Acute Cough Pathophysiology
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Questions and Answers

What is the recommended treatment for cough due to asthma or COPD?

  • Bronchodilators (correct)
  • Antibiotics
  • Over-the-counter cough suppressants
  • Inhaled corticosteroids

    • What is the main reason why no recommendations can be made for the use of inhaled corticosteroids for post-infection cough?

  • They are too expensive for routine use.
  • They are not effective in treating cough.
  • They have not been proven to be safe and effective for this use. (correct)
  • They are only available by prescription.

    • According to the provided text, where can you find recommendations for treating cough secondary to other medical conditions?

  • The text doesn't provide this information.
  • The Compendium of Products for Minor Ailments—Baby Care Products: Cough and Cold
  • Health Canada
  • The Compendium of Therapeutic Choices (correct)

    • Which of the following is true about nonprescription cough and cold medicines for children?

    <p>They are not recommended for children under 2 years of age. (A)</p> Signup and view all the answers

    Which of the following is NOT mentioned as a possible cause of cough in the provided text?

    <p>Gastroesophageal reflux disease (GERD) (A)</p> Signup and view all the answers

    Which of these antihistamines is most likely to be effective for acute cough secondary to allergic rhinitis?

    <p>Second-generation antihistamines (A)</p> Signup and view all the answers

    Which of the following is NOT a common side effect of first-generation antihistamines?

    <p>Increased heart rate (A)</p> Signup and view all the answers

    Which of the following medications is an anticholinergic that can be used to reduce mucus secretion in the airways?

    <p>Ipratropium (C)</p> Signup and view all the answers

    Which of the following is a common antitussive that acts centrally to suppress cough?

    <p>Codeine (B)</p> Signup and view all the answers

    What is the main region where antitussive agents act to inhibit motor control of cough?

    <p>Brain stem (D)</p> Signup and view all the answers

    According to the ACCP 2006 guideline, are centrally acting cough suppressants recommended for cough secondary to upper respiratory tract infections (URTIs)?

    <p>No, they are not recommended. (A)</p> Signup and view all the answers

    Which of the following agents is purported to enhance cough effectiveness by promoting the clearance of airway secretions?

    <p>Guaifenesin (A)</p> Signup and view all the answers

    Which of the following statements about clofedanol (chlophedianol) is TRUE?

    <p>It is indicated for symptomatic relief of cough, but its efficacy is not well-established. (B)</p> Signup and view all the answers

    What is the primary purpose of a cough?

    <p>To protect the respiratory tract (C)</p> Signup and view all the answers

    Which type of cough lasts for more than eight weeks?

    <p>Chronic cough (C)</p> Signup and view all the answers

    What is the most common cause of acute cough?

    <p>Viral infections of the upper respiratory tract (B)</p> Signup and view all the answers

    What condition might be suspected if a patient's cough is paroxysmal or accompanied by vomiting?

    <p>Bordetella pertussis infection (A)</p> Signup and view all the answers

    What should be done if a patient presents with a compromised airway or high fever due to cough?

    <p>Refer to urgent care immediately (D)</p> Signup and view all the answers

    Which of the following is a common cause of acute cough?

    <p>Asthma (C)</p> Signup and view all the answers

    What commonly causes postnasal drip that can lead to acute cough?

    <p>Upper airway cough syndrome (UACS) (C)</p> Signup and view all the answers

    What is the primary action of expectorants in the respiratory tract?

    <p>Reduce sputum viscosity (A)</p> Signup and view all the answers

    In clinical practice, how is cough classified by duration?

    <p>Acute, subacute, and chronic (B)</p> Signup and view all the answers

    What is one of the primary goals of therapy for acute cough?

    <p>Diagnose and treat the underlying cause (B)</p> Signup and view all the answers

    Which factor is least likely to cause acute cough?

    <p>Chronic bronchitis (A)</p> Signup and view all the answers

    Which nonpharmacologic therapy might be used to alleviate symptoms of cough?

