Scribd
Upload
98 views

Chronic Cough: IAP UG Teaching Slides 2015-16

This document discusses chronic cough, including its definition, physiology, etiology, diagnosis, and treatment. Chronic cough is defined as cough lasting more than 3 weeks. The cough reflex is a defensive mechanism involving four phases - inspiratory, contractive, compressive, and expulsive. Common causes of chronic cough vary by age, and may include postnasal drip, asthma, GERD, cystic fibrosis, and foreign body aspiration. Diagnosis involves taking a thorough history, physical exam, chest x-ray, pulmonary function tests, bronchoscopy, and GERD testing such as a pH probe. Case scenarios provide examples of diagnostic approaches for different patients presenting with chronic cough.

Uploaded by

Anmol Kudal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
98 views

Chronic Cough: IAP UG Teaching Slides 2015-16

This document discusses chronic cough, including its definition, physiology, etiology, diagnosis, and treatment. Chronic cough is defined as cough lasting more than 3 weeks. The cough reflex is a defensive mechanism involving four phases - inspiratory, contractive, compressive, and expulsive. Common causes of chronic cough vary by age, and may include postnasal drip, asthma, GERD, cystic fibrosis, and foreign body aspiration. Diagnosis involves taking a thorough history, physical exam, chest x-ray, pulmonary function tests, bronchoscopy, and GERD testing such as a pH probe. Case scenarios provide examples of diagnostic approaches for different patients presenting with chronic cough.

Uploaded by

Anmol Kudal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 33

CHRONIC COUGH

IAP UG Teaching slides 2015-16 1


WHAT IS COUGH?

         COUGH REFLEX IS A DEFENSIVE MECHANISM
    Four Phases TYPES
• Inspiratory • Acute
• Contractive • Chronic
• Compressive
• Expulsive

IAP UG Teaching slides 2015-16 2


WHAT IS CHRONIC COUGH?

Chronic cough is cough of more than
    
3 weeks duration 

IAP UG Teaching slides 2015-16 3


PHYSIOLOGY OF COUGH REFLEX

STIMULANTS

     •IRRITANTS
•SECRETIONS
•FOREIGN BODIES

ARC CONSISTS

•RECEPTORS
•AFFERENTS
•EFFERENTS

IAP UG Teaching slides 2015-16 4


PHYSIOLOGY OF COUGH REFLEX

Receptors Afferents
• Pharynx & Larynx • Cr N. IX, X And V
    
• Bronchi • C 2, 3 & 4
• Esophagus & Stomach
Efferent
• Pleura &Diaphragm
• Cranial Nerve X
• Middle Ear
• C 3,4 & 5
Cough Centre
• Medulla

IAP UG Teaching slides 2015-16 5


ETIOLOGY OF CHRONIC COUGH
0 – 18 MONTHS

IAP UG Teaching slides 2015-16 6


ETIOLOGY OF CHRONIC COUGH
18 MONTHS – 6YEARS

IAP UG Teaching slides 2015-16 7 7


ETIOLOGY OF CHRONIC COUGH
 6YEARS – 16 YEARS

IAP UG Teaching slides 2015-16 8 8


CHRONIC COUGH DIAGNOSITIC PROTOCOL

HISTORY INITIAL EVALN
PHYSICAL EXAM

CXR
PULM FUNCT TESTS

BRONCHOSCOPY

GERD TESTING

IAP UG Teaching slides 2015-16 9 9


CHRONIC COUGH DIAGNOSITIC PROTOCOL

I   EVALUATION     PULMONARY FUNCTION TESTS
• HISTORY •SPIROMETRY

• PHYSICAL EXAM •MIC

• CHEST X‐RAY

IAP UG Teaching slides 2015-16 10 10


CHRONIC COUGH DIAGNOSITIC PROTOCOL

BRONCHOSCOPY GERD TESTING
• pH Probe
•Upper GI Series
OTHERS •Endoscopy
• Laboratory
•CT Scan
•Other Consults

