longer than 8 weeks
not an acute infection
less than 8 weeks
acute infection or post infectious cause
often self limited
rapid coughing with increasingly less lung volue
can lead to emesis (vomiting) due to intensity
severe cough that causes vomiting
associtated with pertussis infection
post nasal drip
secretions ooze down nasopharynx due to nasal or sinus inflammation from allergies or infection
another term for post nasal drip
UACS upper airways cough syndrome
gastric contents can reflux into esophagus and cause cough with or without aspiration into lungs
vocal cord erythema may suggest...
eosinophils infiltrate airways and cause cough
can detect in sputum
treat with inhaled steroids
how is eosinophilic bronchitis UNLIKE asthma...
no airway hypersensitivity with EB and no abnormal breathing tests
medullary cough center
nucleus tractus solitarius
connects afferent impulses to efferent nerves
cough reflex starting in larynx, trachea, bronchi, ear canal, pleura, stomach
vagus nerve --> cough center medulla-->vagus nerve --> larynx and tracheobronchial tree muscles
cough reflex starting in nose and paranasal sinus
trigeminal nerve --> medullary cough center --> phrenic/intercostal/lumbar nerves --> diaphragm, intercostal, abdominal, and lumbar muscles
cough reflex starting in pharynx
glossopharyngeal nerve --> medullary cough center --> trigeminal, facial, hypoglossal, accessory nerves --> upper airways and accessory muscles
cough reflex starting in pericardium, diaphragm
phrenic nerve --> medullary cough center --> trigeminal, facial, hypoglossal, and accessory nerves --> upper airways and accessory muscles
in expiration the glottis______
equal pressure point theory
pressure is equal inside and outside the airway (high lung volume)--> compression occurs and mucus can be moved
irritation of external auditory canal
hurts arnolds nerve - the auricular branch of the vagus nerve
what type of drugs can cause cough?
treat chronic rhinitis...
nasal steroids and antihistimine-decongestent combo
use first generation antihis. because its more effective than 2nd
if patients dont respond to steroids/antihis/decongestant, next?
look for asthma using methacholine challene
if it didnt respond to steroids/antihis, and negative methacholine challenge (isnt asthma, ), thennn?
check for gerd with 24 hr pH probe
treat gerd with proton pump inhibitors (omeprazole or prevacid) at least 8 weeks
order of impiric treatment when cough has no appaarent etiology
1) upper airway cough syndrom - treat w nasal steroids and antihistimine/decongestant
2) asthma - using methacholine challenge
3) gerd - proton pump inhibiotors (omeprazole or prevacid)
4) bronchoscopy - --> reevaluate and repeat a previor approach
alarm symptoms to check for
short of breath
fevers, night sweats or weightloss
what could feversm night sweats, weightloss indicate?
chronic infection (TB) cancer, or chronic inflammatory disease like vasculitis
when the xray is normal, a cough is most likely due to
UACs, PND, asthma, or GERD
for kids, acute vs chronic times?
less or greater than 2-3 weeks
coughing blood from lower respiratory tract (below vocal cords)
vomit blood from GI tract