How long? Otherwise well? Diurnal pattern?

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Presentation transcript:

How long? Otherwise well? Diurnal pattern? Cough How long? Otherwise well? Diurnal pattern?

How long? Sudden - ? Foreign body Days - infection Weeks – bronchitis/pneumonia/TB/cancer Months/years – chronic bronchitis/reflux Variable - asthma

Otherwise well? URT symptoms? Productive of sputum/blood? Breathless/wheeze? Systemic upset? Reflux? Risk?

Diurnal pattern Nocturnal? Exertional? Change of air? Talking/singing? Meals?

Causes URT Extrinsic – FB, air, smoke, ACE inhibitor Lung infection/damage/allergy/cancer Reflux

Chest X-Ray Haemoptysis (unless obvious cause) Longer than 3 weeks (unless clearly improving) Other ‘red flag’ Pain/wt loss/sob/chest signs/hoarse/clubbed Abnormal in most cases of TB/cancer

Infection

Infection Acute URT viral - days Acute bronchits – weeks Pneumonia/pleural infection – months

Antibiotic treatment Acute bronchitis Healthy chest – probably not indicated Chronic chest – if 2/3 of More sputum, darker colour, sob. Little evidence to prefer a particular agent:- Doxycycline/amoxicillin/macrolide/quinolone

Pneumonia CRB65 score Confusion Respiratory rate (over 30) Blood pressure <90/<60 65 or older

C(U)RB65 score 0-1 <3% die Home OK 2 9% die Hospital 3-5 >15% ?ICU Review if not admitted

Pneumonia - treatment Plenty fluids Amoxicillin 500mg tds Doxycycline/Clarithromycin