Differentail diagnosis :

viral rhinosinusitis
acute bronchitis
acute pneumonia

Hypothetical case
Final diagnosis:
Acute pneumonia

EVIDENCE BASED MEDICINE

Population: 48 studies including 10,423 patient cases from


January 1990 to March 2012 representing China, India, Indonesia,
Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan,
Thailand and Vietnam.
Intervention: Systemtic Review
Method: Descriptive
Conclusion: These data have major implications for diagnostic
strategies and empirical treatment.
Outcome: Narrow-spectrum antibiotics targeting S. pneumoniae
may be inappropriate in many Asian settings, and agents active
against TB may lead to partial response and delayed TB
diagnosis.

THANKYOU !