textbook readings pulmonology- clin med

clin med

cough results from

stimulation of mechanical or chemical afferent nerve receptors in the bronchial tree

effective cough depends on

an intact afferent-efferent reflex arc, adequate expiratory and chest wall muscle strength, and normal mucociliary production and clearance

pts with neuromuscular disorders and kyphosis can have a

weak, ineffective cough that may predispose them to respiratory complications

cough peak flow may be a

useful clinical measurement to assess the risk for recurrent pulmonary infection in pts with ineffective cough

acute cough

less than 3 weeks

persistent cough

3-8 weeks

chronic cough

more than 8 weeks

postinfectious cough lasting 3-8 weeks

subacute cough

most acute cough syndromes are due to

viral respiratory tract infections

those with an acute cough will also have features of an infection such as

fever, nasal congestion, sore throat

dyspnea at rest or with exertion may reflect

a more serious condition and oxygenation, airflow, and pulmonary parenchymal disease (CXR) should be assessed/obtained

loss of smell or taste accompanying a new cough illness is

specific but not sensitive for COVID-19 infection

what rules in/rules out pertussis in adult pts

rules in

• presence of posttussive emesis or inspiratory whoop

rules out

• absence of paroxysmal cough and presence of fever

uncommon causes of acute cough should be suspected in those with

HF, hay fever, and those with occupational risk factors

cough d/t acute respiratory tract infection resolves within

3 weeks in more than 90% of pts

when should pertussis be considered

in adolescents and adults who have persistent/severe cough lasting more than 3 weeks

who havent been adequately boosted with Tdap

who have been exposed to a person with pertussis

in geographic areas where the prevalence of pertussis approaches

most cases of persistent and chronic cough are related to

postnasal drip, cough-variant asthma, GERD

ddx for acute cough

acute respiratory tract infection, COVID-19, asthma, allergic rhinitis, HF, ACE Inhibitor therapy

causes of persistent cough

environmental exposure, occupational exposure, pertussis, postnasal drip, asthma, GERD, COPD, chronic aspiration, bronchiectasis, nonasthmatic eosinophilic bronchitis, TB, ILD, bronchogenic carcinoma

common cause of cough in pts older than 50 y/o who have smoked cigarettes

COPD

when to admit those with a cough

pts at high risk for TB for whom adherence to respiratory precautions is uncertain

need for urgent bronchoscopy

smoke or toxic fume inhalation injury

gas exchange is impaired by cough

pts at high risk for barotrauma

persistent cough can be due to

somatic cough syndrome, tic cough, vocal fold dysfunction

somatic cough syndrome

have a dry cough with less nocturnal coughing

chronic cough in association with a globus sensation and a gag reflex when supine may be caused by

an elongated uvula

other causes of chronic cough

OSA

tonsillar or uvular enlargement

environmental fungi

radiotherapy to chest

chemotherapy

nitrofurantoin

cough in the immunocompromised pt

concern for TB, fungi, CMV, varicella, herpesvirus, PJP

when to refer those with a cough

failure to control persistent/chronic cough following empiric treatment trials

pts w/ recurrent symptoms should be referred to otolaryngologist, pulmonologist, or gastroenterologist