Cough and Infections in Adults

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Cough and Infections in Adults

• A/Prof. Cheong Pak Yean
• MBBS FAMS FRCPE FCFPS FACP

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Cough - a natural reflex

• Response to irritation of cough receptors mostly
  found in breathing passages/ tubes
• Protects body by expelling excessive phlegm and
  harmful substances
• In treating cough, two important principles
• Where is the site of irritation
• What is the cause of the irritation

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Where What of Cough?

• WHERE ?
• RESPIRATORY TRACT
• Upper - Nose Sinuses, Throat, Wind-pipe
• Lower - Bronchial (tubes) Lungs
• RARELY OTHER SITES eg. Diaphragm
• WHAT?
• Infections - viral, bacteria
• Air pollutants, some medications

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Where What of Cough?

• WHERE ?
• RESPIRATORY TRACT
• Upper - Nose Sinuses, Throat, Wind-pipe
• Lower - Bronchial (tubes) Lungs
• RARELY OTHER SITES eg. Diaphragm
• WHAT?
• Infections - viral, bacteria
• Air pollutants, some medications

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Cough Infections

• 70 of patients with main complaint of cough in
  adults seen in clinics due to acute Upper
  Respiratory Tract Infection (URTI)
• Most URTI due to virus - but important for
  doctors to detect those URTI due to bacteria
  where antibiotics are useful
• Also important to detect Lower RTI eg pneumonia -
  antibiotics are life-saving
• Antibiotics more readily used for infections of
  existing diseased lungs especially in the elderly

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The crux of issueUse antibiotics wisely

• Both doctors patients have roles in limiting
  the use of antibiotics in cough related ailments
• Doctors in prescribing antibiotics use clinical
  judgement guidelines
• Patients understanding patience- no
  unrealistic expectations of quick-fix- complete
  course of antibiotics

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Benefits of Appropriate Antibiotic Use

• Reduces antibiotic-resistant organisms in the
  community eg. Strep pneumonia
• Reduces costs for patients and payors
• Reduces side-effects of some antibiotics
• How to achieve this?

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Clinical guideline - Acute Rhino-sinusitis

• Bacterial and Viral causes difficult to
  differentiate on clinical grounds alone
• Antibiotics should be reserved for those
  Symptoms lasting 7 days or more with cheek or
  teeth pain especially if one-sided and purulent
  nasal secretion Severe symptoms regardless of
  duration if one-sided pain

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Clinical guideline -Acute Bronchitis

• Aim to rule out complications eg pneumonia
  other serious illness by history clinical
  examination (lung signs)
• Routine use of antibiotics of uncomplicated
  bronchitis with cough of less than 3 weeks not
  useful
• Good doctor-patient communication and trust more
  important than issue of antibiotics

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Patients Role Crucial

• Understanding natural history of cough ailments
• Co-operate in treatment and review
• Be patient
• Red flagsProlonged cough more than 3
  weeksCoughing bloodHigh feverLoss of weight

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Take Home Messages

• Cough is a symptom ( a reflex) - knowing the site
  and cause of irritation important
• Site - If respiratory tract , upper or lower?
• Cause - if infection viral or bacteria?
• Depending on site and cause, decide further
  examination tests necessary Symptom treatment
  (cough medicine) Antibiotics needed

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Cough Medicine

• Medicine that decrease cough
• Cough mixtures ( combination of various active
  pharmocological agents that act to decrease cough
  reflexes)
• Other medicine eg. Broncho-dilator in asthma also
  decrease cough
• Avoidance - If side-effect of some medicine eg.
  High blood pressure medicine or environment
  pollution

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Cough Mixtures

• Concept of suppressant or expectorants out-dated
• Where and what causes the cough?
• Usual components of mixturesCough centre
  suppressant eg. CodeineAntihistaminesDecongestan
  tsMucolyticsDemuclents eg. HoneyCounter-irritan
  ts eg. menthol

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• Thank You!