1. CLINICAL APPROACH TO A PATIENT WITH COUGH… HISTORY TAKING

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

3. 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

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

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

6. 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

7. FROTHY SPUTUM

8. PURULENT SPUTUM

9. RUSTY SPUTUM

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

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

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

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

14. 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

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

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

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

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

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

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

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

22. …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

23. 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

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

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

26. 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

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

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

29. …THANK YOU