This document provides a differential diagnosis for chronic cough and summarizes key details about chronic bronchitis, emphysema, asthma, and lung cancer.
Chronic bronchitis is defined by a persistent cough with sputum production for at least 3 months per year for two consecutive years. It commonly affects heavy smokers aged 40-45 and is associated with cigarette smoking and airway hyperresponsiveness. Emphysema involves abnormal enlargement of the airspaces in the lungs and commonly affects heavy smokers aged 50-75. Asthma causes intermittent wheezing, coughing, and dyspnea that is often fully reversible. Lung cancer typically causes a dry or productive cough and weight loss in long-term smokers over age
This document provides a differential diagnosis for chronic cough and summarizes key details about chronic bronchitis, emphysema, asthma, and lung cancer.
Chronic bronchitis is defined by a persistent cough with sputum production for at least 3 months per year for two consecutive years. It commonly affects heavy smokers aged 40-45 and is associated with cigarette smoking and airway hyperresponsiveness. Emphysema involves abnormal enlargement of the airspaces in the lungs and commonly affects heavy smokers aged 50-75. Asthma causes intermittent wheezing, coughing, and dyspnea that is often fully reversible. Lung cancer typically causes a dry or productive cough and weight loss in long-term smokers over age
This document provides a differential diagnosis for chronic cough and summarizes key details about chronic bronchitis, emphysema, asthma, and lung cancer.
Chronic bronchitis is defined by a persistent cough with sputum production for at least 3 months per year for two consecutive years. It commonly affects heavy smokers aged 40-45 and is associated with cigarette smoking and airway hyperresponsiveness. Emphysema involves abnormal enlargement of the airspaces in the lungs and commonly affects heavy smokers aged 50-75. Asthma causes intermittent wheezing, coughing, and dyspnea that is often fully reversible. Lung cancer typically causes a dry or productive cough and weight loss in long-term smokers over age
*** Chronic Bronchitis Emphysema Asthma Lung Cancer
1. Definition Persistent cough with sputum Abnormal permanent Increase responsiveness of Malignant mass arising from production for at least 3 months in enlargement of the airspaces tracheobronchial tree to the respiratory epithelium at least 2 consecutive years distal to the terminal bronchiole, multiplicity of stimulus Not fully reversible accompanied by destruction of Most time fully their wall, and without obvious reversible fibrosis Not fully reversible 2. Epidemiology 40-45 y/o 50-75 y/o <10 y/o; <40 y/o Peaks at age 55-65 Higher in heavy smoker Higher in heavy smoker y/o men men Higher in men 3. Risk Factor Cigarette smoking Cigarette smoking Airway hyper Cigarette smoking Airway hyper Airway hyper responsiveness Familial history of responsiveness responsiveness Familial history of lung cancer Infection - exacerbation Infection - exacerbation asthma 4. Pathophysiology Hypersecretion of mucus in Protease-antiprotease activity. the large airways Major lung protease comes from hypertrophy of submucosal neutrophil; major antiprotease is glands in the trachea and 1-Antitrypsin. Neutrophilic bronchi proteases (elastase) have the Hypersecretion in small ability to digesting human lung. airways increase of goblet This ability causing the cells in the bronchi and destruction of lung parenchyma. bronchioles Smokers has increase Excessive mucus neutrophil ¯ophages production contributes to in the lungs airway obstruction Smoking enhances the Hypertrophy of activity of elastase; submucosal gland and macrophages elastase is increase of goblet cells not inhibited by 1-AT thought to be caused by Smoking inhibit the action cigarette smoking and of 1-AT pollutants 5. Clinical Persistent productive cough is Do not occur until destruction of Episodic wheezing, cough and Main S & S Manifestation the cardinal sign 1/3 of lung parenchyma dyspnea Cough is dry to Cough early Dyspnea severe & early Onset: productive Dyspnea mild & late Cough late Patient experience a Blood streaked Sputum copious Sputum scanty sense of constriction sputum Appearance blue bloaters Appearance pick puffer in the chest Long history of Airway resistance Airway resistance Non productive cough smoking increase slightly increase Harsh, audible Presentation of Elastic recoil normal Elastic recoil low respiration unintentional weight CXR prominent vessels; CXR hyperinflation; (wheezing) loss large heart small heart Prolonged expiration Horners Syndrome Barrel chest Common weight loss Tachypnea, Enopthalmos Infection common Barrel chest tachycardia and Ptosis, Cor pulmonale common Obvious prolonged systolic hypertension Miosis Hypercapnia expiration Barrel chest (increase Ipsilateral loss of Hypoxia AP diameter) sweating Cyanosis blue bloaters Prolonged: Pancoasts syndrome Loss of adventitious Local invasion in the breath sound superior part of High-pitch wheezing lungs Accessory muscle Involvement of C8, becomes visibly active T1, & T2 nerves Paradoxical pulse involvement develops Causing ulnar pain End of episodes: Superior Vena Cava Cough w/ thick, stingy Vascular destruction mucus charcot- Pericardial leyden crystal tamponade Wheezing is less Arrhythmias extreme Pleural effusion Gasping type of Hypoxemia respiration Dyspnea impending suffocation Lambert-Eaton myasthenic Timing acute/sudden syndrome episodes; may occur during Muscle weakness the night (nocturnal asthma) due to autoimmune antibodies Dermatologic acanthosis nigricans Hypertrophic pulmonary osteoarthropathy clubbing of fingers Paraneoplastic syndrome ADH - hyponatremia ACTH Cushings syndrome Hypercalcemia Calcitonin - hypocalcemia Gonadotropins - gynecomastia Serotonin carcinoid syndrome 6. Diagnosis Cannot be fully reversible Cannot be fully reversible Reversibility of 15% in Sputum cytology (4 slides) N DLCO Decrease DLCO FEV1 after 2 puffs of - CXR hyperopacity on the Increase RV CXR hyperlucency >1 cm with adrenergic agonist area of the mass FEV1<FVC<VC bullae FEV1<FVC<VC CT Scan sensitivity FEV1/FVC <0.7 Increase RV Sputum and blood Tissue biopsy Increase TLC Helium test FEV1<FVC<VC eosinophilia bronchoscopy FEV1/FVC < 0.7 Large increase TLC Helium test 7. Treatment Supportive: Supportive: Supportive: Definitive: Smoking cessation Smoking cessation Removal of allergens Surgery Supplemental oxygen Pharmacology: Quick relief: Pharmacology: Bronchodilator Adrenergic stimulants Bronchodilator Short acting (5-15mins)lasts 4-6h Catecholamines (30-90mins) Short acting (5-15mins) lasts 4-6h Long acting (15-30mins)lasts 12h Fenoterol & Albuterol (4-6h) Long acting (15-30mins) lasts 12h Anticholinergic (30- Salmeterol & Folmoterol (9- Anticholinergic (30-60mins) lasts 60mins)lasts 4-6h 12h) 4-6h Theophyllines (12-24h oral Methylxanthines Theophyllines (12-24h oral prep) prep) theophyllines, caffeine, Inhaled glucocorticoid decrease Inhaled glucocorticoid theobromide controller severity, need of hospitalization decrease severity, need of class, reduces nocturnal and risk of exacerbation hospitalization and risk of symptoms. N-Acetylcystein mucolytic & exacerbation Anticholinergics antioxidant property N-Acetylcystein mucolytic & ipratropium bromide (60- 1-AT augmentation 1-AT def. antioxidant property 90mins) Non-pharmacology: 1-AT augmentation 1-AT Long term Controller: Vaccine influenza & deficiency Glucocorticoids most pneumococcal Non-pharmacology: potent & most effective. Lung Transplant - pt65 y/o, Vaccine influenza & Parenteral & oral is most severe disability despite maximal pneumococcal beneficial for acute and therapy, free of comorbid Lung Transplant - pt65 y/o, chronic attack. Inhaled is for condition severe disability despite maximal pt w/ persistent symptom. therapy, free of comorbid Mast-cell stabilizing agents condition cromolyn sodium and Lung Volume Reduction Surgery nedocromil. Inhibit (LVRS) degranulation of mast cell preventing release of chemical prophylaxis Leukotrienes modifiers Zileuton 5-LO synthesis inhibitor Zafirlukast & montelukast LTD4 receptor antagonist