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Cough and Hemoptysis | How do you treat it? | QuadBloggers

ByDanish syed

Nov 11, 2021 , ,
cough and hemoptysis

Cough is the act of expelling air from the lungs with a sudden sharp sound whereas Hemoptysis is the coughing up of blood.

A) Cough:

  • Acute cough is a condition that occurs for a duration of less than 21 days.
  • And additionally associated with aspiration and respiratory infection.
    • Subacute cough is a condition moreover that occurs for a duration of 3 to 4 weeks and associated with persistent inflammation from a tracheobronchitis episode all in all.
    • Furthermore, Chronic cough is a condition that occurs for a duration of more than 8 weeks and associated with many cardiac and pulmonary diseases.

Causes of Cough:

  • Gastroesophageal reflux disease
  • Sinus disease
  • Cough variant asthma
  • ACE inhibitors

Clinical assessment for Cough:

  • Assessed by symptoms of nasopharyngeal disease hence, like postnasal drip, sneezing and rhinorrhea.
  • Symptoms of gastroesophageal disease like heart burn, hoarseness, sore throat and frequent eructation.
  • Symptoms of Cough variant asthma suggested by noting the relationship of cough onset that triggers asthma.
  • Moreover, usage of ACE inhibitors cause cough after treatment initiated.
  • On physical examination of cardiopulmonary diseases, assessed like auscultation of lung sounds and digital clubbing.
  • Examination of the nose , particularly the nasal passages, posterior pharyngeal wall, auditory canal and tympanic membranes.
  • Simultaneously, Laboratory examination performed like chest x-ray and spirometry and bronchodilator testing.
  • Spirometry with bronchodilator testing can help to assess reversible airflow obstruction.
  • Normal spirometry done subsequently to assess asthma.
  • Additionally, Purulent sputum examination done to assess routine bacterial and mycobacterial cultures.
  • On sputum examination, the cytology would reveal malignant cells in lung cancer and eosinophils in eosinophilic bronchitis.
  • Esophageal PH probes used simultaneously to assess for gastroesophageal reflux disease.
  • in addition, Chest CT done to assess the chronic condition of the lung when the treatment is not showing any improvement on the patients condition.

Treatment for Cough:

  • Systemic antihistamines like cetirizine, levocetirizine, clemastine and fexofenadine.
  • Nasal corticosteroids like Fluticasone, azelastine and triamcinolone.
  • Nasal decongestants like oxymetazoline, phenylephrine and pseudoephedrine.
  • Anticholinergics like nasal atropine sulphate.
  • Brand names: Sinarest (Paracetamol, chlorpheniramine and pseudoephdrine )1-0-1 for 4 days or Levosiz m ( Levocetirizine and montelukast) 0-0-1 for 4 days or Montek lc ( Levocetirizine and montelukast ) and Otrivin nasal drops ( xylometazoline drops) 2 to 3 times a day and steam.
cough and hemoptysis

B) Hemoptysis

  • A condition caused due to expectoration of blood from the respiratory tract, differentiated from blood originating from the GI tract or nasopharynx.

Causes:

  • Infections
  • Malignancies
  • Vascular diseases
  • Hemoptysis that arise from the alveoli is termed as diffuse alveolar hemorrhage .

Sources:

  • Hemoptysis usually arises simultaneously from the bronchi. Bronchial arteries are the main source of bleeding that leads to infection.
  • Airway hemoptysis, caused by viral and bacterial bronchitis.
  • Simultaneously, cancers developing in central airways like squamous cell carcinoma and small cell carcinoma can lead to hemoptysis.
  • Pulmonary vascular sources of hemoptysis include congestive heart failure with pulmonary edema which leads to pink and frothy sputum

Clinical assessment:

  • Patient with hemoptysis – History and physical examination – Massive hemoptysis – Protect airway – Bleeding stop. If bleeding continues – embolization (procedure to stop the blood flow )
  • Patient with hemoptysis – History and physical examination – Non massive hemoptysis – Presents with risk factors – investigation studies like chest x ray , CBC , urine analysis , creatinine and coagulation studies – CT scan – Bronchoscopy – Treat underlying disease – Persistent bleeding – embolization.
  • History: Source of bleeding determined if its from the respiratory tract or nasopharynx or GI tract. Quantity of expectoration assessed.
  • Massive hemoptysis: A condition that occurs due to massive bleeding of as much as 400 ml in less than 24 hours or 100 to 150 ml in that time frame.
  • Frothy and purulent secretions assessed.
  • Simultaneously, sedentary lifestyle like cigarette smoking and previous episodes or history of hemoptysis.
  • Fever and chills assessed for infection.

On physical examination:

  • Clubbing could indicate lung cancer or bronchiectasis.
  • Pedal edema should indicate congestive heart failure.
  • Assessment for epistaxis , vital signs and oxygen saturation.

On radiological examination:

  • Chest x ray.
  • Additionally, CT chest to assess bronchiectasis n pneumonia and lung cancer
  • Furthermore, CT angiography to assess for pulmonary embolism and the location of bleeding

Laboratory tests:

  • CBC
  • Urine analysis
  • Electrolytes
  • Renal function
  • ANCA
  • Sputum examination should be done for gram staining
  • Routine culture for detection of acid base bacilli
  • Bronchoscopy in cases of massive hemoptysis .

Treatment:

  • In addition, Massive hemoptysis should be assessed and treated with endotracheal intubation and mechanical ventilation to provide airway stabilization also.
  • Endobronchial blockers should be given when the source of bleeding has been identified and isolating the bleeding lung.
  • Bronchial arterial embolization by angiography or surgical resection should be performed when the bleeding persists.

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Furthermore, please refer this book for a detailed description of diseases: Harrisons book of internal medicine

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