Download Free Medical Management of acute and chronic cough PowerPoint Presentation

Management of acute and chronic cough PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : This medical presentation titled ""Management of acute and chronic cough"" provides us important information on management of acute and chronic cough.

Tags : Allergy, Management, acute, chronic cough, history, symptoms, Haemoptysis,Breathlessness, Fever, Chest pain, Weight loss, Evidence of vocal cord palsy, History of foreign body inhalation, Neoplasms, Infection, TB, Acute allergy, anaphylaxis, Interstitial lung disease, Bronchoscopy, High resolution CT

Published on : Apr 24, 2021 | Views : 5083 | Downloads : 42

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Management of acute and chronic cough Dr Veronica White MD FRCP Clinical Lead, TB service Barts Health NHS Trust
Slide 2-

Definition “Cough is a forced expulsive manoeuvre against a closed glottis and which is associated with a characteristic sound”
Slide 3-

Acute and chronic cough Acute cough: lasts < 3 weeks Chronic cough: lasts > 8 weeks ?3-8 weeks – difficult to define
Slide 4-

Acute cough Commonest new presentation to primary care Most commonly associated with viral URTI Normally benign and self-limiting Commonest symptom associated with acute exacerbations and hospitalisations with asthma and COPD
Slide 5-

Management In general – advice only Little evidence of pharmacological benefit from over the counter preparations “Honey and lemon” best home remedy(!) Voluntary suppression of cough may be sufficient to reduce symptoms Opiate antitussives not recommended
Slide 6-

Management Worrying history/symptoms: Haemoptysis Breathlessness Fever Chest pain Weight loss Evidence of vocal cord palsy History of foreign body inhalation
Slide 7-

Common serious conditions associated with isolated cough Neoplasms Infection e.g. TB Foreign body inhalation Acute allergy – anaphylaxis Interstitial lung disease
Slide 8-

Chronic cough
Slide 9-

Taking a history Age and sex – more common in middle aged women Smoking Occupation/hobbies/pets Family history
Slide 10-

Taking a history Characteristics: Onset and duration; ?diurnal variation; ?coughing on phonation Relation to infection Sputum Severe coughing spasms/paroxysms Incontinence Chemical triggers; posture; food
Slide 11-

Taking a history Past medical history Asthma, eosinophilic bronchitis COPD Bronchiectasis Lung cancer Pertussis infection; atopic disease Cardiovascular disease Autoimmune disease
Slide 12-

Baseline investigations Primary care Chest X-ray Spirometry Secondary care Bronchoscopy High resolution CT
Slide 13-

ppt slide no 13 content not found
Slide 14-

What I tell patients…. Five commonest cause of chronic cough with normal CXR Asthma Hayfever/post nasal drip GORD Recent URTI Smoking
Slide 15-

Management Asthma – treat as per BTS guidelines GORD – 8 weeks of high dose PPI Upper airways disease – antihistamine, nasal spray
Slide 16-

Management Also: Smoking – STOP! Post viral cough - ?low dose steroid inhaler Treat these empirically first
Slide 17-

ppt slide no 17 content not found
Slide 18-

Other diagnosis COPD Infection – bacterial, TB Interstitial lung disease including sarcoidosis Bronchiectasis Drugs – (ACE) inhibitors Foreign body
Slide 19-

Intractable cough Can lead to musculoskeletal chest pain, cough rib fracture, urinary incontinence. Cough syncope has also been described where an individual collapses after a severe fit of coughing.
Slide 20-

Intractable cough Aggressive treatment: inhaled steroid high dose oral steroids codeine linctus – not in simple coughs Patients with cough associated with an underlying malignancy - diamorphine and morphine - help both the pain and distress
Slide 21-

Specialist cough clinics Selective diagnostics and empirical trials of treatment – cost effective Refer to specialist clinic when empirical treatment has failed Systemic, cost effective approach Management algorithms improve outcome
Slide 22-

Specialist investigations Bronchial provocation testing Oesophageal testing Sinus imaging Fibreoptic laryngoscopy Cough provocation test
Slide 23-

Summary Most acute cough is benign, but look for additional, worrying symptoms Chronic cough: take a good history; baseline investigations Treat presumed/probable underlying cause Refer to specialist clinic if necessary
Slide 24-

Red flags Haemoptysis Breathlessness Fever Chest pain Weight loss Evidence of vocal cord palsy History of foreign body inhalation
Slide 25-

If CXR abnormal Refer urgently to relevant service: 2 WW lung cancer ILD clinic – Dr Gavin Thomas TB clinic – Dr Veronica White, Max Caplin clinic, Mile End Oncology
Slide 26-

ppt slide no 26 content not found
Slide 27-

ppt slide no 27 content not found
Slide 28-

ppt slide no 28 content not found
Slide 29-

Making a diagnosis Cough +/- haemoptysis Fever Night sweats Weight loss
Slide 30-

Making a diagnosis Blood tests – not specific X-rays Samples – sputum, pus, biopsy Scans such as CT and MRI
Slide 31-

Baseline investigations Sputum or pus for AFB CXR
Slide 32-

However….
Slide 33-

ppt slide no 33 content not found
Slide 34-

ppt slide no 34 content not found
Slide 35-

ppt slide no 35 content not found
Slide 36-

ppt slide no 36 content not found
Slide 37-

Summary Symptoms can be insidious Ask about systemic symptoms – often forgotten (by patient and medics) Multi- organ disease; TB can occur at any site Samples/biopsies are crucial – send for AFB
Slide 38-

In Summary If in doubt, refer. Max Caplin Clinic, Mile End Hospital Fax: 0208 1214185 TBenquires@bartshealth.nhs.uk
Slide 39-

ppt slide no 39 content not found