APPROACH TO COUGH.pptx

cough -definition,pathophysiology,types of cough,causes of cough and treatment of cough

1. APPROACH TO COUGH Dr.G.VENKATA RAMANA MBBS DNB FAMILYMEDICINE

2. Dry cough Pleural disorders, diseases of interstitium , mediastinal lesions Productive cough Suppurative lung disease, airway diseases Brassy/Gander cough Metallic sound due to compression of trachea by intrathoracic space occupying lesions or aortic aneurysms also known as leopards growl Bovine cough Loss of expulsive nature as in a tumor pressing on the recurrent laryngeal nerve Paroxysmal cough Whooping cough, chronic bronchitis, foreign body, bronchial asthma Barking cough Involvement of epiglottis, croup ( laryngotracheobronchitis ), hysteria Spluttering cough Tracheoesophageal fistula, cough while swallowing Hacking cough Heavy smokers, chronic pharyngitis or laryngitis Otogenic cough Due to stimulation of Arnold’s nerve in the external auditory meatus (impacted wax/foreign body)

3. CLASSIFICATION Based on etiology: The etiology can be classified into respiratory causes and non-respiratory causes Based on duration of cough: A cute (less than 3 weeks) S ubacute (3-8 weeks) C hronic (more than 8 weeks) Based on expectoration : It is also classified into productive or dry cough depending on the presence or absence of expectoration, respectively

4. Cough syncope ( Post- tussive syncope ) It is due to raised intrathoracic pressure, which reduces venous return to the heart, thereby diminishing cardiac output, resulting in cerebral hypoperfusion and syncope Nocturnal cough It is present in the following conditions: 1. Chronic bronchitis 2. Left sided failure 3. Bronchial asthma 4. Aspiration 5. Tropical eosinophilia 6. Post-nasal drip. Drug induced cough is present in drug therapy with ACE inhibitors

5. SPUTUM Normal Quantity 10–15 mL/24 hour Bronchorrhea Production of more than 100 mL/day Conditions causing bronchorrhea Bronchiectasis Lung abscess Empyema rupturing into the bronchus Necrotising pneumonia Bronchoalveolar carcinoma Organophosphorus poisoning Quality

6. QUALITY Mucoid : Chronic bronchitis, bronchial asthma Mucopurulent : Infections Purulent: Lung abscess, bronchiectasis Green or yellow coloured thick sputum : indicates bacterial infections The green colour to sputum is imparted by the enzyme myeloperoxidase ( verdoperoxidase ) Rust-colored purulent sputum: Pneumococcal pneumonia Red Currant-jelly and sticky sputum : Klebsiella pneumoniae Blood-tinged foamy sputum : Pulmonary edema (pink frothy) Greenish: Pseudomonas Granules—yellow/ black: Actinomycosis Anchovy sauce (brown): Amoebic abscess rupturing into lung Black ( melanoptysis ) : Carbon particles discolor the sputum gray (as in cigarette smokers) or black (as in coal miners or with smoke inhalation) ODOUR Foul smelling sputum: Anaerobic infection seen in lung abscess, bronchiectasis