IAP UG Teaching slides 2015-16 11 11


CHRONIC COUGH
DIAGNOSITIC PROTOCOL

COUGH IN A SEEMINGLY COUGH IN A 
 WELLCHILD SICK CHILD

IAP UG Teaching slides 2015-16 12 12


HISTORY

• Family history
• Stridor
• Atopy
• Choking
• Relief with 
bronchodilators • Feeding problems
• Exposure to smoke • H/o contact
• Serious pulmonary 
infections
• Sino‐pulmonary 
infections
• Skin infections
IAP UG Teaching slides 2015-16 13 13
IAP UG Teaching slides 2015-16 14 14
HISTORY

Cough quality Cough timing
• Seal like • With feeding
• Canada goose  • Nocturnal
• Staccato • With sleep, laughing
• Paroxysmal bouts • Exercise
• With sonorous 
breathing

IAP UG Teaching slides 2015-16 15 15


 HISTORY

Cough Duration Cough Productivity

•Persistent •Productive

•Episodic •Nonproductive

•Blood stained

IAP UG Teaching slides 2015-16 16 16


PHYSICAL EXAM

• Failure to thrive • Cyanosis
• Malabsorption • Clubbing
• Signs of atopy • Chest deformity
• Sinuses
• CVS exam

IAP UG Teaching slides 2015-16 17 17


CHEST X‐RAY

• LUNGS
• CVS

IAP UG Teaching slides 2015-16 18 18


TOTAL ATELECTASIS OF RIGHT LUNG

IAP UG Teaching slides 2015-16 19 19


RIGHT MAIN BRONCHUS SHOWS 
A METAL FOREIGN BODY

IAP UG Teaching slides 2015-16 20


PULMONARY FUNCTION TESTS

• FEV1/FVC
• MIC

IAP UG Teaching slides 2015-16 21 21


BRONCHOSCOPY

Procedures Indications
• Remove F.B • Cough 8 weeks or more
• Evaluate anatomy • Suspicion of F.B or 
obstruction
• Collect specimen
• Failure to make a 
diagnosis

IAP UG Teaching slides 2015-16 22 22


IAP UG Teaching slides 2015-16 23 23
IAP UG Teaching slides 2015-16 24 24
GERD TESTS
TESTS
• PH PROBE
• UPPER GI ENDOSCOPY
• OESOPHAGOSCOPY

IAP UG Teaching slides 2015-16 25 25


OTHER TESTS

•Laboratory Tests

•C.T.Scan

•Other Consults

IAP UG Teaching slides 2015-16 26 26


APPROACH TO A CHILD WITH
CHRONIC COUGH ‐ CASE SCENARIOS

• 7 years boy
• Persistent cough
• Cough quality
• Family H/o asthma
• No clubbing
• Chest deformity+
• Atopy+
• Lungs clear

IAP UG Teaching slides 2015-16 27 27


APPROACH TO A CHILD WITH CHRONIC 
COUGH – CASE SCENARIOS
LEARNING POINTS

Suspect Cough Variant Asthma:
• Family H/o asthma
• Triggers
• H/o or signs of atopy
• Response to bronchodilators
• R/o other causes

IAP UG Teaching slides 2015-16 28 28


APPROACH TO A CHILD WITH
CHRONIC COUGH ‐ CASE SCENARIOS

• 1 year girl
• 7 kg
• Persistent cough
• Nocturnal
• Vomits after feeds
• Fails to respond to 
• Bronchodilators
• Lungs clear

IAP UG Teaching slides 2015-16 29 29


APPROACH TO A CHILD WITH CHRONIC 
COUGH – CASE SCENARIOS
LEARNING POINTS
Suspect GERD:
• Infant 
• Failure to thrive
• Feeding problems
• Vomiting
• Nocturnal cough
• Failure to respond to
• Bronchodilators

IAP UG Teaching slides 2015-16 30 30


APPROACH TO A CHILD WITH 
CHRONIC COUGH ‐ CASE SCENARIOS

• 9 months boy
• Persistent cough
• H/o ear & skin infection
• Hospitalized 4 times till now
• Failure to thrive
• Chest deformity
• Clubbing

IAP UG Teaching slides 2015-16 31 31


APPROACH TO A CHILD WITH CHRONIC 
COUGH – CASE SCENARIOS
LEARNING POINTS

    Suspect altered pulmonary defenses:
•Rec respiratory infection
•Serious pulmonary infection
•Failure to thrive
•Multiple sites sepsis
•Family history

IAP UG Teaching slides 2015-16 32 32


Thank You

IAP UG Teaching slides 2015-16 33 33

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy