8esplraLory 8L1 W1 C2 Cough and SpuLum

TYPE OF COUGH (based on duration)

|FIL !Fl|FIL |EFJNl|
DURATON Less than 3 weeks 3-8 weeks More than 8 weeks
COMMON
CAUSES
common cold or other upper
respiratory infections-
flu, pneumonia and whooping
cough*.
Remains even after a
cold or other
respiratory infection
is over
UACS**, asthma;
and
gastroesophageal
reflux disease.
& ls an lnfecLlous bacLerlal dlsease LhaL causes unconLrollable coughlng
** a Lerm used Lo descrlbe condlLlons LhaL lnflame Lhe upper alrways and cause a cough Lxamples lnclude slnus
lnfecLlons and allergles 1hese condlLlons can cause mucus Lo run down your LhroaL from Lhe back of your nose
1hls ls called posLnasal drlp
TYPE OF COUGH (based on origin and character)
JFlClN |EF|ILF |F!L!
Naso-pharyx/larynx Throat clearing, chronic Postnasal drip, acid reflux
Larynx Barking, painful, acute or persistent Laryngitis, pertussis(whooping
cough), croup
Trachea Acute, painful Tracheitis
Bronchi
ntermittent, sometimes productive,
worse at night
Asthma
Worse in morning Chronic Obstructive Pulmonary
Disease(COPD)
With blood Bronchial malignancy
Lung parenchyma
Dry then productive Pneumonia
Chronic, very productive Bronchiectasis
Productive, with blood Tuberculosis
rritating and dry, persistent nterstitial lung disease
Worse on lying down, sometimes
with frothy sputum
Pulmonary oedema
ACE inhibitors Dry, scratchy, persistent Medication-induced

Pathogenesis
aLhologlcal coughlng resulL from 2 mechanlsms
O SLlmulaLlon of sensory nerves ln Lhe eplLhellum by secreLlon forelgn bodles clgareLLe
smoke and Lumors
O SenslLlzaLlon of cough reflex ln whlch Lhere ls an abnormal lncrease ln Lhe senslLlvlLy of
Lhe cough recepLors demonsLrable by lnhalaLlon of capsalcln or sallne soluLlons





8esplraLory 8L1 W1 C2 Cough and SpuLum

Anattmt CIassItattn tI Causes tI Ctueh
0auses with theit anatomic
locations
Nechanism
0hatactetistic featutes an4 majot
associate4 symptoms
Aose and its sinuses
Rhinitis, sinusitis
Postnasal drip irritating upper airway cough
receptor
Acute or chronic cough with sensation oI
postnasal drip, Irequent hawking (throat
clearing), nasal stuIIiness
!arynx
InIection, neoplasm Irritation oI pharyngeal cough receptors
Hacking cough with sore throat, Irequent
hawking
Zenker's diverticulum
Irritation oI airways by compression or by
aspirated diverticular content
Regurgitation oI undigested Iood,
halitosis, dysphagia
arynx
InIection, allergy, neoplasm,
Ioreign body
Hyperreactivity oI laryngeal cough
receptors, mechanical irritation
Croupy or barking cough, change in
voice, inspiratory stridor
Improper use oI voice Vocal cord irritation Coughing with talking or singing
%racea and bronci
Acute tracheobronchitis
Hyperreactivity oI cough receptors,
increased secretions
The most common cause oI acute selI-
limited cough
Pertussis
Hyperirritability oI cough receptors Irom
necrotizing inIlammation oI respiratory
tract mucosa
Paroxysms oI coughing ending in a loud,
crowing, inspiratory sound (whoop);
expectoration oI mucus plug
Chronic bronchitis Hypersecretion, ciliary dysIunction
Chronic productive cough oI smokers,
worse upon arising in the morning
Bronchiectasis Hypersecretion, retained secretions
Expectoration oI large amounts oI Ioul-
smelling sputum, hemoptysis
Cystic Iibrosis As in bronchiectasis, secretions more viscid
Chronic cough since early childhood,
progressive dyspnea, hemoptysis
Neoplasm
Mechanical irritation oI cough receptors by
tumor, secretions, or secondary inIection
Change oI pattern oI cough in a longtime
smoker, hemoptysis
Bronchial asthma
Airway hyperreactivity, bronchospasm,
increased secretions
Recurrent or chronic cough with or
without wheezing or dyspnea
Aspiration
Irritation oI cough receptors by aspirated
material, secondary inIection
Nocturnal cough, Irequent heartburn,
swallowing disorder
Foreign body
Mechanical stimulation oI cough receptors,
inIectious complication
History oI Ioreign body aspiration (may
be Iorgotten)
Inhalation oI irritating gases
or aerosols
Chemical irritation oI cough receptors
Onset oI cough immediately aIter
exposure
!ulmonary parencyma
Pneumonia
Stimulation oI peripheral cough receptors,
increased secretions
Initial dry cough usually Iollowed by
varying sputum production dependent on
the cause; systemic symptoms oI
inIection
Lung abscess As in pneumonia
Sudden onset or increase in amount oI
purulent, oIten Ioul-smelling sputum
Tuberculosis and other
chronic inIections
As in pneumonia
Chronic, usually productive, cough;
hemoptysis
Chronic inIiltrative or
Iibrosing lung disease
Irritation oI peripheral receptors, distortion
oI airways
Chronic dry cough, progressive dyspnea
Pulmonary edema (cardiac or
noncardiac)
Hypersecretion, airway hyperreactivity
Irom congestion
Acute cough with severe dyspnea, Irothy
and blood-tinged sputum
8esplraLory 8L1 W1 C2 Cough and SpuLum

