Approach to cough and hemoptysis

1. Cough and
Hemoptysis
DR.Bilal Natiq Nuaman,MD
C.A.B.M. ,F.I.B.M.S. ,D.I.M. ,M.B.Ch.B.
2018-2019

2. Cough
• Definition:
‘A Cough is a forced expulsive manoeuvre,
usually against a closed glottis and which is
associated with a characteristic sound’
It is caused by stimulation of sensory nerves
in the mucosa of the pharynx, larynx, trachea and
bronchi.
Cough is the single most common respiratory
complaint for which patients seek care

7. Classification of Cough
• Acute Cough = < 3 Weeks Duration
• Chronic Cough > 8 Weeks Duration

8. Acute Cough <3 weeks
Differential Diagnosis(CAUSES)
• Upper Respiratory Tract infections(URTI):
Viral syndromes, sinusitis , pertussis
• URTI triggering exacerbations of Chronic Lung
Disease eg Asthma/ COPD
• Pneumonia
• Left Ventricular Heart Failure
• Foreign Body Aspiration

11. COPD
1. Chronic Bronchitis :
defined clinically as Productive cough (cough with sputum
expectoration ) in a chronic smoker for at least 3 months
a year during a period of 2 consecutive years with
exclusion of other causes of productive cough .
2. Emphysema :
defined pathologically as an abnormal permanent
enlargement of air spaces distal to the terminal
bronchioles, accompanied by the destruction of alveolar
walls without obvious fibrosis.

12. Post nasal drip PND(upper airway cough syndrome UACS )

13. • Gastroesophageal reflux disease (GERD) refers to
acid reflux, or backward flow, of stomach acid and other
contents into the esophagus. If stomach acid moves backward
up the esophagus, reflexes result in spasm of the airways that
can cause shortness of breath and coughing. In some
individuals, no sensation of heartburn is felt and their only
symptom may be cough.
Diagnostic tests:
• 24-hour esophageal pH probe (best)
• OGD – Esophagogastrodudenoscope
Therapeutic trial: gastric acid suppression with proton pump
inhibitor (e.g. omeprazole) for ≥ 2 months, combined with diet and
lifestyle modification

16. History
1-Onset and Duration :
Acute : < 3weeks
Chronic : > 8 weeks
2-Character :
Bovine with Hoarsness----Left recurrent laryngeal nerve palsy
causing left vocal cord paralysis due to CA Lung
Barking with Hoarsness and Stridor -----Acute Epiglottitis,
Laryngitis , CA Larynx
Wheezy ------COPD , Asthma

19. 2-Amount of Sputum
How much sputum is coughed up each day ? Is it a small
(a teaspoonful) or large (a teacupful) amount?
Bronchiectasis-------- a long history of large amount of purulent
sputum to be coughed up mainly in morning on changing
posture .
Pulmonary Oedema ------ Large volumes of watery frothy
sputum with a pink tinge in an acutely dyspnic patient .

26. Hemoptysis
• Coughing up blood, irrespective of the amount, is an alarming
symptom and patients nearly always seek medical advice. A
history should be taken to establish that it is true hemoptysis
and not hematemesis, or gum or nose bleeding.
• Hemoptysis must always be assumed to have a serious cause
until this is excluded .
• Massive Hemoptysis:
It is coughing of about 600ml blood/24 h

30. History
• A history of repeated small haemoptysis is highly suggestive of
bronchial carcinoma.
• Fever, night sweats and weight loss suggest tuberculosis.
• Pneumococcal pneumonia often causes 'rusty'-coloured
sputum but can cause frank haemoptysis, as can all
suppurative pneumonic infections including lung abscess.
• Bronchiectasis can cause catastrophic bronchial
haemorrhage,
• pulmonary thromboembolism is a common cause of
haemoptysis and should always be considered.

31. Thank you