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Questions and Answers
Which phase of coughing comes first in the sequence of events?
Which phase of coughing comes first in the sequence of events?
What is one of the primary benefits of using protussive medications?
What is one of the primary benefits of using protussive medications?
Which of the following is classified as a cough suppressant?
Which of the following is classified as a cough suppressant?
In what scenario is it recommended to avoid using codeine?
In what scenario is it recommended to avoid using codeine?
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Which of the following adverse effects can be associated with Diphenhydramine?
Which of the following adverse effects can be associated with Diphenhydramine?
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Why should Dextromethorphan be avoided by lactating individuals?
Why should Dextromethorphan be avoided by lactating individuals?
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What triggers are associated with coughing?
What triggers are associated with coughing?
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Which statement about using cough medicines in special populations is accurate?
Which statement about using cough medicines in special populations is accurate?
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Study Notes
Exclusions for Self-Treatment
- Difficulty breathing, shortness of breath (dyspnea)
- Cyanosis (pale/blue face)
- Hemoptysis (coughing up blood)
- Weight loss
- Night sweats
- Cough worsening after 3-5 days or not subsiding after 2-3 weeks
- Children under 4 years old
- Temperature ≥100.4°F (38°C) (oral), or ≥100°F (37.8°C) (oral) lasting >3 days
- Barking cough with inspiratory stridor (croup)
- Severe coughing spells ending with a "whooping" sound (whooping cough)
- Sudden cough without fever or URI symptoms (aspiration)
- Immunocompromised status
- Exposure history to tuberculosis
- Risk factors for HIV infection
- Chronic illness (asthma, COPD, CHF, diabetes, sickle cell anemia)
Cough Treatment
- Cough with or without mucus associated with upper respiratory illness (URI): Consider as a common cold. Nondrug measures recommended. If symptoms improve, continue treatment until resolved. Otherwise, medical referral is necessary.
- Dry cough persisting after viral URI: Nondrug measures and first-generation antihistamine plus decongestant. If symptoms do not improve, seek medical attention.
- Cough likely associated with UACS (Upper Airway Cough Syndrome): Initial nondrug measures. If symptoms improve, continue treatment until resolved. Otherwise, seek medical attention; need for medical referral.
Cough Phases
- Cough occurs in 3 phases: inspiratory, compressive, and expulsive.
Cough Pathophysiology
- Triggers include smoke, perfumes, scents, throat irritation, noxious fumes, speech, exercise, cold/dry air, eating, and humidity.
Cough Clinical Presentation
- Productive (Wet) Cough: Expels secretions from lower respiratory tract. Can be effective or ineffective, depending on the nature of the secretions (clear, purulent, discolored, malodorous)
- Non-productive (Dry) Cough: Associated with viral respiratory tract infections, GERD, cardiac diseases, and certain medications.
Non-Pharmaceutical Treatments
- Stay hydrated
- Reduce throat irritation
- Increase air moisture
- Treat the underlying cause of the cough
Over-the-Counter (OTC) Medications
- Anti-tussives (Cough Suppressants): Control or eliminate cough (for non-productive coughs only). Topical examples include menthol or camphor; codeine (schedule 2 drug); dextromethorphan (Delsym); diphenhydramine (Benadryl). Important note: use diphenhydramine products with caution and consult a medical professional before mixing with other medications.
- Protussives (Cough Expectorants): Changes the consistency of mucus and increases volume of expectorated sputum. Guaifenesin (Mucinex) is an example.
Special Populations
- Pregnancy: Dextromethorphan (Delsym) is generally considered safe; avoid Codeine, Dextromethorphan (Delsym), or Diphenhydramine (Benadryl).
- Lactation (breastfeeding): Avoid Codeine, Dextromethorphan (Delsym), and Diphenhydramine (Benadryl).
- Elderly: Start with lower doses of Codeine, Dextromethorphan (Delsym), and Diphenhydramine (Benadryl) to mitigate potential sedative effects.
- Drug Interactions: Phenytoin inhibits CYP450, and diphenhydramine is metabolized by CYP450; consult a doctor about possible drug interactions.
Additional Considerations
- Children (under 2 years old): Avoid OTC cough products prescribed for adults; consult a pediatrician.
- Exclusions for self-treatment: Cough lasting longer than 7 days, excessive fever, cough accompanied by shortness of breath, chest pain, etc. require immediate medical evaluation.
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Description
This quiz covers essential guidelines for cough treatment and exclusions for self-treatment. It focuses on specific symptoms and conditions that require medical attention, along with recommended treatment for common upper respiratory illnesses. Understanding these guidelines is crucial for effective cough management.
