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COUGH, consider comorbid conditions that may cause cough - Coggle Diagram
COUGH
chronic cough for more than 8 weeks
a range of diseases are associated with chronic cough, majority of people have common clinical presentation - environmental irritants, cough hypersensitivity syndrome is the umbrella term used to describe the excessive stimulation of the normal cough reflex caused by thermal chemical or mechanical stimulation
cigarette is a common exposure, upper airway cough syndrome, asthma, eosinophilic, bronchitis, gastro - oesophageal reflux disease, or use ACE inhibitors
other causes: bronchiectasis, bronchitis, COPD, cough variant asthma, environmental, foreign body aspiration, HF, ILD, lung CA, obstructive sleep apnoea, pertussis, pulmonary tuberculosis, somatic cough syndrome, thoracic aortic aneurysm
Assessment
onset of symptoms, duration of cough, frequency of cough, type of cough, exacerbation factors, diurnal variation, associated symptoms - throat, chest gastrointestinal, smoking history, environmental factors occupational history, family history, RTI, recent travel history
red flags: haemoptysis, hoarseness, peripheral oedema, with weight gain, prominent dyspnoea, especially at rest, smoker aged over 45 years with new cough, change in cough, or coexisting voice disturbance and smokers aged 55-80 years , systemic symptoms such as weight loss, trouble swallowing, vomitting
allergies, asthma, COPD, bronchiectasis, HF, gastroesophageal, sleep apnoea syndrome
Emergency admission
clinical feature of pulmonary embolism or pneumothorax
signs and symptoms of serious, respiraotry rate of 30BPM or more. tachycardia greater than 130 BPM, SPO2 less than 92% on air, systolic less than 90, central cyanosis, peak flow rate less than 33%, altered consciousness, use of accessory muscles of respiration
clinical feature of foreign body aspiration
management of sub acute or chronic cough
emergency admission not needed unless clinical feature of post infectious cough. consider: a trial of inhaled ipratropium, inhaled corticosteroids if quality of life is affected and cough persists despite the use of inhaled ipratropium, short course of oral steroids
chronic cough and clinical features of ACE inhibitor induced cough, asthma, eosinophilic bronchitis, GORD, smoking, upper airway cough syndrome
acute cough less that 3 weeks
commonly caused by viral upper respiratory tract infection such as cold and flu
covid 19, acute bronchitis, tracheobronchitis, pneumonia, acute exacerbations of asthma, COPD, bronchiectasis, pulmonary embolism, pneumothorax
Definition
cough is a reflex response to airway irritation. triggered by stimulation of airway cough receptors, either by irritants or by conditions that cause airway distortion.
sub-acute cough 3-8 weeks
most commonly caused by post infectious cough
management of acute cough
upper respiratory tract infection, usually persists for up to 3 or 4 weeks
advised on self care paracetamol or ibuprofen, over the counter medication or homely remedies
seek medical advise if symptoms worsen rapidly or do not significantly or do not improve in 3-4 weeks or they become systemically unwell
do not offer for the following treatments unless the person has an underlying airway disease: oral or inhaled bronchodilator, oral or inhaled corticosteroids, do not offer mucolytic, do not offer ABX to people who are systemically unwell, or high risk of complications
give advise of ABX are not needed
consider ABX for people identified as high risk of complication as per local ABX prescribing guidelines, give advise on adverse reaction and seek advise from medical professional
covid 19
acute bronchitis or pneumonia
acute exacerbations of asthma, COPD or bronchiectasis
reassess people with an acute cough if their symptoms worsen rapidly or significantly taking into account of alternative diagnosis, any symptoms or signs suggesting more serious illness or condition, such as cardiorespiratory failure or sepsis, previous ABX use, which have led to resistant bacteria
consider comorbid conditions that may cause cough