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Chapter 034. Cough and Hemoptysis (Part 2)

Approach to the Patient: Cough A detailed history frequently provides the most valuable clues for the etiology of the cough. Particularly important questions include: 1. Is the cough acute, subacute, or chronic? 2. At its onset, were there associated symptoms suggestive of a respiratory infection? 3. Is it seasonal or associated with wheezing? 4. Is it associated with symptoms suggestive of postnasal drip (nasal discharge, frequent throat clearing, a "tickle in the throat") or gastroesophageal reflux (heartburn or sensation of regurgitation)? However, the absence of such suggestive symptoms does not exclude either of these diagnoses. 5. Is it associated with fever or sputum? If sputum is present, what is its character? 6. Does the. | Chapter 034. Cough and Hemoptysis Part 2 Approach to the Patient Cough A detailed history frequently provides the most valuable clues for the etiology of the cough. Particularly important questions include 1. Is the cough acute subacute or chronic 2. At its onset were there associated symptoms suggestive of a respiratory infection 3. Is it seasonal or associated with wheezing 4. Is it associated with symptoms suggestive of postnasal drip nasal discharge frequent throat clearing a tickle in the throat or gastroesophageal reflux heartburn or sensation of regurgitation However the absence of such suggestive symptoms does not exclude either of these diagnoses. 5. Is it associated with fever or sputum If sputum is present what is its character 6. Does the patient have any associated diseases or risk factors for disease e.g. cigarette smoking risk factors for infection with HIV environmental exposures 7. Is the patient taking an ACE inhibitor The general physical examination may point to a systemic or nonpulmonary cause of cough such as heart failure or primary nonpulmonary neoplasm. Examination of the oropharynx may provide suggestive evidence for postnasal drip including oropharyngeal mucus or erythema or a cobblestone appearance to the mucosa. Auscultation of the chest may demonstrate inspiratory stridor indicative of upper airway disease rhonchi or expiratory wheezing indicative of lower airway disease or inspiratory crackles suggestive of a process involving the pulmonary parenchyma such as interstitial lung disease pneumonia or pulmonary edema . Chest radiography may be particularly helpful in suggesting or confirming the cause of the cough. Important potential findings include the presence of an intrathoracic mass lesion localized pulmonary parenchymal opacification or diffuse interstitial or alveolar disease. An area of honeycombing or cyst formation may suggest bronchiectasis while symmetric bilateral hilar adenopathy may suggest sarcoidosis. Pulmonary function