IAP UG Teaching slides 2015-16
WHAT IS COUGH?
COUGH REFLEX IS A DEFENSIVE MECHANISM
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Four Phases• Inspiratory• Contractive• Compressive• Expulsive
TYPES• Acute• Chronic
IAP UG Teaching slides 2015-16
WHAT IS CHRONIC COUGH?
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Chronic cough is cough of more than
3 weeks duration
IAP UG Teaching slides 2015-16
PHYSIOLOGY OF COUGH REFLEX
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STIMULANTS
•IRRITANTS•SECRETIONS•FOREIGN BODIES
ARC CONSISTS
•RECEPTORS•AFFERENTS•EFFERENTS
IAP UG Teaching slides 2015-16
PHYSIOLOGY OF COUGH REFLEX
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Receptors• Pharynx & Larynx• Bronchi• Esophagus & Stomach• Pleura &Diaphragm• Middle Ear
Afferents• Cr N. IX, X And V• C 2, 3 & 4
Efferent• Cranial Nerve X• C 3,4 & 5
Cough Centre• Medulla
IAP UG Teaching slides 2015-16 9
INITIAL EVALN
PULM FUNCT TESTS
BRONCHOSCOPY
GERD TESTING
HISTORY
PHYSICAL EXAM
CXR
CHRONIC COUGH DIAGNOSITIC PROTOCOL
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IAP UG Teaching slides 2015-16 10
CHRONIC COUGH DIAGNOSITIC PROTOCOL
I EVALUATION• HISTORY
• PHYSICAL EXAM
• CHEST X‐RAY
PULMONARY FUNCTION TESTS•SPIROMETRY
•MIC
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IAP UG Teaching slides 2015-16 11
GERD TESTING• pH Probe•Upper GI Series•EndoscopyOTHERS
• Laboratory•CT Scan•Other Consults
BRONCHOSCOPY
CHRONIC COUGH DIAGNOSITIC PROTOCOL
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IAP UG Teaching slides 2015-16 12
COUGH IN A SEEMINGLY WELLCHILD
COUGH IN A SICK CHILD
CHRONIC COUGHDIAGNOSITIC PROTOCOL
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IAP UG Teaching slides 2015-16 13
HISTORY
• Family history• Atopy• Relief with bronchodilators
• Exposure to smoke• Serious pulmonary infections
• Sino‐pulmonary infections
• Skin infections
• Stridor• Choking• Feeding problems• H/o contact
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IAP UG Teaching slides 2015-16 15
HISTORY
Cough quality• Seal like• Canada goose • Staccato• Paroxysmal bouts• With sonorous breathing
Cough timing• With feeding• Nocturnal• With sleep, laughing• Exercise
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IAP UG Teaching slides 2015-16 16
HISTORY
Cough Duration
•Persistent
•Episodic
Cough Productivity
•Productive
•Nonproductive
•Blood stained
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IAP UG Teaching slides 2015-16 17
PHYSICAL EXAM
• Failure to thrive• Malabsorption• Signs of atopy• Sinuses• CVS exam
• Cyanosis• Clubbing• Chest deformity
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IAP UG Teaching slides 2015-16 22
BRONCHOSCOPY
Procedures• Remove F.B• Evaluate anatomy• Collect specimen
Indications• Cough 8 weeks or more• Suspicion of F.B or obstruction
• Failure to make a diagnosis
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IAP UG Teaching slides 2015-16 27
APPROACH TO A CHILD WITHCHRONIC COUGH ‐ CASE SCENARIOS
• 7 years boy• Persistent cough• Cough quality• Family H/o asthma• No clubbing• Chest deformity+• Atopy+• Lungs clear
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IAP UG Teaching slides 2015-16 28
APPROACH TO A CHILD WITH CHRONIC COUGH – CASE SCENARIOS
LEARNING POINTS
Suspect Cough Variant Asthma:• Family H/o asthma• Triggers• H/o or signs of atopy• Response to bronchodilators• R/o other causes
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IAP UG Teaching slides 2015-16 29
APPROACH TO A CHILD WITHCHRONIC COUGH ‐ CASE SCENARIOS
• 1 year girl• 7 kg• Persistent cough• Nocturnal• Vomits after feeds• Fails to respond to • Bronchodilators• Lungs clear
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IAP UG Teaching slides 2015-16 30
APPROACH TO A CHILD WITH CHRONIC COUGH – CASE SCENARIOS
LEARNING POINTS
Suspect GERD:• Infant • Failure to thrive• Feeding problems• Vomiting• Nocturnal cough• Failure to respond to• Bronchodilators
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IAP UG Teaching slides 2015-16 31
APPROACH TO A CHILD WITH CHRONIC COUGH ‐ CASE SCENARIOS
• 9 months boy• Persistent cough• H/o ear & skin infection• Hospitalized 4 times till now• Failure to thrive• Chest deformity• Clubbing
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IAP UG Teaching slides 2015-16 32
APPROACH TO A CHILD WITH CHRONIC COUGH – CASE SCENARIOS
LEARNING POINTS
Suspect altered pulmonary defenses:•Rec respiratory infection•Serious pulmonary infection•Failure to thrive•Multiple sites sepsis•Family history
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