Cough and expectoration

zhengcuixia

Concept

A protective reflex act

clean excessive secretion & foreign material

Initiated by miscellaneous stimuli or by voluntary exertion.

The most common respiratory symptom.

Severe cough is a serious clinical problem.

Cough reflex

Afferent inform.from: larynx, trachea, bifurcation of the bronchi

Irritant type: mechanical, chemical, inflammation

Afferent fibers are in the vague nerve

cough center.

Cough reflex

Efferent signals larynx, muscles of diaphragm, chest

wall, abdomen A coordinated series of movement com

plete the cough. Deep inspiration – expiration effort with glottis closed- glottis open abruptly – high volocity of airflow brings out screations from airways.

Influencing factors

Suppressed afferent or efferent nerve function

Failed glottis function (laryngopharynx dis) Diminished muscle force Obstructed airway seen in severe COPD Trachea intubation Chest or abdominal pain limit cough moveme

nt

Causes

Airway stimulation by chemicals & foreign material (smoker & occupational exposure)

Airway infection & inflammation Lung parenchyma disorders Pleural & chest wall disorders Cardiovascular abnormalities Other causes Psychiatric cough

classify

Non production ( dry cough ) Production (with sputum)

Acute Chronic or acute on chronic

Clinical appearance in common diseases

Acute respiratory infection or excesobation of chronic infectious illnesss

Neoplasms Pleural disease Cardiovascular diseases General disease affecting the respiratory system Chronic cough: postualnasal drip syndrom, cough ty

pe asthma, smoker, occupational exposure

Accompanied abnormalities

FeverChest pain Dyspnea & wheezeSputum production

Accompanied CXF abnormalities

Neoplasm

Efussional

interstinal

Mediastinum

Cardiovascular

Pleural or chest wall

complication Cough syncope syndrom Fatigue Fractures due to severe persistent cough Pneumomediastinum, pneumothorax, and

subcutaneous emphysema due to high intrathoracic pressure during cough.

Investigation General condition of the patient Time specialties Voice specialties Productive or not In relation with posture Accompany with chest pain; with dyspnea,

or other complications

Sputum production(expectoration)

Characters: mucoid, tenasious, purulent, blood stained, with special odor, rusty, serous

Volume: Accompanied manifestation

Laboratory examination

Rutine Microbiologic test ( including culture ) Cellular

hemoptysis

Bleeding below the level of the larynx that being coughed out

Degrees: from blood-tinged sputum to massive gross blood, even leading to airway occlusion (apnea ) & shock. The latter is much less seen.

Common causes

Infectious respiratory disease: TB, bronchiactesis, bronchitis

Neoplasm: Cardiovascular disease: MS, PE, PAH,

deformity of blood vessle Other less seen disease leading to hem

optysis.

Clacification

Small Moderate Massive

Differentiating from hematemesis

hemoptysis hematemesis

Coughed up & frothy Vomited without frothy

Preceded by stimulating cough

Preceded nausea, vomiting

Bright red Dark red or brown

alkaline acid

History of coughing Gastric, liver disease

Blood-tinged sputum Tar stool

Mixed with sputum Mixed with food

Anemia variable Blood loss common

Differentiating from upper airway bleeding

Post nasal bleeding Mouth and farynxil membrane bleeding by intenssive investigation and examin

ation

Investigation

If coughed out or vomitted outVolume: how muchTime durationAny accompanied appearances