Cough and Dyspnea

							                                                                 History

Cough and                                         • Careful history and description of the
                                                    cough including aggravating, alleviating
 Dyspnea                                            and associated symptoms

                                                  • Acute cough: less than 3 weeks

                                                  • Chronic cough: more than 3 weeks




   Physical Examination
                                                          Pathophysiology
     and Diagnostics
• Emphasize upper respiratory tract, chest, and   • What does a cough do?
  cardiovascular system
• Diagnostics                                         – Remove foreign substances
• Chest X-ray                                         – Consists of deep inspiration, increasing lung
• Sinus films                                           volume, muscular contraction against closed
• Sputum sample
                                                        glottis and sudden opening of glottis
• Bronchoscopy
• Spirometry
• PFTs
• Esophageal pH monitoring




     Common causes of
                                                      Differential Diagnosis
         cough:
• Environmental irritants                         •   Lung Cancer
   – Pollutants/Irritants                         •   Asthma
   – Lower respiratory tract problems             •   Chronic Bronchitis
   – Upper respiratory tract problems             •   Nasal / Otic problems
   – Lesions and compression
                                                  •   Reflux
   – Other factors/Psychogenic factors
                                                  •   Psychogenic cough




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               Treatment                                           Dyspnea--Definition

  • First, treat the underlying cause of the                  • Shortness of breath or breathlessness
    cough                                                     • Dyspnea is subjective and therefore is
  • Symptomatic treatment                                       variable among individuals with apparently
  • Stop smoking                                                similar degrees of impairment
  • Humidification                                            • May occur in health individuals
  • Hydration                                                 • Distinct from the specific physical signs
                                                                associated with it
                                                              • Outcome measure in studies of cardiac
                                                                and pulmonary patients




   Mechanisms of Dyspnea                                           Severity of Dyspnea

• experienced in the part of the
  cerebral cortex responsible                                 •   Obesity
  for sensory perception                                      •   Greater respiratory effort
    –requires stimulation of                                  •   Hyperinflation
    the respiratory center as
    occurs with, hypoxia,                                     •   Severe heart disease or pulmonary
    hypercapnia, metabolic                                        hypertension
    acidosis, or exercise




       Measurement of
                                                                  Differential Diagnosis
     Dyspnea: Word Scale
     – 0: No breathlessness except with strenuous             • Nonspecific symptom of any disease
       exercise
                                                                involving the respiratory system
     – 1: Breathlessness when hurrying on the level or
       walking up a slight hill                               • Other system diseases may impact the
     – 2: Walks slower than people of the same age on           respiratory system and cause dyspnea
       the level because of breathlessness or has to stop
       for breath when walking at own pace on the level       • Differential diagnosis
     – 3: Stops for breath after walking about 100 yards or
       a few minutes on the level
     – 4: Too breathless to leave the house or breathless
       when dressing or undressing




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    Differential Diagnosis                             Work-up of Dyspnea

•   Physical Constraints on Breathing             •   Key questions
•   Increased Respiratory Drive                   •   Intermittent dyspnea
•   Ventilatory Muscle Dysfunction                •   Persistent or progressive dyspnea
•   Psychological Disorders                       •   Exercise dyspnea
•   Acute dyspnea may suggest potentially life-   •   Nocturnal dyspnea
    threatening involvement of the heart or
    lungs




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