    <p>Nasal saline irrigation (D)</p> Signup and view all the answers

    Which of the following is concluded to be more effective than no treatment for relieving cough symptoms?

    <p>Honey (B)</p> Signup and view all the answers

    What potential risk is associated with using room humidifiers for cough prevention?

    <p>Aerosolizing mould if not well cleaned (C)</p> Signup and view all the answers

    What adverse event may be caused by taking zinc lozenges?

    <p>Nausea (B)</p> Signup and view all the answers

    Which agents have been used as antitussives with poor evidence for efficacy?

    <p>Local anesthetics (D)</p> Signup and view all the answers

    Which of the following is NOT listed as a less common cause of cough?

    <p>Heart failure (C)</p> Signup and view all the answers

    Which recommendation is NOT supported due to conflicting evidence?

    <p>Use of cough drops (A)</p> Signup and view all the answers

    Which effect is NOT associated with honey as a cough suppressant?

    <p>Increased sputum viscosity (A)</p> Signup and view all the answers

    What has been found regarding the efficacy of NSAIDs on cough symptoms?

    <p>They have no effect on cough symptoms (C)</p> Signup and view all the answers

    What is a suggested preventative measure regarding cough management?

    <p>Avoid exposure to inhaled irritants (A)</p> Signup and view all the answers

    Which ingredient may slow recovery time in cough due to the common cold?

    <p>Zinc lozenges (B)</p> Signup and view all the answers

    Which of the following medications is listed as a cause of cough in sensitive individuals?

    <p>ACE inhibitors (C)</p> Signup and view all the answers

    What is the risk associated with giving honey to children?

    <p>Risk of botulism (D)</p> Signup and view all the answers

    What is a key approach to treating cough associated with gastroesophageal reflux disease?

    <p>Treating the reflux itself (B)</p> Signup and view all the answers

    Why are nonprescription cough medicines considered to lack strong evidence of effectiveness?

    <p>The positive results in studies are often of questionable clinical relevance (B)</p> Signup and view all the answers

    What role does the placebo effect play in the treatment of cough?

    <p>It can significantly affect patient outcomes (C)</p> Signup and view all the answers

    What is the current recommendation regarding the use of antihistamines for acute cough?

    <p>They are no longer recommended until further evidence supports their efficacy (A)</p> Signup and view all the answers

    What is the primary reason for smokers to be counseled about cessation strategies when they present with cough?

    <p>Smoking can significantly contribute to chronic cough (D)</p> Signup and view all the answers

    What is indicated about first-generation antihistamines like diphenhydramine in relation to cough caused by upper respiratory tract infections?

    <p>They can help by reducing postnasal drip (C)</p> Signup and view all the answers

    What does the current evidence say about the effectiveness of nonspecific treatments such as nonprescription antitussives?

    <p>There is insufficient evidence supporting their use (D)</p> Signup and view all the answers

    Which group of medications is no longer recommended for acute cough treatment until further evidence is available?

    <p>Antihistamines (B)</p> Signup and view all the answers

    Flashcards

    Second-generation antihistamines

    Antihistamines with minimal anticholinergic effects, not effective for acute cough unless due to allergic rhinitis.

    Decongestants

    Drugs that can help relieve postnasal drip, though evidence for efficacy is limited.

    Ipratropium

    An anticholinergic that reduces mucus secretion, recommended for rhinitis and common cold symptoms.

    Antitussives

    Nonprescription drugs that suppress cough by acting on the brainstem, not recommended for productive coughs.

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    Dextromethorphan

    A common antitussive that may be abused for its euphoric effects but has limited efficacy for URTIs.

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    Codeine

    An antitussive with risks of dependence, effective for cough related to COPD but not for URTIs.

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    Expectorants

    Drugs like guaifenesin that increase the effectiveness of coughing by clearing airway secretions.

