Cough and expectoration

1. Cough and expectoration zhengcuixia

2. 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.

3. 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.

4. 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.

5. 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

6. 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

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

8. 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

9. Accompanied abnormalities • Fever • Chest pain • Dyspnea & wheeze • Sputum production

10. Neoplasm Efussional interstinal Mediastinum Cardiovascular Pleural or chest wall Accompanied CXF abnormalities

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

12. 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

13. Sputum production(expectoration)

14. Characters: mucoid, tenasious, purulent, blood stained, with special odor, rusty, serous • Volume: • Accompanied manifestation

15. Laboratory examination • Rutine • Microbiologic test ( including culture ) • Cellular

16. 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.

17. 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.

18. Clacification • Small • Moderate • Massive

19. Differentiating from hematemesis

20. Differentiating from upper airway bleeding • Post nasal bleeding • Mouth and farynxil membrane bleeding • by intenssive investigation and examination

21. Investigation • If coughed out or vomitted out • Volume: how much • Time duration • Any accompanied appearances