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COUGH, SPUTUM, HEMOPTYSIS. Prof. Dr. Bilun Gemicioğlu. COUGH. A cough is an action your body takes to get rid of substances that are irritating to your air passages, which carry the air you breathe in from the nose and mouth to the lungs.
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COUGH, SPUTUM, HEMOPTYSIS Prof. Dr. Bilun Gemicioğlu
COUGH • A cough is an action your body takes to get rid of substances that are irritating to your air passages, which carry the air you breathe in from the nose and mouth to the lungs. • A cough occurs when special cells along the air passages get irritated and trigger a chain of events. The result? Air in your lungs is forced out under high pressure; an explosive expiration • You can choose to cough (a voluntary process), or your body may cough on its own (an involuntary process).
Anatomiccauses of cough İntra-thoracic Extra-thoracic Upper GIS CNS Headandneck Mediastinum Stomac Pleura Lowerairwaysdiseases LungParenchyma Cardiovascular Diaphragm
Cough receptors and related nerves Simpson CB. et al. Otolaryngology–Head Neck Surg 2006; 134: 693-700
Anamnesis: History • While ? • When ? • Characteria ? • Productive/nonproductive • Additionalsymptoms? • Risk factors: tabaccosmoke additionaldiseasesoruse of drugs ?
Anamnesis: While • Shorterthen 3 weeksacutecough • 3 to 8 weekssubacutecough • Longerthen 8 weekschroniccough Irwin RS et al. Chest 1998, 114:2 suppl
Causes of acute cough • Respiratory Causes: • Inhaled gases or particule • Mucus secretion • Inflammatory exudate • Foreing body • Endobronchial lesion • Bronchial boosts
Other causes of acute cough -acute heart failure -acute rhinosinusitis -Eusephageal reflux -Middle ear patologies and infections -Diaphragm, pleura and pericardium irritations
PNDS Allergic rhinitis chronic sinusitis GER cough-variant asthma ACE Inhibitors tabacco smoke Whoopping Neurogenic Travmatic vagal injury After upper respiratory tract infection Psychogenic chronic aspiration Zenker diverticule Foreign body Tracheobronchial tree Laryngopharingeal Sinonasal External ear way Chronic bronchitis, COPD Bronchiectasis Lung Cancer Subglottic stenosis Tracheomalasia Tracheosephageal fistula Tuberculosis Sarkoidosis Congestive heart disease Chronic cough causes in adult Simpson CB. et al. Otolaryngology–Head Neck Surg 2006; 134: 693-700 Chung KF, Pavord ID Lancet 2008; 371: 1364-1374
PatogenicTriad Irwin RS et al. Chest 1998, 114:2 suppl Palombini BC et al. Chest 1999, 116:2,279-284
Anamnesis: When • Morning • Bed time; night • After meal • After irritant • Only waking • Talking • Stress
Anamnesis: Characteria • Like barking Larynx tm, inf. • Metalic cough Trachea, brochies. • Cow cough V.Chord paralisis • Vomitig cough Whoopping cough • Smoking cough tabacco smoke • Irrıtative cough URTI
Anamnesis: Characteria • In prospective adult studies time and character of the coughing cannot guide the diagnosis. Mello CG et al. Arch Intern Med 1996,156; 997-1003
Anamnesis: Productive/Nonproductive • Productive Airway diseases • Non productive Pleura, pericardium, Ear, GIS, heart, ACEI usage, diaphragm, mediastinum, thyroid… Irwin RS et al. Chest 1998, 114:2 suppl