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    Clofedanol

    Reclassified as an OTC antitussive, indicated for symptomatic cough relief with little evidence of efficacy.

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    Cough reflex

    A physiological response to protect the respiratory tract by expelling irritants.

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    Acute cough

    Cough lasting less than 8 weeks, often seen in respiratory diseases.

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    Postinfectious cough

    A cough that persists after the resolution of a viral infection.

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    Upper airway cough syndrome (UACS)

    A type of cough due to postnasal drip or throat clearing.

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    Common causes of acute cough

    Includes viral infections, acute bacterial sinusitis, and rhinitis.

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    Chronic bronchitis

    A long-term condition causing persistent cough and mucus production.

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    Signs for urgent care referral

    High fever, compromised breathing, dehydration, or seizures indicating severe illness.

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    Bordetella infections

    Coughing illnesses like whooping cough associated with Bordetella pertussis.

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    Underlying conditions for cough

    Conditions such as GERD that can cause coughing.

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    Gastroesophageal reflux disease (GERD)

    A chronic digestive condition where stomach acid flows back into the esophagus, potentially causing cough.

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    Smoking cessation and cough

    Discussing quitting smoking with patients who cough, as smoking is a major contributing factor.

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    Treatment for viral infection cough

    No specific cure for cough caused by viral infections like the common cold.

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    Nonspecific cough treatments

    Nonprescription antitussives and expectorants used without specific evidence of effectiveness.

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    Efficacy of nonprescription cough medicines

    Limited evidence for the effectiveness of nonprescription cough products on reducing cough severity.

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    Placebo effect in cough treatment

    Patients may experience relief from cough due to the placebo effect, despite actual medication effects.

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    Antihistamines for acute cough

    First-generation antihistamines are not recommended for acute cough until proven effective.

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    Asthma

    A common respiratory condition causing acute cough.

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    Cough Causes

    Includes both common and less common reasons for cough.

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    Gastroesophageal Reflux Disease

    A condition where stomach acid irritates the esophagus, causing cough.

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    Nonpharmacologic Therapy

    Treatments for cough without medication, such as hydration and humidification.

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    Cough Drops

    Lozenges that may provide temporary symptom relief for cough.

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    Avoiding Irritants

    Important step in managing cough by reducing exposure to triggers.

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    Patient Assessment

    Algorithm used to evaluate patients presenting with cough.

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    Prevention of Complications

    Goal of cough management to avoid further health issues.

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    Efficacy of Expectorants

    Lack of evidence showing expectorants effectively thin or increase sputum volume even at high doses.

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    Hydration

    Adequate fluid intake to assist in loosening mucus in the respiratory tract.

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    Honey as a Cough Suppressant

    Honey is effective at reducing cough symptoms in children and adults and is better than some treatments.

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    Zinc Lozenges

    Used to alleviate cough from the common cold, but evidence on their effectiveness is mixed.

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    Local Anesthetics as Antitussives

    Agents like benzocaine and menthol may numb cough receptors, but evidence for efficacy is poor.

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    Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

    Investigated for cough treatment, but found to have no effect on cough symptoms.

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    Ivy/Thyme Syrups

    Show modest efficacy in relieving cough symptoms according to accumulating evidence.

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    Bronchodilators

    Medications like salbutamol or formoterol to relieve cough due to asthma or COPD.

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    Inhaled corticosteroids

    Steroids that can help relieve cough after respiratory infections; need more studies for routine use.

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    Acute cough in children

    Children have a higher chance of URTI-associated acute cough than adults, affecting them four times more.

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    Health Canada's relabeling

    Since 2008, nonprescription cough and cold medicines for children must indicate they are not recommended for young users.

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    Compendium of Therapeutic Choices

    Resource providing treatment options for various conditions, including cough and related diseases.

