Cough

1. COUGH

2. OUTLINEDefinition
Mechanism
Importance
History
Classification
Physical examination
Tests and diagnosis
Associated symptoms
Complications
Treatment

3. DEFINITION
Cough is an explosive expiration that
provides a normal protective mechanism
for clearing the tracheobronchial tree of
secretions and foreign material, which is
associated with a characteristic sound.

4. MECHANISM

6. The shearing forces that develop
aid in the elimination of mucus
and foreign materials

7. IMPORTANCE
1) Defense mechanism (physiological natural reflex):
Providing a normal protective mechanism for clearing the
tracheobronchial tree free of secretions and foreign material
2) Complication of its force:
Excessive coughing can be exhausting; can be complicated by
vomiting, syncope, muscular pain or rib fractures; and can aggravate
abdominal or inguinal hernias , urinary incontinence and Uterine
prolapse
3) Symptom of disease:
Associated with many medical diseases and conditions

8. 4) Transmit infections to others by air droplets diseases that
are commonly spread by coughing or sneezing include:
− Bacterial Meningitis
− Chickenpox
− Common cold
− Influenza
− Mumps
− Strep throat
− Tuberculosis
− Measles
− Rubella
− Whooping cough

9. HISTORY
1) Onset and Duration:
Acute: < 3weeks
Subacute: 3-8 weeks
Chronic: > 8 weeks
2) Character :
Bovine with Hoarsness: Left recurrent laryngeal nerve palsy
causing left vocal cord paralysis due to CA Lung
Barking with Hoarsness and Stridor: Acute Epiglottitis,
Laryngitis, CA Larynx
Wheezy: COPD, Asthma

10. 3) Timing and associated features:
Nocturnal: Asthma, CHF
Early Morning: Bronchiectasis, Chronic Bronchitis, Asthma
Recumbent: Postnasal drip (PND), CHF,
Gastroesophageal reflux disease (GERD)
Change position (Standing): Bronchiectasis

11. 4) With or without sputum:
Dry cough - without sputum:
Causes of dry cough (Asthma, Viral infection of respiratory
system, Interstitial Lung Disease)
Productive cough - with sputum:
Causes of productive cough (Respiratory Infections, COPD,
Bronchiectasis)
• With or without blood:
Hemoptysis - with blood

12. Hemoptysis (bloody sputum):
If with purulent and long standing sputum:
Chronic bronchitis (small amount of blood)
Bronchiectasis (large amount of sputum)
If with fever, recent, recent onset, SOB:
Pneumonia
If + LOA, LOW, H/O smoking:
Bronchial carcinoma
If sputum is pink in color and frothy:
Pulmonary edema
If sudden onset:
Pulmonary embolism, acute RT infections

13. PHYSICAL EXAMINATION
– PERCUSSION
1) Of chest:
Hyperresonance (COPD)
Dullness (consolidation, pleural thickening)
Stony dull (pleural effusion)
2) Liver dullness
3) Cardiac dullness

14. PHYSICAL EXAMINATION
– AUSCULTATION
1) Decreased breath sounds:
COPD
Pleural effusion
Pneumothorax
Pneumonia
Large neoplasm
Pulmonary collapse

15. 2) Bronchial breath sounds:
Lung consolidation (common)
Localized pulmonary fibrosis
Lung collapse
Pleural effusion
uncommon

16. TESTS AND
DIAGNOSIS
The medical history and physical examination help to
determine which tests should be ordered.
− Imaging tests
CXR: lung cancer and pneumonia
CT: cavities for pockets of infection

17. − Lung function tests:
These simple, noninvasive tests measure how much air your lungs can
hold and how fast you can exhale. This test is required to diagnose
asthma.
− Lab tests:
If the mucus that is coughed up is discolored, the doctor may want to test
a sample of it for bacteria.
− Scope tests:
• cellular abnormalities
• as well as biopsy

18. CLASSIFICATION
OF COUGH
1) Acute Cough: < 3 Weeks Duration
2) Subacute Cough: 3 - 8 Weeks Duration
3) Chronic Cough: > 8 Weeks Duration

19. 1) Acute Cough (Differential Diagnosis):
− Upper respiratory tract infections (URTI):
• Viral syndromes
• Sinusitis
• Pertussis
− URTI triggering exacerbations of chronic lung disease e.g.
Asthma/ COPD
− Pneumonia
− Left ventricular heart failure
− Foreign body aspiration

20. Red flags in acute cough
Symptoms:
− Haemoptysis
− Breathlessness
− Fever
− Chest Pain
− Weight Loss

21. Signs:
− Tachypnoea
− Cyanosis
− Dull chest
− Bronchial Breathing
− Crackles
THINK pneumonia, lung cancer, LVF
GET a CHEST X-Ray

