????? ( Cough

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?????( Cough Expectoration)

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• Professor?Doctor director ?Neurologist

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Concept and Definition of cough

• Coughing is an essential defense mechanism
  that it prevents the airways from the
  foreign substance and clear the excretion of
  respiratory tract.
• Coughing is a reflex. permanent and frequent
  coughing indicates an abnormality.

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Concept and definition of Expectoration
Expectoration is a pathological phenomenon
that human being remove the pathological
secretion from respiratory system by means
of coughing.
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cough and expectoration

• The daily quantity of bronchial secretions
  produced by a normal person is unknown. But
  it is sufficiently small to be removed
  by mucocillary action alone.
• Cough and expectoration are not required

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Mechanism

• Mechanical, chemical, inflammation ?larynx,
  trachea, bifurcation of the bronchi. ?Afferent
  fibers are in the vague nerve ?cough center.
• Efferent signals ?larynx ? muscles of diaphragm,
  chest wall, abdomen
• A coordinated series of movement complete the
  cough. Deep inspiration expiration effort with
  glottis closed- glottis open abruptly high
  velocity of airflow brings out secretions from
  airways.

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Etiology

• Respiratory
• pleural disease
• cardiovascular disease
• central nerve system factor

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Respiratory disease
Stimulator --- extra and intrathoracic --- from
nose,oropharynx --- bronchi --- cough reflex.
such as 1.inhalation of foreign
material 2.inflammation of respiratory
tract 3.bleeding of respiratory
tract 4.tumor of respiratory tract
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Pleural Disease

• Such as
• pleurisy, thoracic effusion
• pleural biopsy or pleuracentisis

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Cardiovascular Disease

• Mitral stenosis --- left heart failure
  ---pulmonary edema --- trausudate or exudate ---
  stimulates intra-thoracic-cough receptor ---
  cough
• Embolism of pulmonary can cause pulmonary
  venous pressure elevate ---pulmonary edema
  ---transudate or exudate ---stimulates intra
  thoracic cough receptor ---cough

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Central nerve system

• Inflammatory of CNS can cause coughing
• such as encephalitis and meningitis

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Manifestation

• Character of cough
• The duration and pattern of cough
• The tone quality of cough
• The character and volume of sputum

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Character of cough

• Cough without sputum---unproductive or dry cough
  mainly in the patient of acute pharyngitis,
  early stage of bronchitis,pleurisy and TB.
• Cough with sputum is called productive .
• It is caused by pneumonia, chronic
  bronchitis, bronchiectasis, lung abscess
  and cavitious TB

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The duration and pattern of cough

• Cough initiated(??) suddenly --- acute upper
  airway infection
• Chronic cough --- chronic bronchitis, bronchial
  asthma and TB
• Paroxysmal cough --- whooping cough, bronchi
  compressed by tumor and TB

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The
duration and pattern of cough

• Periodic cough --- chronic bronchitis
  bronchiectasis related to the change of body
  position.
• Nocturnal cough---asthma, TB,chronic heart
  failure--associated with the vagal excitation at
  night.

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The tone(??) quality of cough

• It means the change of the sound and may suggest
  the the location of pathology.
• breaking cough --- epiglottal(???)disease
• brassy cough --- tracheal airways
• hacking or cleaning of throat--postnasal
  discharge
• barkingor croupy--laryngeal disease.

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The tone quality of cough

• Hoarseness with cough --- larynto-tracheal
  bronchitis or impaired the function of recurrent
  laryngeal nerve,as from aneurysm of the aorta,
  left atrial enlargement,mediastinal malignancy.
• Inspiratory stridor --- upper airway obstruction

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The tone quality of cough

• Cough with hemoptysis also raises the
  possibility of a malignant process,
  bronchiectasis, lung abscess, chronic
  bronchitis.

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The character and volume of sputum

• Characters mucoid, tenasious, purulent, blood
  stained.

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Sputum color

• White
• mucoid or serofluid sputum
• Yellow
• general bacterial infection
• Green
• aeruginosus Bacillus infection
• Grey or black
• dust inhalation
• Rusty
• Lobar pneumonia
• Pink
• cardiac edema
• Red
• hemoptysis

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Sputum foul odor

• anaerobic bacterium infection

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Sputum amount

• Bulk frothy(??) sputum
• Pulmo edema
• Bulk serofluid sputum
• Alveolar carcinoma
• Bulk pus sputum
• Bronchiectasis
• Lung abscess
• Layering
• upper frothy,
• middle mucoid or mucopus,
• lower necrosis substance

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Sputum consistency

• Mucoid sputum
• Bronchitis (without bacterial infection)
• Asthma
• Early stage of pneumonia
• Serofluid sputum
• Pulmo edema
• Pus sputum
• Any bacterial infection
• Bloody sputum

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The associated clinical features

• 1?cough with fever --- acute respiratory
  infection including measles, pneumonia,
  influenza, lung abscess, TB, pleurisy.
• 2?cough with chest pain --- plural cavity
  involve, heart disease, pneumonia, pleurisy,
  bronchogenic carcinoma.

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The associated clinical features

• 3?cough with dyspnea -------- edema of larynx,
  larynx tumor, chronic obstructive pulmonary
  disease, sever pneumonia, TB, massive pleural
  effusion, pulmonary congestion, pneumothorax and
  pulmonary edema.
• 4?cough with quantitative purulent sputum
  ---bronchiectasis, lung abscess,
  bronchi-fistula.

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The associated clinical features

• 5?Cough with hemoptysis --- bronchiectasis, TB,
  lung tumor, lung abscess, mitral stenosis.
• 6?cough with clubbed fingers --- bronchiectasis,
  TB, lung abscess ,carcinoma of lung, thoracic
  empyema(??).

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The associated clinical features

• Cough with wheeze --- bronchial asthma, cardiac
  asthma, foreign body in trachea and bronchi.

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Investigation

• General condition of the patient
• Time characters
• Voice characters
• Productive or not
• In relation with posture
• Accompany with chest pain with dyspnea, or other
  complications

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