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    Study Notes

    Acute Cough Pathophysiology

    • Cough is a normal physiological response protecting the respiratory tract.
    • Receptors in head, neck, and chest stimulate nerve pathways to the cough centre.
    • The afferent limb of the vagus nerve transmits information to the cough centre.
    • Efferent pathways to airway and respiratory muscles result from the cough reflex.
    • Cough duration classifies acute (<3 weeks), subacute (3-8 weeks), and chronic (>8 weeks).
    • Acute cough accounts for over 50% of new patient visits to primary care.
    • Viral infections in the upper respiratory tract frequently cause acute cough.
    • Postinfectious cough, a subacute type, can persist after viral infection resolution.
    • Postnasal drip (or Upper Airway Cough Syndrome) is another common cause.

    Common Causes of Acute Cough

    • Common Causes: Asthma, COPD, ACE inhibitor/NSAID use, environmental/occupational irritants, foreign bodies, GERD, heart failure, pulmonary embolism, rhinitis, sinusitis, Upper Airway Cough Syndrome, upper/lower respiratory tract infection (acute) & (post-infectious).
    • Less Common Causes: Bronchiectasis, cystic fibrosis, interstitial lung disease, lung cancer, psychogenic cough, unexplained cough, Zenker diverticulum.

    Goals of Therapy

    • Diagnose and treat underlying cause.
    • Relieve symptoms.
    • Prevent complications.

    Nonpharmacological Therapy

    • Hydration and humidified air may be helpful, but evidence is limited.
    • Nasal saline irrigation or nasal suctioning can help with nasal congestion.
    • Avoid inhaling irritants like smoke, dust, pollutants, and allergens.

    Pharmacologic Therapy

    • Treating underlying conditions (e.g., GERD) is paramount.
    • Specific treatments are not always possible (viral infections).
    • Nonprescription antitussives and expectorants are often used.
    • Evidence for efficacy of nonprescription cough medicines is limited, especially for children.
    • Placebo effect is significant.

    Antihistamines and Decongestants

    • First-generation antihistamines may slightly reduce cough from URTIs.
    • Second-generation antihistamines generally lack anticholinergic effects and often aren't effective for acute coughs.
    • Decongestants, such as oxymetazoline, xylometazoline, pseudoephedrine, phenylephrine, may minimally help with postnasal drip.

    Antitussives

    • Act centrally within the brainstem to suppress cough mechanisms.
    • Dextromethorphan and codeine may reduce cough counts in people with COPD, but evidence of effectiveness and risk of dependence/addiction associated with these substances is varied.
    • Codeine and dextromethorphan are not recommended for URTI cough.

    Expectorants

    • Guaifenesin may enhance cough's effectiveness by promoting secretion clearance.
    • Evidence for efficacy is limited.
    • Adequate fluid intake and humidified air are considered complementary protussive or expectorant measures.

    Other Agents

    • Honey may be effective in suppressing cough, especially in children.
    • Zinc lozenges can be used, although some studies question their efficacy.
    • Local anesthetics like benzocaine, phenol, and menthol are sometimes used but lack sufficient evidence for widespread recommendations.
    • NSAIDs have not shown efficacy in reducing cough severity.
    • Ivy/thyme syrups may exhibit demonstrable, but modest cough reduction, but evidence supporting its tolerability is still insufficient.

    Prescription Therapy

    • Bronchodilators (e.g., Salbutamol, formoterol) may be useful in cases of obstructive lung diseases like asthma or COPD.
    • Inhaled corticosteroids are sometimes used following respiratory infections, although more conclusive studies are needed to support this treatment strategy.

    Cough in Special Populations (Children)

    • Children experience URTI-associated acute cough 4 times more frequently than adults
    • Health Canada restricts use of specific ingredients (cough suppressants, antihistamines) in children under 6 years of age.
    • Codeine and hydrocodone should be avoided in children under 18 years of age.

    Monitoring of Therapy

    • Regularly assess patient symptom resolution and daily activities.

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