Cough &
Expectoration
Zhengcuixia
Concept
? A protective reflex that can be controlled
consciously
? Remove excessive secretion & foreign
material from the airway
? Initiated by miscellaneous stimuli or by
voluntary exertion,
? The most common respiratory symptom,
Cough reflex,
?Irritant type,mechanical,chemical,
inflammation
?Afferent inform.from,larynx,trachea,
bifurcation of the bronchi,
?Afferent fibers are in the vague nerve
cough center,
Cough reflex
? 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,
Influencing factors
? depressed afferent or efferent nerve function
? Failed glottis function
? Diminished muscle force
? Obstructed airway seen in severe COPD
? Trachea intubation
? Chest or abdominal pain limit cough movement
Causes
? Airway stimulation by chemicals & foreign
material
? Airway infection & inflammation
? Afferent nerve fiber
? Lung parenchyma disorders
Causes
? Pleural & chest wall disorders
? Cardiovascular abnormalities
? Other causes Psychiatric cough
classification
? Non production ( dry cough )
? Production (with sputum)
Clinical appearance in common
diseases
? Acute respiratory infection
? Exacerbation of chronic infectious illnesss
COPD
Bronchyactesis
?Chronic cough,postualnasal drip syndrom,cough type asthma,
smoker
Clinical appearance in common
diseases
? Neoplasms
? Pleural disease
? Cardiovascular diseases
? General disease affecting the respiratory system
Accompanied abnormalities
? Fever
? Chest pain
? Dyspnea & whistle
? Sputum production
complication
? Tussic emesis
? Fatigue
? Fractures due to severe persistent cough
（骨折）
? Pneumomediastinum,pneumothorax,and
subcutaneous emphysema due to high
intrathoracic pressure during cough,
? Cough syncope syndrome
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
roentgenogram
normal abnormal
Smoker Pneumonia & other infectious
diseases
Asthma Neoplasm
Postnasal drip Cardiovascular problem
Common cold Pleural effusion
Sputum production
(expectoration)
Denote airway secretions being
coughed out,
? Characters,mucoid,tenasious,
purulent,blood stained,with
special odor,rusty,serous
? Volume,
? Accompanied manifestation
? Special conditions
?Mucoid sputum can be produced with many acute or
chronic infections
?Pneumococcal pneumonia,rusty
?Klebsiella pneumonia,the sputum resembles currant
jelly
?Abcess,the massive purulent sputum forms layers
contains WBC pieces and necrotic tissue,
?Bronchiectasis,recurrent massive yellow-green
thick purulent sputum with intermittent hemoptysis
Aspired pneumonia,foul smelling purulent
sputum due to anaerobic infection
? trachio-esophagal fistula,
? Broncho-pleural fistula,
? Frothy pink serous sputum seen in acute LVF
? Massive serous sputum can be seen in alveolar
carcinoma
Laboratory examination
? Routine
? Microbiologic test ( including culture &
drug sensitivity)
? Cellular test
hemoptysis
? Blood originate below the level of the
larynx that being coughed out is called
hemoptysis,
? Degrees,from blood-tinged sputum to
massive gross blood,even leading to airway
occlusion (apnea ) & shock,The latter is
much less seen,
Common causes
? Infectious respiratory disease,
Bronchitis
Bronchiactesis
TB
? Cardiovascular disease,
MS
PE
PAH
Deformity of blood vessle
? Neoplasm,
? Other less seen disease leading to
hemoptysis
Clacification
? Small
? Moderate
? Massive
Differentiating from hematemesis
hemoptysis hematemesis
Coughed up with frothy Vomited without frothy
Preceded by stimulating cough Preceded nausea,vomiting
Bright red Dark red or brown
alkaline acid
History of coughing History of gastric,liver disease
Blood-tinged sputum for days No blood-tinged sputum
Mixed with sputum materials Mixed with food particles
Anemia variable Blood loss common
Differentiating from upper airway
bleeding by intenssive
investigation and examination
? Post nasal bleeding
? Mouth and farynxil membrane bleeding
Investigation
? If coughed out or vomitted out
? Volume,how much
? Time duration
? Any accompanied appearances
Emergency precedure
Maintain airway opened
