Cough: Pearls

00:01 Clinical pearls that you must know.

00:03 Rust. What does this mean to you? Good. Blood tinged.

00:09 So when you say blood tinged it means that with enough cough, then you might be causing damage to the respiratory tree.

00:13 You're thinking about, well, even to this day, we have Streptococcus pneumoniae being very common, and two ends of the spectrum of age.

00:21 We have elderly, they're susceptible; and young, they're susceptible to streptococcus pneumonia.

00:26 Hence, Pneumovax, and it's a vaccine is therefore, given priority to these two populations.

00:33 We'll talk more about this later as well.

00:36 If your patient is in a state of splenic compromise, because you know, the Streptococcus pneumoniae is an encapsulated organism, that you have to make sure that you vaccinate yourself against such bacteria.

00:50 Foul smelling, aspiration pneumonia.

00:53 Daily morning cough, chronic bronchitis.

00:57 Remember our definition, once again, how long would you have this cough consecutively? Three months, of what kind of cough? Productive.

01:04 And for how many years? Two years.

01:06 Now, the definition over and over again, at some point you will be presented.

01:10 And the way the presentation of it would be maybe perhaps your patient comes in and says, "I've been coughing doc." "Okay, for how long?" "Maybe perhaps about a couple months." You know what I mean? They're not gonna say exactly three.

01:22 And how long has it been going on? I don't know. It seems like a long time.

01:25 So, from the patient's point of view, it'd be rather vague, but you have to put all this together in terms of a pattern.

01:31 Move on. Cough with exertion, exercise induced asthma.

01:35 So this would be the intrinsic type of asthma.

01:37 So let's go ahead and branch this into two divisions.

01:40 Asthma, atopic. What does that mean? You've heard of atopic topic dermatitis, haven't you? What happened? Patient got exposed to allergens.

01:49 This is atopic asthma.

01:51 And oftentimes, eczema and atopic asthma will go together.

01:54 If it's exercise induced, this is more of your intrinsic adult, interesting.

02:00 If it is exercise, and what kind of branch? You tell me this, what kind of branch your autonomic nervous system is then responsible for bronchoconstriction.

02:10 Bronchoconstriction.

02:12 You dare not say sympathetic, right? So you're telling me parasympathetic.

02:16 Is it possible that doing exercise that you might be releasing parasympathetic? Sure, you are.

02:20 Talk all about balance.

02:22 So, if there's something in there in terms of theories, and the theory that you want to keep in mind is maybe there's excess parasympathetic activity in these populations on the bronchi.

02:32 Cough with exertion, CHF.

02:33 Hacking, high pitched cough.

02:36 This is Bordetella. Another word, this is your whooping cough.

02:40 (whooping cough) Alright.

02:43 So does he hacking, high pitched cough? Bordetella pertussis. See enough for the acute infection.

02:49 And then you have mycobacterium avium, intracellular, MAI.

02:56 Who is your patient here? Immunocompromised, your CD4 count, and an HIV patient.

03:00 Oh boy, might be as low as 50. Quite low.

03:04 So mycobacterium avium intercellular, this is more of your suppressed type of cough.

03:10 Descriptions that are important associations, diseases, infections.