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Management of acute and chronic cough PowerPoint Presentation

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Description : This medical presentation titled ""Management of acute and chronic cough"" provides us important information on management of acute and chronic cough.

Tags : Allergy, Management, acute, chronic cough, history, symptoms, Haemoptysis,Breathlessness, Fever, Chest pain, Weight loss, Evidence of vocal cord palsy, History of foreign body inhalation, Neoplasms, Infection, TB, Acute allergy, anaphylaxis, Interstitial lung disease, Bronchoscopy, High resolution CT

Published on : Apr 24, 2021 | Views : 4431 | Downloads : 39

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Management of acute and chronic cough Dr Veronica White MD FRCP Clinical Lead, TB service Barts Health NHS Trust
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Definition “Cough is a forced expulsive manoeuvre against a closed glottis and which is associated with a characteristic sound”
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Acute and chronic cough Acute cough: lasts < 3 weeks Chronic cough: lasts > 8 weeks ?3-8 weeks – difficult to define
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Acute cough Commonest new presentation to primary care Most commonly associated with viral URTI Normally benign and self-limiting Commonest symptom associated with acute exacerbations and hospitalisations with asthma and COPD
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Management In general – advice only Little evidence of pharmacological benefit from over the counter preparations “Honey and lemon” best home remedy(!) Voluntary suppression of cough may be sufficient to reduce symptoms Opiate antitussives not recommended
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Management Worrying history/symptoms: Haemoptysis Breathlessness Fever Chest pain Weight loss Evidence of vocal cord palsy History of foreign body inhalation
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Common serious conditions associated with isolated cough Neoplasms Infection e.g. TB Foreign body inhalation Acute allergy – anaphylaxis Interstitial lung disease
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Chronic cough
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Taking a history Age and sex – more common in middle aged women Smoking Occupation/hobbies/pets Family history
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Taking a history Characteristics: Onset and duration; ?diurnal variation; ?coughing on phonation Relation to infection Sputum Severe coughing spasms/paroxysms Incontinence Chemical triggers; posture; food
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Taking a history Past medical history Asthma, eosinophilic bronchitis COPD Bronchiectasis Lung cancer Pertussis infection; atopic disease Cardiovascular disease Autoimmune disease
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Baseline investigations Primary care Chest X-ray Spirometry Secondary care Bronchoscopy High resolution CT
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What I tell patients…. Five commonest cause of chronic cough with normal CXR Asthma Hayfever/post nasal drip GORD Recent URTI Smoking
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Management Asthma – treat as per BTS guidelines GORD – 8 weeks of high dose PPI Upper airways disease – antihistamine, nasal spray
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Management Also: Smoking – STOP! Post viral cough - ?low dose steroid inhaler Treat these empirically first
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Other diagnosis COPD Infection – bacterial, TB Interstitial lung disease including sarcoidosis Bronchiectasis Drugs – (ACE) inhibitors Foreign body
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Intractable cough Can lead to musculoskeletal chest pain, cough rib fracture, urinary incontinence. Cough syncope has also been described where an individual collapses after a severe fit of coughing.
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Intractable cough Aggressive treatment: inhaled steroid high dose oral steroids codeine linctus – not in simple coughs Patients with cough associated with an underlying malignancy - diamorphine and morphine - help both the pain and distress
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Specialist cough clinics Selective diagnostics and empirical trials of treatment – cost effective Refer to specialist clinic when empirical treatment has failed Systemic, cost effective approach Management algorithms improve outcome
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Specialist investigations Bronchial provocation testing Oesophageal testing Sinus imaging Fibreoptic laryngoscopy Cough provocation test
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Summary Most acute cough is benign, but look for additional, worrying symptoms Chronic cough: take a good history; baseline investigations Treat presumed/probable underlying cause Refer to specialist clinic if necessary
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Red flags Haemoptysis Breathlessness Fever Chest pain Weight loss Evidence of vocal cord palsy History of foreign body inhalation
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If CXR abnormal Refer urgently to relevant service: 2 WW lung cancer ILD clinic – Dr Gavin Thomas TB clinic – Dr Veronica White, Max Caplin clinic, Mile End Oncology
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Making a diagnosis Cough +/- haemoptysis Fever Night sweats Weight loss
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Making a diagnosis Blood tests – not specific X-rays Samples – sputum, pus, biopsy Scans such as CT and MRI
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Baseline investigations Sputum or pus for AFB CXR
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However….
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Summary Symptoms can be insidious Ask about systemic symptoms – often forgotten (by patient and medics) Multi- organ disease; TB can occur at any site Samples/biopsies are crucial – send for AFB
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In Summary If in doubt, refer. Max Caplin Clinic, Mile End Hospital Fax: 0208 1214185 TBenquires@bartshealth.nhs.uk
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