Approach to cough Flashcards
Most probable causes of cough
URTI Postnasal drip Smoking Acute Bronchitis Chronic Bronchitis (COPD)
Serious Disorders not to be missed
LV HF Lung Cancer --> Bronchial carcinoma presents w/ worsening cough Severe infections: TB Pneumonia Influenza Lung Abscess HIV Infection
Asthma
Cystic Fibrosis
Fireign Body
Pneumothorax
Cough: Commonly missed diagnoses
Atypical Pneumonias GORD (nocturnal cough) Smoking (in children/adolescents) Bronchiectasis Whooping Cough (Pertussis) Interstitial Lung Disorders Sarcoidosis
Drugs
Common causes of non-productive cough
URTI LRTI --> Viral or mycoplasma Inhaled Irritants --> Smoke, dust, fumes Drugs --> e.g. ACEI Bronchial Neoplasm --> gradually worsening, 'bovine' cough without explosiveness due to carcinoma infiltration of recurrent laryngeal nerve Pleurisy Interstitial Lung Disorders: Fibrosing Alveolitis, Allergic Alveolitis, Pneumoconosis, Sarcoidosis TB --> Non-cavitating stage LV HF (especially nocturnal cough) Whooping Cough (pertussis) GORD (esp nocturnal) Hiatus Hernia Postnasal Drip
Common Causes of Productive Cough
Chronic Bronchitis Bronchiectasis Pneumonia Asthma Foreign body (later response) Bronchial Carcinoma (dry or loose) Lung Abscess TB --> in Cavitating stage
Investigations of chronic cough
And when should investigations be done?
If cause of cough not apparent, or if unresolved after initial treatment
CXR: first line
Next step in chronic cough if CXR normal
Spirometry
Consider sinus xray
Gastroscopy
Oesophageal pH monitoring
Possible diagnoses = Asthma, GORD, Chronic Bronchitis, Postnasal drip
Next step in chronic cough if diffuse opacity on CXR
Exclude Pulmonary Odema
Spirometry –> Total lung capacity and diffusion concentration to rule out CO
Bronchoscopy –> alveolar lavage or transbronchial biopsy
Possible Diagnoses = LV HF, Diffuse Pneumonic Process, Interstitial Lung Diseases, Opportunistic infection
Next step in chronic cough if localized opacity on CXR
Sputum: cultures, microscopy, cytology
Bronchoscopy
Thorax CT scan
Possible Diagnoses = Pneumonia, Lung Neoplasms, Inhaled foreign body, Bronchiectasis
Clear white mucoid sputum?
Normal or uninfected bronchitis
Yellow / green (purulent) sputum?
Usually infection but not necessarily bacterial
Asthma
Bronchiectasis (copious amounts)
Rusty coloured sputum
Pneumonia
Thick and sticky sputum
Asthma
Profuse, watery sputum
Alveolar cell carcinoma
Thin, clear mucoid sputum
Viral infection
