Cough and expectoration
description
Transcript of Cough and expectoration
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