CLINICAL APPROACH TO A PATIENT WITH COUGH… HISTORY TAKING

Protective mechanism Seeks MEDICAL CARE Discomfort from cough itself Interference with normal lifestyle Concern for cause of cough

HISTORY 1.Onset & Duration Acute :- URTI; pneumonia; aspiration; foreign body; pulmonary emboli; CHF Chronic :-COPD; bronchogenic CA; post nasal drip; asthma; GERD; TB; ILD; psychogenic

2.Character and timing Short,dry irritating cough with pain behind jaw or neck:- Pharyngeal Harsh,irritative and repetitive with stridor and cyanosis:- Laryngeal

Productive: amount; colour; consistency; smell Large amounts:- a)regular coughing up-bronchiectasis b)Single occasion-lung abcess, empyema c)Pink frothy-Pulm edema

Types of sputum Types Appearance Cause Serous Clear,watery frothy pink A/c pulm edema Mucoid Clear grey- white viscid C/c bronchitis, COPD,Asthma Purulent Yellow/green Bronchopulmonary infection Rusty Rusty,golden yellow Pneumococcal pneumonia

FROTHY SPUTUM

PURULENT SPUTUM

RUSTY SPUTUM

Foul smelling sputum- bronchiectasis, lung abcess, empyema Solid matter present in viscid secretions in asthma, allergic brochopulmonary aspergillosis, necrotic tumour, foreign body

Haemoptysis;- C/c bronchitis, Bronchiectasis, Bronchogenic carcinoma, Pulmonary emboli, Pulmonary edema

3.Diurnal variation Cough which gets worse in night and early morning :- Asthma Persistent moist cough on waking up in smokers :- C/c bronchitis

4.Seasonal variation Asthma, C/c bronchitis 5.Postural variation Bronchiectasis, Lung abcess,

6.Aggravating & Relieving factors Cold,smoke,dust,exertion:- asthma Swallowing of liquids:- NM d/s of oropharynx Otogenic cough:- impacted wax or foreign body in ext auditory meatus:…..subsides with removal of cause

7.Associated symptoms Fever:- RTI; lung abcess; Chest pain:-Bronchitis, bronchogenic carcinoma Pleuritic chest pain:-Pleurisy, pleural effusion,bronchiectasis

Dyspnoea:- COPD, Asthma, ILD, Pneumonia, Bronchogenic carcinoma, Sarcoidosis, CHF ( orthopnoea & PND) Wheeze:- asthma “cough variant asthma” Nasal discharge, tickling sensation in throat:- Postnasal drip

Loss of weight:- bronchogenic carcinoma Stridor:-FB,Laryngeal nerve involvment Hoarseness of voice:-Lary.N invlvmt Heart burn, regurgitation:- GERD Erythema nodosum:-Sarcoidosis

HISTORY OF PAST ILLNESS COPD, Asthma, Postnasal drip, GERD R/c or complicated Pneumonia, tuberculosis.whooping cough:- Bronchiectasis Immunosuppression Surgery ;bed rest BCG vaccination

Personal history Loss of appetite, sleep Smoking Occupational exposure Allergy or atopy

FAMILY HISTORY Chronic bronchitis with emphysema, Respiratory allergy, Asthma, Cystic fibrosis TB

TREATMENT HISTORY Angiotensin Converting Enzyme Inhibitors Past treatment of d/s like allergies,asthma,pneumonia,TB,Bronchitis Immunosuppressants

…DDs 1.Pneumonia:-fever, cough,dyspnoea, rigor,night sweats 2.Asthma:-episodic wheeze,dyspnea, c/c dry or productive cough worst at night,chest tightness 3.COPD:-persistent cough,large amount sputum,shortness of breath

4.Bronchiectasis:-c/c cough,copious amount of foul smelling sputum, hemoptysis,pleuritic chest pain, dyspnoea,loss of weight,anemia 5.Bronchogenic carcinoma:-new cough/change in cough,dyspnoea, hemoptysis,anorexia,loss of weight, chest pain

6.Tuberculosis:-cough (dry…purulent …blood streaks in sputum), anorexia,LOW, night sweats, evening rise of temperature

7.ILD:-insidous onset exertional dyspnoea,cough 8.CHF:-exertional dyspnoea,cough, fatigue,orthopnea.PND,edema

9.Sarcoidosis:-cough,dyspnoea,erythema nodosum, eye inflammation,fatigue,fever 10.Cystic fibrosis:-c/c or r/c cough with sputum,dyspnoea,wheeze, hemoptysis..young adult

11.Post nasal drip;-nasal discharge… mucoid or mucopurulent,tickle in throat 12.GERD:-cough,heart burns, regurgitation

13.Laryngeal inflammation:-cough, hoarseness of voice,stridor 14.FB:-cough,stridor,history 15.ACEI:-dry cough starting within 1-6 months of treatment

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