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1、Cough and expectorationConceptA protective reflex act clean excessive secretion & foreign materialInitiated by miscellaneous stimuli or by voluntary exertion.The most common respiratory symptom.Severe cough is a serious clinical problem.Cough reflexnAfferent inform.from: larynx, trachea, bifurcation
2、 of the bronchin Irritant type: mechanical, chemical, inflammationnAfferent fibers are in the vague nerve cough center.Cough reflexnEfferent signals larynx, muscles of diaphragm, chest wall, abdomen nA coordinated series of movement complete the cough. Deep inspiration expiration effort with glottis
3、 closed- glottis open abruptly high volocity of airflow brings out screations from airways.Influencing factorsnSuppressed afferent or efferent nerve function nFailed glottis function (laryngopharynx dis)nDiminished muscle forcenObstructed airway seen in severe COPDnTrachea intubationnChest or abdomi
4、nal pain limit cough movementCausesnAirway stimulation by chemicals & foreign material (smoker & occupational exposure)nAirway infection & inflammationnLung parenchyma disordersnPleural & chest wall disordersnCardiovascular abnormalitiesnOther causes Psychiatric coughclassifynNon production ( dry co
5、ugh )nProduction (with sputum)nAcute nChronic or acute on chronicClinical appearance in common diseasesnAcute respiratory infection or excesobation of chronic infectious illnesssnNeoplasmsnPleural diseasenCardiovascular diseasesnGeneral disease affecting the respiratory systemnChronic cough: postual
6、nasal drip syndrom, cough type asthma, smoker, occupational exposureAccompanied abnormalitiesnFevernChest pain nDyspnea & wheezenSputum productionAccompanied CXF abnormalitiesnNeoplasmnEfussionalninterstinalnMediastinumnCardiovascularnPleural or chest wallcomplicationnCough syncope syndromnFatiguenF
7、ractures due to severe persistent cough nPneumomediastinum, pneumothorax, and subcutaneous emphysema due to high intrathoracic pressure during cough. InvestigationnGeneral condition of the patientnTime specialtiesnVoice specialtiesnProductive or notnIn relation with posturenAccompany with chest pain
8、; with dyspnea, or other complicationsSputum production(expectoration)nCharacters: mucoid, tenasious, purulent, blood stained, with special odor, rusty, serousnVolume: nAccompanied manifestationLaboratory examinationnRutinenMicrobiologic test ( including culture )nCellularhemoptysisnBleeding below t
9、he level of the larynx that being coughed out nDegrees: from blood-tinged sputum to massive gross blood, even leading to airway occlusion (apnea ) & shock. The latter is much less seen. Common causesnInfectious respiratory disease: TB, bronchiactesis, bronchitisnNeoplasm:nCardiovascular disease: MS,
10、 PE, PAH, deformity of blood vesslenOther less seen disease leading to hemoptysis. ClacificationnSmall nModeratenMassiveDifferentiating from hematemesishemoptysishematemesisCoughed up & frothyVomited without frothyPreceded by stimulating coughPreceded nausea, vomitingBright redDark red or brownalkal
11、ineacidHistory of coughingGastric, liver diseaseBlood-tinged sputumTar stoolMixed with sputumMixed with foodAnemia variableBlood loss commonDifferentiating from upper airway bleedingnPost nasal bleedingnMouth and farynxil membrane bleedingnby intenssive investigation and examinationInvestigationnIf coughed out or vomitted outnVolume: how muchnTime durationnAny accompanied appearances
