Cough/sputum

This child is actually not coughing. He's just being choked by that man, just before having his neck broken.

Definition

Cough is a reflex for clearing the large airways. Productive means bringing things up with the cough ("dry" means the opposite). Haemoptysis is coughing up blood.

Epidemiology

Differential Diagnosis

• Airways - asthma, COPD (bronchiectasis)
• Infection - pneumonia, TB, URTI
• Cancer - lung cancer, laryngeal cancer
• PE - er, pulmonary embolism
• GI - GORD
• Inheritied - CF
• Foreign body
• Paediatric - bronchiolitis, croup

Clinical and Associated Features

Haemoptysis is a red flag, mainly because it's a symptom of cancer, PE and TB, all of which are serious, and thus it shouldn't be ignored!

• Asthma - non-productive cough, particularly in the evening. SOBOE, wheeze
• COPD - smokers with a productive cough - phlegm is green. Also get breathlessness, wheeze, weight loss, PND, tiredness
• Cancer - haemoptysis, weight loss, smoking, family history of lung cancer
• Pullmonary embolism - haemoptysis, SOB, chest pain
• URTI - fever, infection
• Pneumonia - fever, breathlessness, tiredness, productive cough, dull on percussion, crackles on auscultation, asymmetric chest expansion (reduced on affected side) if severe
• 'TB - as for pneumonia, with haemoptysis, weight loss, from developing world, more long-term.
• 'Reflux - burning sensation in chest, chest pain, worse on eating, worse on lying down
• Cystic fibrosis - failure to thrive, recurrent infection, loose stools, child
• Foreign body - there's a foreign body

Paeds

• • Bronchiolitis - generally in under 2 year olds. Wheeze, SOB, fever.
  • Croup - barking cough, mild fever; don't mistake for epiglottitis.

Investigations

• CXR - everybody will need one of these
• FBC - check for infection
• U+E - useful for hydration and important in assessing severity of pneumonia