C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical...
-
Upload
destinee-sides -
Category
Documents
-
view
222 -
download
6
Transcript of C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical...
![Page 1: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/1.jpg)
COUGH AND HEMOPTYSISLevy Liran, M.D.Institute of PulmonologyHadassah-Hebrew University Medical CenterJerusalem, Israel
![Page 2: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/2.jpg)
DEFINITION
‘Explosive expiration that provides a normal protective mechanism for clearing the tracheobronchial tree free of secretions and foreign material.’
![Page 3: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/3.jpg)
COMPLICATIONS OF COUGH
Chest and abdominal wall soreness
Exhaustion
Urinary incontinence
Cough syncope
Hernias, Uterine prolapse
Cough fractures
![Page 4: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/4.jpg)
COUGH REFLEX
![Page 5: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/5.jpg)
ETIOLOGYPost nasal drip
Laryngitis, tumor, whooping cough, croup
Tracheitis
Bronchitis, COPD, Asthma, Bronchial Carcinoma
TB, Pneumonia, Bronchiectasis, Pulmonary Oedema, Interstitial Fibrosis
![Page 6: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/6.jpg)
DIFFERENTIAL DIAGNOSIS
Acute- < 3 weeksURTI- common cold, sinusitis, pertussisAspirationInhalation of chemical/smoke
Subacute- 3 to 8 weeks Post infectious (pertussis, post viral)
Chronic- > 8 weeksMetabolic/MuladInflammatory asthma, eosinophilic bronchitis, COPD, bronchiectasis,
PND, ILD, pneumoconiosisInfectious TB, mycobacteria, fungus, atypical bacteriaNeoplastic mass involving tracheo-bronchial treeDrugs ACE inhibitors Vascullar pulmonary congestion, PEToxin/Chemical GERD, smoking
![Page 7: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/7.jpg)
APPROACH TO CHRONIC COUGH
History
• Circumstances surrounding onset of cough• Sputum – color, smell• Type• Hemoptysis • Duration• Variation- posture, time• Precipitating factors & what makes it better• Associated symptoms
![Page 8: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/8.jpg)
APPROACH TO CHRONIC COUGH
Physical Examonation
Full cardio-pulmonary examination: InspectionPalpationPercussionAuscultation
Investigations:
Chest X RaySputum cytology & microbiologyPumonary Function Tests (PFT)High Resolution CT (HRCT)Fibreoptic bronchoscopyEchoPH metriaSwallow studySinus imaging
![Page 9: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/9.jpg)
MANAGEMENT OF COUGH > 8 WEEKSCough > 8 weeks
ACEI Smoking
Stop
Cough persists
CXR
Normal
Post nasal drip
Asthma
Eosinophilic bronchitis
GERD
Abnormal
Evaluate with: HRCTSputum testingBronchoscopyEchoPH metriaSwallow studySinus imaging
![Page 10: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/10.jpg)
TREATMENT Acute- < 3 weeks
or Subacute- 3 to 8
weeks
Treatment Diagnosis
If CXR normal target most common causes and treat empircally
stop ACE inhibitors
Anti acids / PPI / Life styleICS
GERD
antihistamine, steroidal nasal spray
PND
/ bronchodilators Asthma / Eeosinophilic bronchitis /COPD
Treatment Diagnosis
Cough suppression:• Narcotics (codeine or
hydrocodone)• Not to be used in productive
cough
Infectious / aspiration / inhalation
90% of diagnoses
of chronic cough
with normal CXR
Treatment Diagnosis
antibiotic / anti fungal / anti Tb
Infectious
anti-coagulation PE
airway hygiene, antibiotics
Bronchiectasis
symptomatic / systemis steroids
ILD / Pneumoconiosis
radiotherapy / chemotherapy
Cancer
treat CHF Pulmonary congestion
Fail to respond merits further investigation
Chronic- > 8 weeks
![Page 11: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/11.jpg)
HEMOPTYSIS
Expectoration of blood from the respiratory tract
Massive hemoptysis- 100-600ml per day
![Page 12: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/12.jpg)
ETIOLOGY
Tracheo bronchial
Pulmonary parenchyma
Primary Vascular
Miscellaneous
![Page 13: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/13.jpg)
ANATOMYBronchial artery
Pulmonary artery
Pulmonary vein
![Page 14: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/14.jpg)
DIFFERENTIAL DIAGNOSISMost common cause is infection of
medium-sized airways:• Western world viral/bacterial
• World wide TB
![Page 15: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/15.jpg)
APROACH TO PATIENT WITH HEMOPTYSIS
![Page 16: C OUGH AND H EMOPTYSIS Levy Liran, M.D. Institute of Pulmonology Hadassah-Hebrew University Medical Center Jerusalem, Israel.](https://reader034.fdocuments.net/reader034/viewer/2022051417/56649c9b5503460f949592f8/html5/thumbnails/16.jpg)
TREATMENT
Blood streaking or small amounts of bloodEstablish the diagnosisFollow up
Massive Hemoptysis *Proper positioning
*Endotracheal intubation (single lung) *Balloon Catheter
*Bronchoscopy with laser phototherapy/ electrocautery *Bronchial artery embolization *Surgery