Anamnesis: Additional symptoms • Specific Dyspnea, wheezing, sputum, pyrosis, retronasal discharge….. • Non specific Eshaustion, insomnia, sweating, muscular pain, urine incontinence, headache, loss of appetite, axiety
Anamnesis: Specific additional symptoms • PNDS post nasal drip, throat clearing runny nose, nasalcongestion, sputum • Asthma Dispnea, thightness of breath, wheezing • GER Burning, regurgitation, • COPD sputum, effort dispnea • Bronchiectasia Sputum • Heart failure Effort dispnea, tachycardia, edema
Anamnesis: Risk factors • SmokingcasesLungcancer, COPD, asthma, irritation • Additional diseases AIDS, cancer, viral URI • Drug usage ACEI, Nitrofurantoin, Immunosupresives Irwin RS et al. Chest 1998, 114:2 suppl
PhysicalExamination • Head and neck • Thorax • Upper GIS • Heart • ENT
Laboratory • Chest X Ray • Pulmonary function tests • Paranasal sinus X-Ray • Blood analysis • Sputum examination • Bronchoscopy • ECG, ECO • Thorax CT, HRCT • Rhinoscopy • Barium eseuphagography • Allergy prick tests
NON SPECIFIC SPECIFIC ANTITUSSİVE PROTUSSIVE TARGET THERAPY Codein Dekstrometorfan Difenhidramin Pseudoephedrine Dekstrobromfeniramin İpratropiumBromid Naproxen Hipertonicsaline Erdostein Amilorid N acetylcysteine Terbutaline Phisiotherapy Posturaldrenage Treatment of cough Irwin RS et al. Chest 1998, 114:2
SPUTUM • Mucus glands and goblet cells of lower respiratory tract secrete 10ml mucus every day • Exess of lower respiratory track expectoration is called sputum
General causes of sputum • Exess of mucus production • Changement in the quality of mucus • Lacking activity of mucociliar clearance
Sputum:Anamnesis: • Quantity of sputum • Quality of sputum; density, calour • Odor of sputum • Time of expectoration
Sputum: Diagnosis • Physical examination of the lungs • Chest X-ray, CT, HRCT • Sputum analysis • Blood analysis • Bronchoscopy
Sputum: Treatment • Treat the causative disease • Postural dranage • Mucolytics • Decongestant
HEMOPTYSIS • Lower respiratory track bleeding below epiglottis • Differential diagnosis with ENT ve GIS must be evaluated before saying hemoptysis
Causes of hemoptysis: Chest X Ray: Anormal I.Infections: -Pneumonia -Tbc -Lungabcess -Bronchiectasis -Fungalinfections II.Lungtumours: -BronchialCancers -Metastaticcancers -B.adenoma
Causes of hemoptysis: III. Alveolarhemorrhage: -Vasculitis -Goodpasture’ssyndrome -Wegenergranulomatosis -Behçet Disease -SLE -Drugs (penicillamine) IV.Other-Thoraxtrauma -A-V malformations -P.E -Disorders of coagulation
Causes of hemoptysis Normal X-Ray -Chronic bronchitis -Pulmonary Embolism -Bronchiectasis -Lung cancer -Mitral stenosis -Endometriosis
Massive hemoptysis Hemoptysis > 600 mL /24 h Cause is % 90 bronchial arteries causes:1-Tbc 2-Bronchiectasis 3-Malignity 4.Behçet disease
Hemoptysis: Physical examination -Vital signs -Telengiectasia (Osler-Weber-rendu Syndrome) -Clubbing -Deep venous thrombosis -ENT (URT haemorrhage) -Oral ulcer =>Behçet ? -Chest exanination -Cardiovascular system examination (mitral stenosis)
Hemoptysis: Diagnosis Radiology: PA, Latchest X-ray, BT, HRCT ifneeded PA ChestXrayand CT: normal => Angiography
Hemoptysis: Diagnosis Laboratory: -Blood analysis, bloodgoup -Electrolytes, liverandkidneyfunctiontests -PFT, ABG -PT, aPTT -ECG, Urineanalysis - Bronchoscopy
Masif hemoptysis: Tedavi Prensipleri • 1-Block asphyxia • 2-Stop bleeding • 3-Treat primary disaese