Cough

Acute Cough: <3 wk

• • common cold

  • allergic rhinitis

  • Postnasal drip

  • acute bacterial sinusitis

  • COPD

  • Foreign body

  • aspiration

  • inhalation of irritative substances

  • PE

Subacute cough: 3 - 8 wks

• • Post-inf

  • Pertusis

  • asthma

  • subacute bacterial sinusitis

  • mycoplasma inf

Chronic cough: >8 wk

• • postnasal drip

  • GERD

  • asthma - cough may be the sole sx.

  • bronchitis

  • ACE-I

  • Chronic bacterial sinusitis

  • AIDS

  • Lung inf

  • TB

  • bronchiectasis

  • cig. smoking

  • Bronchogenic CA, especially in the presence of smoking hx.

  • Endobronchial compressing masses

  • carcinoid

  • CHF

  • Aortic aneurysm

  • EAC or TM irritation (CN X supply)

Cough reflex:

• • Afferent pathways: V, IX, superior laryngeal, X

  • Efferent pathways: recurrent laryngeal n (causes closure of glottis), phrenic, spinal

History:

• • Duration, mode of onset.

    • How long? Upto 3 wks or more?

    • Daily cough and expectoration of approx 2 tbsp sputum on most days, for at least 3 mo of 2 consecutive years - chronic bronchitis.

  • Character of cough.

    • Dry or productive? sputum characteristics (qty, color, odor, hemoptysis?) - etiology?

    • Hacking, short, dry, spasmodic, paroxysms with whoops

    • Change in character

  • Is the patient smoking, on ACE-I?

  • Preceding URI - post-infectious; post-nasal drip (upper airway cough syndrome); pertussis; cough variant asthma; GERD?

  • Precipitating or aggravating factors

  • Relieving factors

  • Accompanying sx:

    • Fever, chills, wt. loss, nightsweats, sorethroat, runny nose, SOB, wheezing, chest pain, dysphagia, hoarseness, n/v/d; syncope

  • SH:

    • H/o cig smoking, EtOH, drugs, occupational exposure, pets, birds, allergies, exposure to TB, HIV.

    • Travel to Southwest US - Coccidioidomycosis; travel to Central US - Histoplasmosis; Asian/African countries: TB

  • CXR, TB test, Fiber optic bronch +/- BAL, and/or Bx, PFTs, HRCT, intubations, hospitalizations, sputum (gram stain) and cytology?.

    • If asthma is considered and the Pt's PEFR are normal, consider bronchoprovacation testing with methacholine or cold-air inhalation.

    • >3% eosinophils seen on staining of induced sputum in a Pt. without h/o asthma suggests eosinophilic bronchitis.

    • HRCT is the procedure of choice for confirming the dx of bronchiectasis.