Cough & Dyspnea Diagnostic Approach

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Block B1 - Chest Problems


Cough[edit]

  • Originally a defense mechanism of the respiratory tract.
  • Some diseases can stimulate the cough reflex.

Etiology[edit]

  • Chronic cough:
    • Reflux (46.1%)
    • Asthma (38.7%)
    • Rhinitis (15.2%)

Dyspnea[edit]

  • Sensation of not having enough breath.
  • Condition of painful and/or difficult breathing.
  • Is a type of symptom ;
    • Must be distinguished from increased work of breathing (labored breathing/tachypnea) which is a type of sign.
    • Subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. - The American Thoracic Society.
    • Uncomfortable awareness of breathing.

Etiology[edit]

  1. Pulmonary System
    • Acute
      • Infection : Pneumonia
      • ALI - Acute lung injury
      • ARDS - Acute respiratory distress syndrome.
      • Pneumothorax
      • Foreign body
      • Embolism
    • Chronic
      • COPD : Chronic bronchitis, emphysema
      • Asthma
      • Pleural effusion
      • Infected bronchoectasis
      • Cancer - Primary or metastasis
      • Interstitial Lung Disease
  2. Non-Pulmonary System
    • Cardiovascular
    • Neuromuscular
      • Stroke
      • CNS infection
    • Metabolic
      • Thyroid crisis
      • Hyperuremia
    • Psychiatric
      • Psychoneurosis
      • Panic disorder, etc.
  3. Mixed
  4. Acute or chronic

Top ten Cough & Dyspnea in Sardjito Hospital.

Differential Diagnosis[edit]

First anemnesis:

  1. Chronic or acute?
    • Acute onset: Decide first whether it's cardial or non-cardial (pulmonary)
    • Usually chronic are of pulmonary cause, except embolism and foreign body.
  2. Young or old (>50 years old)?
    • Old man + acute: consider CARDIAL first.
  3. Pulse: if irregular, refer patient to ICCU.
    • Trial Nitrate Sublingual: if patient's condition gets better → cardial cause.
  4. Febrile or non-febrile?
    • Acute + febrile = lung infection.
    • Acute + febrile + old man = worse.
      • Refer to emergency room
      • Oxygen first
      • Consider any comorbid factor

Comorbid Factor[edit]

  • Old
  • Cardial
  • Diabetic
  • Renal impairment
  • Cancer
  • Chronic disease
  • Immobilization
    • Arthritis
    • Stroke
    • Malnutrition
    • Debility

Comorbid factor--> refer to emergency room.

Management[edit]

  • Oxygen 3-5 L/min with cannula or mask.
  • Fowler's position.
  • Determine :
    • Pulmonary or Non-pulmonary
    • Cardial or Non-cardial
    • Presence of any comorbid factor → refer to emergency room.
  • Give treatment for underlying cause.