We continue our discussion with cough.
We’ll do the same thing. Mean to say that
with dyspnoea, we walked through why dyspnoea
could be perhaps found with standing up, lying
down, maybe with exertion.
With cough, once again, the characteristics
and description of how the patient's presenting
with cough becomes incredibly important for
you. So, along with dyspnoea, cough is another
main way for you to diagnose your respiratory
disease. Let's continue.
Respiratory causes of cough: asthma, COPD,
infection, interstitial lung disease. In the
overview section, we talked about how these
may then give you, while depending on the
site of what kind of cough you might have?
Asthma, we talked about 2 different types
and we will go into these again, atopic or
intrinsic. The most common, would be atopic.
That’s the one in which, upon exposure to
allergens in the society, we have difficulty
with breathing. COPD, more chronic. Infections,
we talked about atypical and typical.
Other causes: allergy, post-nasal drip or
even GERD. Don’t forget this. Think about
where you are with GERD, in the GI system.
Where are you? At the gastro-oesophageal junction.
And now the lower oesophageal sphincter is
quite weak and therefore acid is then
going to do what? Reflux into the oesophagus.
And so much so, that it might actually
cause irritation to the respiratory tree.
Common causes are bolded, but keep in mind
that we will go through all the diseases in
great detail. We’re just setting up the
foundation of cough. We’ll ask the same
question here. For cough, is it acute or chronic?
Acute then suggests infection or say that
your patient is intubated and if your patient
is intubated, there is every possibility that
those food particles might then aspirate into
your trachea. You’re not able to properly
get it into the oesophagus, aspiration pneumonia
you’ve heard of, or maybe perhaps acute exacerbation
Chronic cough, as you can imagine here, just
like chronic dyspnoea, will be more of your
COPD’s and interstitial lung disease. Is
your cough productive? Big time. Ask this question.
If it is dry, well, that’s a little bit
different. Maybe it’s drug-induced and
maybe it’s dry, you’re thinking more
along the lines of allergies and such. But,
if your cough is productive, then productive
cough, if it’s purulent, mean to say that
if it’s gold or yellow, something like staph.
If it’s rusty, now, understand, with enough
coughing, you might then introduce enough
damage and injury to the bronchial tree
in which at some point, sure, you’re going
to have a little bit of blood, that’s rusty.
Now, if it’s straight up just blood, then
that’s a little bit more concerning and
we’ll go through differentials. Maybe it’s
cancers or maybe a haemoptysis that
you’ve seen with granulomatosis
with polyangiitis or Goodpasture's even. If
it’s purulent, we’ve talked about green.
Things like pyocyanin from pseudomonas, so
on and so forth.
Dry cough, this is usually interstitial lung
disease. ILD stands for interstitial lung
disease and by that, we mean that we’re
referring to? Atypical pneumonia perhaps or
maybe even eosinophilics. We’ll talk more
about these eosinophilic conditions when the
time is right.