Cough and expectoration

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Cough and expectoration

• zhengcuixia

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Concept
cough

• A protective reflex act
• clean excessive secretion foreign material
• Initiated by miscellaneous stimuli or by
  voluntary exertion.
• The most common respiratory symptom.
• Severe cough is a serious clinical problem.

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Cough reflex

• Afferent inform.from larynx, trachea,
  bifurcation of the bronchi
• Irritant type mechanical, chemical,
  inflammation
• Afferent fibers are in the vague nerve
• cough center.

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Cough reflex

• Efferent signals
• larynx, muscles of diaphragm, chest wall,
  abdomen
• A coordinated series of movement complete the
  cough. Deep inspiration expiration effort with
  glottis closed- glottis open abruptly high
  volocity of airflow brings out screations from
  airways.

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Influencing factors

• Suppressed afferent or efferent nerve function
• Failed glottis function (laryngopharynx dis)
• Diminished muscle force
• Obstructed airway seen in severe COPD
• Trachea intubation
• Chest or abdominal pain limit cough movement

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Causes

• Airway stimulation by chemicals foreign
  material (smoker occupational exposure)
• Airway infection inflammation
• Lung parenchyma disorders
• Pleural chest wall disorders
• Cardiovascular abnormalities
• Other causes Psychiatric cough

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classify

• Non production ( dry cough )
• Production (with sputum)
• Acute
• Chronic or acute on chronic

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Clinical appearance in common diseases

• Acute respiratory infection or excesobation of
  chronic infectious illnesss
• Neoplasms
• Pleural disease
• Cardiovascular diseases
• General disease affecting the respiratory system
• Chronic cough postualnasal drip syndrom, cough
  type asthma, smoker, occupational exposure

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Accompanied abnormalities

• Fever
• Chest pain
• Dyspnea wheeze
• Sputum production

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Accompanied CXF abnormalities

• Neoplasm
• Efussional
• interstinal

• Mediastinum
• Cardiovascular
• Pleural or chest wall

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complication

• Cough syncope syndrom
• Fatigue
• Fractures due to severe persistent cough
• Pneumomediastinum, pneumothorax, and subcutaneous
  emphysema due to high intrathoracic pressure
  during cough.

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Investigation

• General condition of the patient
• Time specialties
• Voice specialties
• Productive or not
• In relation with posture
• Accompany with chest pain with dyspnea, or other
  complications

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Sputum production(expectoration)
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• Characters mucoid, tenasious, purulent, blood
  stained, with special odor, rusty, serous
• Volume
• Accompanied manifestation

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Laboratory examination

• Rutine
• Microbiologic test ( including culture )
• Cellular

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hemoptysis

• Bleeding below the level of the larynx that being
  coughed out
• Degrees from blood-tinged sputum to massive
  gross blood, even leading to airway occlusion
  (apnea ) shock. The latter is much less seen.

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Common causes

• Infectious respiratory disease TB,
  bronchiactesis, bronchitis
• Neoplasm
• Cardiovascular disease MS, PE, PAH, deformity of
  blood vessle
• Other less seen disease leading to hemoptysis.

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Clacification

• Small
• Moderate
• Massive

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Differentiating from hematemesis
hemoptysis hematemesis
Coughed up frothy Vomited without frothy
Preceded by stimulating cough Preceded nausea, vomiting
Bright red Dark red or brown
alkaline acid
History of coughing Gastric, liver disease
Blood-tinged sputum Tar stool
Mixed with sputum Mixed with food
Anemia variable Blood loss common
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Differentiating from upper airway bleeding

• Post nasal bleeding
• Mouth and farynxil membrane bleeding
• by intenssive investigation and examination

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Investigation

• If coughed out or vomitted out
• Volume how much
• Time duration
• Any accompanied appearances