22. 2) Subacute Cough:
− Postinfectious:
A cough that begins with an cute respiratory tract infection
and is not complicated * by pneumonia
• * Not complicated = normal lung exam normal chest
X-ray
• Resolve without treatment
• Cause: PND or tracheobronchitis
• Indication for CXR: with automated biopsy needle (ABN)
lung exam
− Sinusitis
− Asthma

23. 3) Chronic Cough (Differential Diagnosis):
− SMOKER (Abnormal Chest X-ray):
• COPD: Chronic Bronchitis, Emphysema
• CA Lung
− NON-SMOKER (Normal Chest X-ray):
• Drug (ACEI- Angiotensin Converting Enzyme Inhibitor- Captopril)
• PND-Post Nasal Drip
• Asthma-Cough Variant Asthma
• GERD - Gastroesophageal regurgitation disease

24. ASSOCIATED
SYMPTOMS
Fever, recent symptoms, SOB
− Pneumonia
Postnasal drip, sinus congestion, headache
− UACS (Upper Airway Cough Syndrome)
− When asked to cough, they clear the throat

25. Wakes a patient up:
− Cardiac failure, GERD, Asthma
Worse in morning:
− COPD
h/ o stroke, neurogenic dysphagia :
− Aspiration pneumonia
Wheezing:
− Asthma (episodic wheezing)
− FB/ Tumor (monophonic wheezing – intraluminal obstruction)

26. Burning chest pain:
− GERD
Pleuritic chest pain:
− PE, Pneumonia
LOA, LOW, h/ o smoking:
− Lung carcinoma
Appears after meal/ drinking:
− GERD
− Tracheo-esophageal fistula (rare)
Joint pain, dry eyes, LN enlargement:
− SLE, SJOGREN (with interstitial lung dss)

27. COMPLICATIONS
Cardiovascular:
− Arterial hypotension
− Loss of consciousness
− Rupture of subconjunctival, nasal and anal veins
− Dislodgement/malfunctioning of intravascular catheters
− Bradyarrhythmias, tachyarrhythmias

28. Neurologic:
− Cough syncope
− Headache
− Cerebral air embolism
− CSF rhinorrhea
− Acute cervical radiculopathy
− Malfunctioning ventriculoatrial shunts
− Seizures
− Stroke due to vertebral artery dissection

29. Gastrointestinal:
− Gastroesophageal reflux events
− Hydrothorax in peritoneal dialysis
− Malfunction of gastrostomy button
− Splenic rupture
− Inguinal hernia
Genitourinary:
− Urinary incontinence
− Inversion of bladder through urethra
Musculoskeletal:
− From asymptomatic elevations of serum creatine
phosphokinase to rupture of rectus abdomens muscles
Rib fractures

30. Respiratory:
− Pulmonary interstitial emphysema, with potential risk of
− pneumatosis intestinalis, pneumomediastinum,
pneumoperitoneum, pneumoretroperitoneum, pneumothorax,
subcutaneous
− emphysema
− Laryngeal trauma
− Tracheobronchial trauma (e.g., bronchitis, bronchial rupture)
− Exacerbation of asthma
− Intercostal lung herniation

31. Coughs can be treated in a variety of ways, depending on the
cause of the cough. For most healthy adults, most treatments
will involve self-care.
TREATMENT:

32. Self-Treatment
A cough that is cased by virus cannot be treated with antibiotics. You can,
however, soothe it in the following ways:
− Use decongestant sprays to unblock the nose and ease breathing
− Elevate your head with extra pillows when sleeping
− Use cough drops to soothe the throat
− Avoid irritations, including smoke and dust

33. − Gargle hot saltwater regularly to remove mucus and soothe the
throat
− Keep hydrated by drinking plenty of water
− Add honey or ginger to hot tea to relieve the cough and clear the
airway

34. AntihisMedications used to treat cough may include:
tamines and decongesta:
These drugs are standard treatment for allergies and postnasal .
Inhaled asthma drugs:
The most effective treatments for asthma-related cough are inhaled
medications that reduce inflammation and widen the airways.
Antibiotics:
If a bacterial infection is causing the cough, antibiotics will be prescribed.

35. Acid blockers:
When lifestyle changes don't take care of acid reflux, patient may be
treated with medications that block acid production. Some people need
surgery to resolve the problem.
Cough suppressants:
If the reason for your cough can't be determined, the doctor may
prescribe a cough suppressant, especially if the cough is interfering with
your sleep.

36. ‫ولووو‬THANK YOU FOR YOUR ATTENTION