sopagus
Swallowing disorders As in aspiration Frequent choking on Iood or drink
Esophageotracheal and
esophageobronchial Iistula
Stimulation oI cough by passage oI
swallowed liquid to airways
Coughing upon swallowing liquids
eart and blood vessels
LeIt-side heart Iailure As in pulmonary edema As in pulmonary edema, nocturnal cough
Aortic aneurysm, leIt atrial
enlargement
Compression oI large airways
Nonproductive cough
Pulmonary thromboembolism
Largely unknown; irritation oI peripheral or
pleural cough receptors with inIarct
Acute cough, dyspnea, hemoptysis
ediastinum
Mediastinal tumors Airway compression and deIormation
Nonproductive, "brassy" cough,
sometimes related to body position
!leura
Pleural eIIusion
Irritation oI pleural cough receptors, airway
deIormation with large eIIusion
Dry cough, chest pain, dyspnea
xternal ear canal and
tympanic membrane
Stimulation oI cough receptors by hair,
cerumen, or Ioreign body
Occasional cause oI dry cough eliminated
by removing the cause
Ao organic causes
Psychogenic cough Habit cough (respiratory tic) Dry cough, absent during sleep
Intentional cough
Deliberate cough Ior attention seeking or
other personal gain
Dry and noisy cough occurring only in
presence oI people
Drug-induced cough
(angiotensin-converting enzyme
inhibitors)
Not known
Dry, annoying, and oIten incessant cough,
disappearing aIter stopping the drug

8CuuC1lvL CCuCP (assoclaLed wlLh spuLum)
SpuLum conLalns mucus and oLher subsLances 1hese oLher subsLances can lnclude dead cells pus or forelgn
parLlcles such as dusL.
1ype of spuLum
urulenL(pus yellow/greenlsh spuLum ofLen coplous and Lhlck)presence of cellular
maLerlal(bronchlal eplLhellal cells neuLrophll eoslnophll granulocyLes)bronchlecLasls lobar
pneumonla n asthmatics, the sputum may look purulent from the eosinophilic cells.
oulsmelllng dark colour presenL of anaeroblc organlsms AssoclaLed wlLh bronchlecLasls lung
abscess or cysLlc flbrosls
,ucold spuLum clear and whlLe buL can conLaln black specks resulLlng from lnhalaLlon of
carbon
PaemopLysls(bloodsLalned spuLum)varles from small sLreaks of blood Lo masslve bleedlng
mosL common ln carclnoma cysLlc flbrosls bronchlecLasls and Luberculosls