Chronic Cough PDF

Chronic cough Pemra Cöbek Unalan, Prof. Family Medicine  A chronic cough is a cough that lasts eight weeks or longer in adults, or four weeks in children. A chronic cough can interrupt your sleep and leave you feeling exhausted. Severe cases of chronic cough can cause vomiting,...

Chronic cough Pemra Cöbek Unalan, Prof. Family Medicine  A chronic cough is a cough that lasts eight weeks or longer in adults, or four weeks in children. A chronic cough can interrupt your sleep and leave you feeling exhausted. Severe cases of chronic cough can cause vomiting, lightheadedness and even rib fractures.  Persistent (Chronic) Cough Pathophysiology Differential Diagnosis Evaluation of Cough in Adults Other Causes in Patients with Normal Chest Radiography Patients with Abnormal Chest Radiography  FC is a 35 year old female who presents to the outpatient center with complaints of cough for 3 months. She has no significant past medical history and is no on medications. 1. What historical questions do you want to ask about the cough? What is the significance of each; what diagnoses does each suggest?  She denies any post nasal drip or heartburn symptoms. She states the cough is dry, and worse at night. She occasionally takes 7Ups and mints to clear her throat. She denies dyspnea, chest tightness, or wheezing. She cannot specifically recall any preceding fever. She has no known allergies and denies any triggers to her cough. She is a non-smoker and denies HIV risk factors.  What specific physical findings are you looking for, and what is the significance of each?  On physical examination, she is mildly overweight. She appears comfortable, with a RR of 12, with no accessory muscles use. HEENT exam reveals no sinus tenderness, normal appearing nasal mucosa, pharynx is without discharge or cobblestoning in the posterior aspect. Tympanic membranes are without hairs or cerumen. Neck is free of masses or thyromegaly. Lungs are clear to auscultation. Cardiac, abdominal and extremity exams are normal.  What are the most common causes of cough? What is your prioritized differential diagnosis now, and why? What would you recommend at this point.  Postnasal drip. This condition is also called upper airway cough syndrome (UACS). Asthma. In one type of asthma (cough-variant asthma), a cough is the main symptom. Gastroesophageal reflux disease (GERD). The constant irritation of gastric acid can lead to chronic coughing. The coughing, in turn, worsens GERD — a vicious cycle. Smoking Blood pressure drugs. Angiotensin-converting enzyme (ACE) inhibitors, The cough is usually dry and hacking. Switching to another medication often improves the cough over the course of one to two weeks. Chronic bronchitis. This long-standing inflammation of your major airways (bronchial tubes) can cause a cough that brings up colored sputum. Most people with chronic bronchitis are current or former smokers. Chronic obstructive pulmonary disease (COPD); smoking-related lung disease. Emphysema is also incorporated under this term, and chronic bronchitis and emphysema often coexist in current or former smokers with COPD.  Associated Symptoms A runny or stuffy nose A feeling of liquid running down the back of your throat (postnasal drip) Frequent throat clearing and sore throat Hoarseness Wheezing and shortness of breath Heartburn or a sour taste in the mouth (rarely) coughing up blood Women tend to have more-sensitive cough reflexes  The Patient... GER or Asthma??? What would you now recommend? GER treatment (Acid blockers) and follow-up. The patient returns in three weeks and reports little improvement. Order PFT  Less commonly, chronic cough causes Aspiration (food in adults; foreign bodies in children) Bronchiectasis (damaged airways) Bronchiolitis-Infections Cystic fibrosis Laryngopharyngeal Lung cancer Nonasthmatic eosinophilic bronchitis (airway inflammation not caused by asthma) Sarcoidosis (collections of inflammatory cells in different parts of your body, most commonly the lungs)  Lung cancer — Although lung cancer can cause coughing, very few people with a chronic cough have lung cancer. Cancer is possible, however, especially if you are a smoker and your cough changes suddenly, you begin to cough up blood, or if you continue to cough more than one month after quitting smoking. Eosinophilic bronchitis — A special type of inflammation in the airways called eosinophilic bronchitis can cause a chronic cough. This is diagnosed when your breathing tests show no evidence of asthma, but your phlegm or airway biopsy shows cells called eosinophils. Eosinophilic bronchitis is much less common than asthma.  Respiratory tract infection A cough can linger long after other symptoms of pneumonia, flu, a cold or other infection of the upper respiratory tract have gone away. A common but under-recognized cause of a chronic cough in adults is pertussis Many people with a chronic cough after a respiratory infection respond to treatment for postnasal drip or cough variant asthma. Sometimes bacterial tracheobronchitis or bacterial sinusitis can develop following a viral upper respiratory tract infection. Bacterial tracheobronchitis, patients will have a cough that produces sputum. The sputum is colored from light yellow to dark green or even brown. Likewise, in almost all cases of cough from bacterial sinusitis, patients will have sinus congestion and the nasal secretions that drip or flow into the back of the throat are similarly off-colored.  Diagnosis X-rays. a routine chest X-ray won't reveal the most common reasons for a cough — postnasal drip, acid reflux or asthma — it may be used to check for lung cancer, pneumonia and other lung diseases. An X-ray of sinuses may reveal evidence of a sinus infection. Computerized tomography (CT) scans.  Lung function tests : simple, noninvasive tests are used to diagnose asthma and COPD. They measure how much air your lungs can hold and how fast you can exhale. Sputum culture :  Scope tests Bronchoscopy : A biopsy can also be taken from the mucosa to look for abnormalities. Rhinoscopy, look for upper airway causes of cough. Children: A chest X-ray and spirometry, at a minimum, are typically ordered to find the cause of a chronic cough in a child.