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Approach to chronic cough, Immunocompetent patient - Coggle Diagram
Approach to chronic cough
COMMON CAUSES
GERD,
Medication,
Post-viral status,
Allergic Rhinitis,
Medistinal Mass,
TB,
Sarcoid,
Anxiety
Diagnostic Evaluation
Diagnostic Chronic Cough
Algorithm
**
No
Dyspnea at Rest
No
Weight Loss
Yes
Mediastinal Mass, Tuberculosis
No
1 more item...
Yes
Trauma
Yes
1 more item...
NO
1 more item...
ACE Inhibitors Use
Yes
ACEi Induced Chronic Cough
CXR:
A. May be needed if hemoptysis, weight loss, dyspnea or concern of malignancy.
B. Consider in children if hypoxemia or concern of foreign body aspiration.
C. All patients with subacute cough if not deemed postinfectious.
D. All patients with chronic cough (> 8 weeks).
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Laboratory Studeies: Usually not needed for acute cough>
A. Concern for severe illness: CBC, ESR, CRP, Electrolytes.
B. Rapid influenza testing if fevers, myalgia, fatigue
C. Bordetella Pertussis testing if cough > 2 weeks and > 1 of the below:
i. Paroxysms of coughing
ii. Inspiratory "woops:
iii. Posttussive emesis
iv. Apnea in children <1
D. Pulmonary Function testing (PFT)
i. Consider in cases of chronic cough, dyspnea, wheezing.
ii. Can distinguish between restrictive and obstrictive disease.
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Red flags
Sputum production
Hoarsenes
Recurrent penumonia
Dyspnea(excessive)
Smoking history of 20 pack-years
Difficulty breathing
Smoker > 45 years
Hemoptysis
Inability to sleep
Change in mental status
Pleuritic chest pain
Fever-high or prolonged fever.
Night sweats :
Weight loss
Cyanosis
Abnormal respiratory exam-wheeze,crackles,steidor.
Significant systemic illness
Increased work of breathing-RR>20bpm,use of accesory muscles of respiration,inability to speak.
TREATMENT
*Upper Airway Cough syndrome
treat sinusitis
first generation Antihistamines
Avoid Allergens
Asthma
Beta A agonist
inhaled corticosteriods
Oral corticosteriods
leukotriene inhibitors
in severe cases Iv corticosteroids,Mgso4 or intubation
Non Allergen eosinophilic Bronchitis
ICS,ORal corticosteroids for refractory Cases
GERD
PPI
DIET and Lifestyle changes
other causes
investigation of causes and treat accordingly, such as Covid,TB etc.
Immunocompetent patient