Expectoration
Zhengcuixia
Concept
? A protective reflex that can be controlled
consciously
? Remove excessive secretion & foreign
material from the airway
? Initiated by miscellaneous stimuli or by
voluntary exertion,
? The most common respiratory symptom,
Cough reflex,
?Irritant type,mechanical,chemical,
inflammation
?Afferent inform.from,larynx,trachea,
bifurcation of the bronchi,
?Afferent fibers are in the vague nerve
cough center,
Cough reflex
? 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,
Influencing factors
? depressed afferent or efferent nerve function
? Failed glottis function
? Diminished muscle force
? Obstructed airway seen in severe COPD
? Trachea intubation
? Chest or abdominal pain limit cough movement
Causes
? Airway stimulation by chemicals & foreign
material
? Airway infection & inflammation
? Afferent nerve fiber
? Lung parenchyma disorders
Causes
? Pleural & chest wall disorders
? Cardiovascular abnormalities
? Other causes Psychiatric cough
classification
? Non production ( dry cough )
? Production (with sputum)
Clinical appearance in common
diseases
? Acute respiratory infection
? Exacerbation of chronic infectious illnesss
COPD
Bronchyactesis
?Chronic cough,postualnasal drip syndrom,cough type asthma,
smoker
Clinical appearance in common
diseases
? Neoplasms
? Pleural disease
? Cardiovascular diseases
? General disease affecting the respiratory system
Accompanied abnormalities
? Fever
? Chest pain
? Dyspnea & whistle
? Sputum production
complication
? Tussic emesis
? Fatigue
? Fractures due to severe persistent cough
（骨折）
? Pneumomediastinum,pneumothorax,and
subcutaneous emphysema due to high
intrathoracic pressure during cough,
? Cough syncope syndrome
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
roentgenogram
normal abnormal
Smoker Pneumonia & other infectious
diseases
Asthma Neoplasm
Postnasal drip Cardiovascular problem
Common cold Pleural effusion
Sputum production
(expectoration)
Denote airway secretions being
coughed out,
? Characters,mucoid,tenasious,
purulent,blood stained,with
special odor,rusty,serous
? Volume,
? Accompanied manifestation
? Special conditions
?Mucoid sputum can be produced with many acute or
chronic infections
?Pneumococcal pneumonia,rusty
?Klebsiella pneumonia,the sputum resembles currant
jelly
?Abcess,the massive purulent sputum forms layers
contains WBC pieces and necrotic tissue,
?Bronchiectasis,recurrent massive yellow-green
thick purulent sputum with intermittent hemoptysis
Aspired pneumonia,foul smelling purulent
sputum due to anaerobic infection
? trachio-esophagal fistula,
? Broncho-pleural fistula,
? Frothy pink serous sputum seen in acute LVF
? Massive serous sputum can be seen in alveolar
carcinoma
Laboratory examination
? Routine
? Microbiologic test ( including culture &
drug sensitivity)
? Cellular test
hemoptysis
? Blood originate below the level of the
larynx that being coughed out is called
hemoptysis,
? Degrees,from blood-tinged sputum to
massive gross blood,even leading to airway
occlusion (apnea ) & shock,The latter is
much less seen,
Common causes
? Infectious respiratory disease,
Bronchitis
Bronchiactesis
TB
? Cardiovascular disease,
MS
PE
PAH
Deformity of blood vessle
? Neoplasm,
? Other less seen disease leading to
hemoptysis
Clacification
? Small
? Moderate
? Massive
Differentiating from hematemesis
hemoptysis hematemesis
Coughed up with frothy Vomited without frothy
Preceded by stimulating cough Preceded nausea,vomiting
Bright red Dark red or brown
alkaline acid
History of coughing History of gastric,liver disease
Blood-tinged sputum for days No blood-tinged sputum
Mixed with sputum materials Mixed with food particles
Anemia variable Blood loss common
Differentiating from upper airway
bleeding by intenssive
investigation and examination
? Post nasal bleeding
? Mouth and farynxil membrane bleeding
Investigation
? If coughed out or vomitted out
? Volume,how much
? Time duration
? Any accompanied appearances
Emergency precedure
Maintain airway opened
