Cough and

Hemoptysis

DR.Bilal Natiq Nuaman,MD C.A.B.M. ,F.I.B.M.S. ,D.I.M. ,M.B.Ch.B. 2016-2017

Cough • Definition: ‘A Cough is a forced expulsive manoeuvre,

usually against a closed glottis and which is associated with a characteristic sound’

It is caused by stimulation of sensory nerves

in the mucosa of the pharynx, larynx, trachea bronchi.

and

Cough is the single most common respiratory complaint for which patients seek care

Classification of Cough • Acute Cough = < 3 Weeks Duration

• Subacute Cough 3-8 Weeks Duration

• Chronic Cough > 8 Weeks Duration

Acute Cough <3 weeks Differential Diagnosis(CAUSES) • Upper Respiratory Tract infections(URTI):

Viral syndromes, sinusitis , pertussis • URTI triggering exacerbations of Chronic Lung

Disease eg Asthma/ COPD • Pneumonia • Left Ventricular Heart Failure • Foreign Body Aspiration

COPD 1. Chronic Bronchitis : defined clinically as Productive cough (cough with sputum

expectoration ) in a chronic smoker for at least 3 months a year during a period of 2 consecutive years with exclusion of other causes of productive cough .

2. Emphysema : defined pathologically as an abnormal permanent

enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls without obvious fibrosis.

Post nasal drip PND(upper airway cough syndrome UACS )

• Gastroesophageal reflux disease (GERD) refers to

acid reflux, or backward flow, of stomach acid and other contents into the esophagus. If stomach acid moves backward up the esophagus, reflexes result in spasm of the airways that can cause shortness of breath and coughing. In some individuals, no sensation of heartburn is felt and their only symptom may be cough. Diagnostic tests: • 24-hour esophageal pH probe (best) • OGD – Esophagogastrodudenoscope

Therapeutic trial: gastric acid suppression with proton pump inhibitor (e.g. omeprazole) for ≥ 2 months, combined with diet and lifestyle modification

History1-Onset and Duration :Acute : < 3weeks Subacute :3-8 weeks Chronic : > 8 weeks

2-Character : Bovine with Hoarsness----Left recurrent laryngeal nerve palsy

causing left vocal cord paralysis due to CA LungBarking with Hoarsness and Stridor -----Acute Epiglottitis,

Laryngitis , CA Larynx Wheezy ------COPD , Asthma

2-Amount of Sputum How much sputum is coughed up each day ? Is it a small

(a teaspoonful) or large (a teacupful) amount? Bronchiectasis-------- a long history of large amount of purulent

sputum to be coughed up mainly in morning on changing posture .

Pulmonary Oedema ------ Large volumes of watery frothy sputum with a pink tinge in an acutely dyspnic patient .

Hemoptysis

• Coughing up blood, irrespective of the amount, is an alarming symptom and patients nearly always seek medical advice. A history should be taken to establish that it is true hemoptysisand not hematemesis, or gum or nose bleeding.

• Hemoptysis must always until this is excluded .

be assumed to have a serious cause

• It

Massive Hemoptysis: is coughing of about 600ml blood/24 h

History• A history of repeated small haemoptysis is highly suggestive of

bronchial carcinoma.Fever, night sweats and weight loss suggest tuberculosis.•

• Pneumococcal pneumonia often causes 'rusty'-colouredsputum but can cause frank haemoptysis, as can all suppurative pneumonic infections including lung abscess.

• Bronchiectasis can cause catastrophic bronchialhaemorrhage,

• pulmonary thromboembolism is a common cause ofhaemoptysis and should always be considered.

Thank you