Abstract
Cough, shortness of breath, and chest pain are symptoms that millions of patients experience each year. There are many causes of these symptoms, some of which are the result of minor illness and others that denote life-threatening emergencies. This chapter is designed to briefly discuss some of the most commonly diagnosed conditions and their management.
Keywords
bronchitis, cough, chest pain, pneumonia, shortness of breath
1
What are the most common triggers for cough?
Viruses, viruses, viruses! The majority of cases of acute cough are due to viral upper respiratory infections that lead to increased nasal secretions and subsequent postnasal drip. Other common triggers include asthma, chronic obstructive pulmonary disease (COPD), environmental or occupational exposures, gastroesophageal reflux disease (GERD), and congestive heart failure (CHF).
2
What is the best way to treat a cough?
The best management strategy depends on the specific problem that triggers the cough. For example, bronchospasm caused by asthma is best treated with corticosteroids and inhaled beta agonists. For cough associated with postnasal drip or viral bronchitis, symptomatic treatment may be achieved with over-the-counter antihistamines, decongestants, antitussives, or expectorants. More severe cough or bronchospasm sometimes responds to codeine-containing medications or to prescription antitussives such as benzonatate (Tessalon).
3
What are some complications that may accompany severe or prolonged coughing?
Common complaints in patients with persistent cough include musculoskeletal chest pain, pleurisy, posttussive emesis, sore throat, and headache. Rarely, more serious complications such as rib fractures, pneumothorax, or pneumomediastinum can occur with severe or prolonged bronchospasm.
4
A patient presents with shortness of breath. What are the most important parts of the history?
Age and history of known cardiac or pulmonary disease. Other key features of the history include associated symptoms such as diaphoresis or chest pain, presence of fever or cough, and status as a current or former smoker.
5
What physical exam finding would be most concerning in a patient complaining of shortness of breath?
Work of breathing! Vital signs and overall appearance are critical in determining how to manage these patients. Abnormal vital signs, accessory muscle use, and decreasing mental status are likely to have a more serious etiology as a cause of their difficulty breathing. Auscultating lung sounds, checking for lower extremity edema, and evaluating the nasopharynx, throat, and ears for signs of infection/inflammation are also important pieces of the clinical puzzle.
6
Describe the relevance of wheezing, rales, rhonchi, and diminished breath sounds
Wheezing is generally associated with reactive airway disease such as COPD or asthma. It can also be heard in acute bronchitis, foreign body aspiration, or CHF. Rhonchi are generally coarse sounds heard in specific lobes that tend to correspond to underlying infection. Rales or crackles are wet sounds often heard at lung bases that usually are due to fluid accumulation. Diminished breath sounds can be due to diminished air movement, pleural effusion, pneumothorax, or prohibitive body habitus.
7
What features of the history favor noncardiac etiology of chest pain?
Younger patients without known cardiac risk factors are unlikely to have chest pain due to occlusive coronary artery disease. Pain that is very brief in duration, described as sharp or burning, does not radiate, is not associated with shortness of breath, Nausea/Vomiting (N/V), or diaphoresis, and that is not worse with exertion or improved with rest all decrease the chances of serious underlying disease as the cause of their symptoms.
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