Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

416 Cough

differential diagnosis

Acute Cough

■Infectious:

➣Otitis media, acute bronchitis, acute sinusitis, laryngopharyngi-

tis

➣Pneumonia (CXR)

➣TB (PPD, CXR, sputum for AFB)

■Pulmonary embolus (50% present with acute cough; arterial blood

gas, ventilation/perfusion scan and/or spiral chest CT first tests

done)

■Foreign body in large airways (bronchoscopy)

■Pulmonary edema (cardiac evaluation)

Chronic Cough (>3 Wks Duration)

■Most commonly due to postnasal drip/chronic sinusitis, asthma,

GERD, chronic bronchitis and bronchiectasis

■Chronic sinusitis (sinus CT)

■Cough variant asthma (spirometry; methacholine bronchoprovoca-

tion if spirometry normal)

■GERD (esophageal pH monitoring)

■Chronic bronchitis (cough with daily sputum x 3 mo in 2 conse-

cutive y)

■Bronchiectasis (HRCT)

■Pulmonary fibrosis (pulmonary function tests, HRCT, broncho-

scopy, lung biopsy)

■Bronchogenic carcinoma (chest CT, transbronchial or Wang needle

biopsy, CT-guided FNA)

■Tracheal narrowing: carcinoma, thyroid enlargement (CT)

■Chronic aspiration (barium swallow)

■Medications (ACE inhibitor)

management

What to Do First

■Treat potentially rapidly progressive process (infection, asthma, PE,

CHF)

General Measures

■Avoid toxins, irritants and allergens (change home or work environ-

ment)

■Smoking cessation

■Treat underlying cause