Managing Cough

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Managing Cough
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Cough

• Cough is a forced expulsive manoeuvre usually
  against a closed glottis and which is associated
  with a characteristic sound
• Acute cough onsetlt3 weeks
• Most commonly due to viral upper respiratory
  tract infection
• Chronic coughgt8 weeks duration
• Experienced by 10-20 Adults ,commoner in
  females/obese

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• Coughing may appear trivial but should be
  assessed to exclude
• Infection Temp Sputum Pain
• Reaction to medication (usually ace inhibitors)
• Pulmonary oedema

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Impact of persistent cough

• Affect sleep/ability to rest
• Affects spouse/carers sleep
• Pain (Ribs Throat)
• Impaired QOL
• Stress Incontinence (can be a major concern in
  Females)

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Further investigations required in the following
circumstances

• Pyrexia
• Yellow/Green Sputum
• Blood in Sputum
• Chest Pain
• Weight Loss

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Investigation

• Detailed History
• Smoking history/ exposure to cigarettes
• Chest examination
• Sputum culture
• Chest x-ray

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Common causes of cough

• Direct link to smoking and worse in heavy smoking
• Infection
• Allergy
• Airways disease
• Pulmonary oedema
• Gastro-oesophageal reflux disease
• Exposure to aggravant
• Malignancy

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Cough associated with ACE Inhibitors

• First reported with captopril in 1985
• Reported incidence may be as high as 16
• Not dose related
• Time of onset variable- may occur within hours or
  up to a year after commencing Ace inhibitors
• ACE inhibitors associated with increase
  sensitivity of cough reflex
• Cough resolves on cessation of drug but mean
  resolution is 26days but can take up to 40 weeks
• Most patients with ACE inhibitor cough can
  tolerate angiotensin II receptor blockers

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Conservative Management

• If no reversible causes detected
• Humidifier
• Ioniser
• Positioning
• Support
• Sips of water
• Honey

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Pharmacological Interventions

• Antibiotics (if infection present)
• Review medications
• Inhalers Bronchodilator
• Anti-cholinergic
• Simple Linctus (Check sugar content)
• Antitussive (Check with consultant)
• Expectorant (Check contra-indications)
• Opiate based Preparation