COUGH

- ATHEER ALJTHALIN -
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OBJECTIVES
:
List common causes of acute and chronic cough.

Discuss the management plan of acute and chronic cough .

 ACUTE COUGH: 3

- In the absence of significant co-morbidity, an acute cough is normally benign and self-limiting.
- According to aafp the cause of acute cough can be classified as:
 ACUTE
DENTITION COUGH:
IN DETERMINING 4

AGE
1. Acute cough duration: typically 1 -3 weeks
2. Common cold: first-generation antihistamine (chlorpheniramine), decongestant, naproxen
(Naprosyn) , Antitussives (dextromethorphan)
3. influenza: oseltamivir
4. Chlamydophila or Mycoplasma infection (pneumoniae): first-line antibiotics include
erythromycin or doxycycline.
5. in some patients with bronchitis: inhaler medications (B2 agonist), antibiotics
 CONT.
5

1. postnasal drip: antihistamines, decongestants, or nasal steroid spray

2. GERD: H2-blockers or proton­pump inhibitors
3. vitamin C (at least 1 g daily) can prevent colds among persons with major physical stressors (pos-
marathon) or malnutrition.
4. Zinc lozenges: when initiated within 24 hours of symptom onset, can reduce the duration and severity
of cold symptoms.
5. cough syrup: e.g. (Cough suppressants, expectorants) (OTC) cough medications shouldn’t be given for
less than 2yrs (FDA)
 CHRONIC COUGH 7

✔ Chronic cough is defined as one lasting > 8 weeks.

chronic cough in adults can be caused by many etiologies, four conditions account for most cases:
1. upper airway cough syndrome
2. gastroesophageal reflux/laryngopharyngeal reflux disease.
3. asthma
4. Non-asthmatic eosinophilic bronchitis.

Other potential causes include

5. angiotensin-converting enzyme inhibitor use
6. environmental triggers, tobacco use
7. COPD
8. obstructive sleep apnea.

cough is considered chronic if present for > four weeks.

In children 6 to 14 years of age:
most commonly caused by asthma, protracted bacterial bronchitis, upper airway cough syndrome.
Evaluation should focus initially on these etiologies, with targeted treatment and monitoring for resolution
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 Chronic cough management: 9

UPPER AIRWAY COUGH SYNDROME:

1. initial treatment includes a decongestant combined with a first-generation antihistamine.
2. intranasal corticosteroids, saline nasal rinses, nasal anticholinergics
3. Clinical improvement should occur within days to weeks, and up to two months.

ASTHMA:
4. inhaled bronchodilator and high dose inhaled corticosteroid.
5. Symptoms should resolve within 1-2wks after starting treatment.
6. For severe or refractory cough: a 5-10 days course of prednisone 40 to 60 mg, or equivalent
oral corticosteroid can be considered if asthma is strongly suspected.
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COPD:
1. inhaled bronchodilator, inhaled anticholinergic, inhaled corticosteroid

NONASTHMATIC EOSINOPHILIC BRONCHITIS:

2. inhaled corticosteroids.
3. Avoidance strategies should be recommended when it’s due to occupational exposure or inhaled
allergens.
4. if high dose inhaled corticosteroids are ineffective then Oral corticosteroids

ACE Inhibitor–Related Cough:

5. When the medication is discontinued, resolution of the cough should occur within one week to three
months; this is the only way to determine if the ACE inhibitor is causing the cough.
6. Angiotensin receptor blockers good alternative to ACE inhibitors.
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GASTROESOPHAGEAL/LARYNGOPHARYNGEAL REFLUX DISEASE

1. empiric therapy for at least eight weeks with lifestyle changes such as dietary changes and weight loss.
2. antacid treatment
3. H2 antagonist
4. continuous positive airway pressure may improve chronic cough by decreasing GERD
 NON-PHARMACOLOGICAL: 12

•Advise and educate concerning:

• Discontinue smoking if the patient is smoker.
• Avoid contact with animals if the patient is asthmatic.
• Avoid dusty weather if the patient is allergic.

•Prescribe non-pharmacological therapy such as:

• lifestyle changes (cessation of smoking).
• Use steam inhalation if the diagnosis was croup
• Get rest and drink warm fluids
• ensure getting enough nutrients daily
• increase the humidity in home or use a humidifier.
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When to Refer
1. Failure to control persistent or chronic cough following empiric treatment trials.
2. Patients with recurrent symptoms should be referred to an otolaryngologist,
pulmonologist, or gastroenterologist.

When to Admit
3. Patient at high risk for tuberculosis for whom compli­ance with respiratory precautions
is uncertain.
4. Need for urgent bronchoscopy, such as suspected for­foreign body.
5. Smoke or toxic fume inhalational injury.
6. Intractable cough despite treatment, when cough impairs gas exchange, or in patients at
high risk for barotrauma (eg, recent pneumothorax).
 SUMMARY: 14

1- chronic cough: last more than 8wk

Common causes: upper airway cough syndrome, GERD, asthma,
non-asthmatic bronchitis
2- acute cough: last less than 3wks
Commonest causes: Bronchitis, influenza and common cold
3- Management start by treating the underlying cause
4- if Failure to control cough occur, then refer
REFERANCES 15
THAN
K YOU