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COUGH, SPUTUM, HEMOPTYSIS

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

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  1. COUGH, SPUTUM, HEMOPTYSIS Prof. Dr. Bilun Gemicioğlu

  2. 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).

  3. Anatomiccauses of cough İntra-thoracic Extra-thoracic Upper GIS CNS Headandneck Mediastinum Stomac Pleura Lowerairwaysdiseases LungParenchyma Cardiovascular Diaphragm

  4. Cough receptors and related nerves Simpson CB. et al. Otolaryngology–Head Neck Surg 2006; 134: 693-700

  5. Anamnesis: History • While ? • When ? • Characteria ? • Productive/nonproductive • Additionalsymptoms? • Risk factors: tabaccosmoke additionaldiseasesoruse of drugs ?

  6. Anamnesis: While • Shorterthen 3 weeksacutecough • 3 to 8 weekssubacutecough • Longerthen 8 weekschroniccough Irwin RS et al. Chest 1998, 114:2 suppl

  7. Causes of acute cough • Respiratory Causes: • Inhaled gases or particule • Mucus secretion • Inflammatory exudate • Foreing body • Endobronchial lesion • Bronchial boosts

  8. Other causes of acute cough -acute heart failure -acute rhinosinusitis -Eusephageal reflux -Middle ear patologies and infections -Diaphragm, pleura and pericardium irritations

  9. 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

  10. PatogenicTriad Irwin RS et al. Chest 1998, 114:2 suppl Palombini BC et al. Chest 1999, 116:2,279-284

  11. Anamnesis: When • Morning • Bed time; night • After meal • After irritant • Only waking • Talking • Stress

  12. 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

  13. 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

  14. 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

  15. Anamnesis: Additional symptoms • Specific Dyspnea, wheezing, sputum, pyrosis, retronasal discharge….. • Non specific Eshaustion, insomnia, sweating, muscular pain, urine incontinence, headache, loss of appetite, axiety

  16. 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

  17. 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

  18. PhysicalExamination • Head and neck • Thorax • Upper GIS • Heart • ENT

  19. 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

  20. 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

  21. SPUTUM • Mucus glands and goblet cells of lower respiratory tract secrete 10ml mucus every day • Exess of lower respiratory track expectoration is called sputum

  22. General causes of sputum • Exess of mucus production • Changement in the quality of mucus • Lacking activity of mucociliar clearance

  23. Sputum:Anamnesis: • Quantity of sputum • Quality of sputum; density, calour • Odor of sputum • Time of expectoration

  24. Sputum: Anamnesis

  25. Sputum: Diagnosis • Physical examination of the lungs • Chest X-ray, CT, HRCT • Sputum analysis • Blood analysis • Bronchoscopy

  26. Sputum: Treatment • Treat the causative disease • Postural dranage • Mucolytics • Decongestant

  27. HEMOPTYSIS • Lower respiratory track bleeding below epiglottis • Differential diagnosis with ENT ve GIS must be evaluated before saying hemoptysis

  28. Causes of hemoptysis: Chest X Ray: Anormal I.Infections: -Pneumonia -Tbc -Lungabcess -Bronchiectasis -Fungalinfections II.Lungtumours: -BronchialCancers -Metastaticcancers -B.adenoma

  29. 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

  30. Causes of hemoptysis Normal X-Ray -Chronic bronchitis -Pulmonary Embolism -Bronchiectasis -Lung cancer -Mitral stenosis -Endometriosis

  31. Massive hemoptysis Hemoptysis > 600 mL /24 h Cause is % 90 bronchial arteries causes:1-Tbc 2-Bronchiectasis 3-Malignity 4.Behçet disease

  32. 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)

  33. Hemoptysis: Diagnosis Radiology: PA, Latchest X-ray, BT, HRCT ifneeded PA ChestXrayand CT: normal => Angiography

  34. Hemoptysis: Diagnosis Laboratory: -Blood analysis, bloodgoup -Electrolytes, liverandkidneyfunctiontests -PFT, ABG -PT, aPTT -ECG, Urineanalysis - Bronchoscopy

  35. Masif hemoptysis: Tedavi Prensipleri • 1-Block asphyxia • 2-Stop bleeding • 3-Treat primary disaese

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