Professional Documents
Culture Documents
1 . Acute Cough :
lasting < 3 weeks
2. Subacute Cough :
lasting between 3 and 8 weeks
3. Chronic Cough :
– lasting > 8 weeks
Acute Cough
– Usually non-life-threatening diagnosis
– Infectious
– Exacerbation of pre-existing conditions
Environmental/Occupational
Present Illness:
No evaluation of pulmonary symptoms is complete
without a detailed history of smoking habits.
If the patient says “no” when asked “do you smoke?”
the next question must be “did you ever smoke?
” Exposure to cigarettes is customarily quantified as
the number of “pack-years,” which is calculated by
multiplying the average number of packages of
cigarettes smoked daily by the number of years they
were consumed.
Cough
Chronic bronchitis and bronchogenic
carcinoma coexist being a complication of
CIGARETTE SMOKING
***Any change in the character or pattern of
a chronic cough warrants immediate
diagnostic evaluation, with special
attention directed toward the detection of
bronchogenic carcinoma
Cough
Productive cough
Underlying inflammatory process
Often infectious
Non productive cough
Mechanical or other irritative stimulus
Character
Paroxysmal coughing with ‘whoops’ is
characteristic of pertussis
‘Barking’ or ‘croupy cough’ occurs in laryngeal
disease
Coughing at night may accompany congestive
cardiac failure
Cough occuring at meals suggests
esophagogastric disease (hiatal hernia,
diverticulum)
Worse upon awakening in severe bronchitis or
bronchiectasis
A description of the secretions
produced in association with
cough is diagnostically useful:
***
Foul-smelling sputum indicates anaerobic
infection (lung abscess or necrotizing
pneumonia)
Abundant frothy saliva-like sputum symptom of
bronchoalveolar carcinoma
Pink foamy sputum indicates pulmonary edema
Rust-colored or prune juice colored sputum may
be observed in pneumococcal pneumonia
Chronic production of copious purulent sputum
with intermittent blood streaking clue for
bronchiectasis
*** Clues to Common Causes of Cough
That May Be Apparent by History
Wheezing Asthma
Nocturnal wheezing
Asthma, congestive heart
failure
Cough is worse at work Occupational environment
Cough following upper respiratory cause
infection or exposure to Postnasal drip
allergen
Sensation of postnasal drip Postnasal drip, asthma
Facial pain, tooth pain Sinusitis
Heartburn or sour taste in Gastroesophageal reflux
mouth disease
History of weight loss Cancer, tuberculosis
Cough
Associated features:
Wheezing– a disorder with obstruction to air flow
such as asthma
Stridor– involvement of the pharynx-larynx-
extrathoracic trachea
Fever and chills– acute infection
Weakness and weight loss—tuberculosis or
other chronic infection or malignancy
Recurrent pneumonias—bronchiectasis, foreign
body or obstructing tumor
Treatment:
The ideal treatment of cough is the elimination of its
underlying cause
In bronchopulmonary infections –suitable antimicrobial
treatment of the responsible microorganism
Cessation of cigarette smoking in chronic bronchitis
Productive cough should not be suppressed because
retention of secretions impairs the distribution of inspired
air which worsens gas exchange and promotes the
development of atelectasis and secondary infection
Adequate hydration
Respiratory physical therapy with postural drainage and
percussion may be helpful
Hemoptysis
Sources
The first step in the evaluation of hemoptysis is to
decide if it is really hemoptysis—that is, is the blood
coming from the bronchial tree or lungs or from
some other site?
In most cases, history will suggest that blood is
actually being coughed up from the airways or
lungs, but it may be difficult at times to distinguish
blood being coughed up from the lower respiratory
system from blood coming from two other sites:
1. bleeding in the upper respiratory tract, in the
nasopharynx or sinuses,
2. or blood originating in the gastrointestinal tract
that was regurgitated or vomited . (hematemesis)
Hemoptysis
The most common causes are:
bronchitis,
lung cancer,
pneumonia,
lung abscess
tuberculosis,
bronchiectasis,
pulmonary thromboembolism.
Evaluation of Hemoptysis