clinical approach to a patient with chest pain

1. ETIOLOGY
OF COUGH

2. CAUSES
Respiratory Cause
COUGH
Non-respiratory Cause

3. RESPIRATORY CAUSE
 Airway irritation
 Aspirated material
 Inflammation
 Infiltration
 Constriction of airway
 Parenchymal lung diseases - Interstitial Lung
Disease, Pneumonia, Lung abscess
 Drugs- ACE inhibitor, beta blockers, NSAID

4. AIRWAY IRRITANTS
 EXOGENOUS
Smoke, dust, fumes, foreign bodies
 ENDOGENOUS
Upper airway secretions, gastric contents

5. INFLAMMATION
 Airway infection
viral or bacterial
 Bronchitis, bronchiectasis
 Asthma, cough variant asthma
INFILTRATION
 Bronchogenic carcinoma
 Infiltration with granulomas- endobronchial
sarcoidosis, TB

6. BASED ON DURATION
ACUTE (<3 Weeks)
COUGH
CHRONIC (>3 Weeks)

7. ACUTE
 URTI, common cold, inhaled foreign
body, inhalation of irritant dust or fumes
 Pneumonia, pulmonary
embolism, CCF, bacterial sinusitis

8. CHRONIC
 GERD
 Asthma
 Post nasal drip
 COPD
 Bronchogenic carcinoma
 TB
 ILD
 ACE inhibitor

9. ORIGIN
 Pharynx – post nasal drip
 Larynx – laryngitis, tumor, whooping cough
 Trachea – tracheitis
 Bronchi – bronchitis, COPD, asthma, bronchogenic
CA
 Lung parenchyma –
TB, pneumonia, bronchiectasis, pulmonary
edema, interstitial fibrosis

10. NON-RESPIRATORY CAUSES
 PRESSURE ON TRACHEA OR BRONCHUS
Aortic
aneurysm, cardiomegaly, mediastinal
tumor, lymph node
 CVS – pulmonary edema, mitral stenosis
 GIT – GERD
 Reflex causes – foreign body
 Psychogenic causes