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Approaches to Chronic Cough in Adults (Non-infective (Chronic Bronchitis (…
Approaches to Chronic Cough in Adults
Non-infective
Chronic Bronchitis
:check: HX: Smoking
Diagnosis by exclusion
, 3 or more months over 2 years
:silhouette: PE: clear sputum unless LRTI/URTI
Cancer
:check: HX: weight loss, loss of appetite; (late) cough, hemoptysis, chest pain, dyspnea, hoarseness, , fullness in head (SVC syndrome), bone pain,
haemoptysis
:silhouette: PE: dilated neck veins, Horner's Syndrome, wasting of hand muscles
Interstitial Lung Disease
:silhouette: PE: fine crepitus, diminished breath sounds
:mag: Inv: abnormal CXR, restrictive spirometry results
:check: HX: dyspnea,
non productive cough
Upper Airway Cough Syndrome
:silhouette: cobblestone appearance to nasopharyngeal mucosa. presence of secretions in nasopharynx, nasal polyps
:check: HX: Past history of sinusitis, (allergic/viral) rhinitis;
frequent nasal discharge, sensation of liquid to the back of the throat, throat clearing
:red_flag: may be silent
COPD
:umbrella: emphysema, chronic bronchitis, chronic obstructive asthma
:check: HX:
progressive dyspnea
, chronic cough, sputum production, fatigue, wheezing, fatigue
:silhouette: PE: use of accessory muscles, barrel chest
Asthma
:mag: Inv: reversible airflow obstruction, hyperreactivity to bronchoprovocation; post-glucocorticoid therapy conf..
Eosiniophilic bronchitis
:check: HX: FHX of asthma, seasonal, worsen to environmental agents, follow URTI, after beta blocker/NSAID therapy
Dry Cough
, worse in morning
:silhouette: episodic (high pitch) wheezing (on inhalation) and dyspnea; atopy; eczema, allergic rhinitis/conjunctivitis
Nonasthmatic Eosinophiplic Bronchitis
Atopic tendencies, hypereosinophilia without airway hyperresponsiveness.
non productive
Non-Respiratory
Laryngopharyngeal reflux
:red_flag: heart burn as DDX b/w LPR and GERD
:mag: Inv: Direct Laryngoscope with arytenoid erythema, edema and pharyngeal inflammation
:check: HX: dysphonia, chronic cough, dysphagia, nonproductive throat clearing
GERD
:check: HX: hearburn, sourtaste in mouth (postprandial), dysphagia (chronic), chest pain radiating to back/neck/jaw/arms, hypersalivation, globus sensation, odynophagia, nausea, burping, lying down
:mag: Inv: Barium swallow, pH monitor, esophagoscopy
Pharmacological
ACE Inhibitors
Within one week to six months, tickling, scratchy, itchy, women, chinese, no airflow obstruction
Infective
Post Infectious Cough Syndrome
:check: HX: prior URTI, persisting cough
Treat with corticosteroid and reassurance, cough suppressants
Recurrent Infections
Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordetella pertussis
:mag: Inv: Bronchoscopic culture, sputum culture
Bronchiectasis
:check: HX: long standing daily cough, copious sputum, pleuritic chest pain, fatigue, urinary incontinence,
haemoptysis
:silhouette: PE: clubbing, coarse crepitation, crackles (75%), wheezing (25%)
aetiologies: immunodeficiency, CF, rheumatic disease, COPD
focal: Post pneumonia/TB, aspiration, obstruction
:mag: Inv: CBC, Ig, CFTR PCR, sputum spear; low FEV1, low FEV1/FVC
TB
:check: HX: fever, night sweats, weight loss, travel hx, contact,
haemoptysis
:silhouette: PE: Upper lobe fibrosis from dullness and tracheal deviation, supraclavicular adenopathy
:red_flag: addicts, poor nutrition, HIV.AIDS, TravelHX
Bordatella pertussis
:check: HX: pertussis vaccination and booster, >65 YO
:silhouette: PE: inspiratory whooping sound, coughing paroxysms, post-tussive emesis
Habitual/Psychogenic
Anxiety, Depression, Domestic Violence