COUGH

Whooping Cough

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Whooping cough (or, Pertussis) is an acute infectious,communicable disease affecting the respiratory tract, characterized by
spasmodic attacks of coughing & accompanied by an inspiratory whoop.

CAUSES


Causative organism – Haemophilus Pertussis (or Ordetella Pertussis)

  • AGE- mostly less than 05 years.
  • mostly females.
  • Season -usually colder months.. Spread -by droplet infection

PATHOLOGY‣ The whole respiratory tract from nasopharynx down to bronchi is involved in a narcotizing inflammation along with inflammation of the peri-bronchial and tracheobronchial lymphoid tissue. The stickiness of exudate is responsible for obstruction of bronchioles leading to atelectasis.

SYMPTOMS

  • Incubation period 01 to 03 weeks.
  • CLINICALs Catarrhal stage: Duration – one week withgradual onset.
  • Dry cough, vomiting occasionally following a severe bout of cough.
  • Anorexia and insomnia.
  • Sneezing, coryza and lacrymation (sometimes conjunctivitis).
  • Moderate fevers.
  • Paroxysmal Stage: Duration – 2 to 4 weeks.
  • Cough(paroxysmal) 30 to 50 times a day. thick mucoid sputum and vomiting maybccur at the end of bouts.
  • ‘Glottis may have ulcer, spasm and oedema.
  • Tetany due to severe vomiting.
  • Bleeding tendency i.e. haemoptysis, epistaxis, purpura,Whoop immediately following the intestinal haemorrhage may occur.
  • Convalescent Stage: Usually begins within 4 weeks after the acute onset.
  • Cough becomes less frequent and sputum is less tenacious.
  • Vomiting may rarely occur as a matter of habit.
  • Improving appetite.
  • Immunity after illness lasts long.

INVESTIGATION

  • CBC
  • ESR
  • SPUTUM CULTURE
  • X-Ray Chest

PROGNOSIS

Better in older children and in the aged but comparatively worse below 03 years.

PROPHYLAXIS

Triple antigen should be given in a dose of 1-cc subcutaneously after every month for three doses. Booster doses after one year and once again before going to school.

COMPLICATIONS

  • Pneumonia
  • Emphysema
  • Dyspnea
  • Toxic Encephalitis
  • Pneumothorax
  • Umbilical hernia
  • Convulsions
  • Meningitis
  • Cerebral hemorrhage
  • Enteritis
  • Otitis media
  • Fulminant Tuberculosis

MANAGEMENT & TREATMENT

  • Bed rest in a well ventilated calm and quiet room during catarrhal stage and for a time during paroxysmal stage.
  • Diet liquids and semi solid diet, feeds should be given immediately after vomiting or paroxysms and should be small & frequent.
  • Cough suppressants may also be used, e.g. phensedyl (promethazinecodeine, ephedrine) .
  • Sedativeday Satriclofos (Tricloryl) syrup 250-mg.
  • Antibiotics tetracycline 50-mg- per kg of body weight daily in divided doses (or Ampicillin 150-mgm. per kg of body wenght.Erythromycin 50-mg. or Hyper-immune convalescent serum 20-ml. intravenously at 2-3 days intervals.

All treatment should be given on the instructions of your Physician.

ASTHMA

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It is an allergic condition characterised by paroxysmal attacks of dyspnoea accompanied by wheezing,chiefly expiratory in nature,associated with bronchial spasm.

TYPES

  1. Extrinsic – Starts in childhood,becomes alright in adult life.
  2. Intrinsic- Starts in adult,continue rest of life.

CAUSES

  • Psychic upset- emotional strain,anxiety,worry,etc.
  • Bronchial stimulation- by cold air or fog,dust,fumes etc.
  • Bronchial infection by various pathogenic organisms.
  • Allergy to various- (a)-inhalants,ex-pollens,room dust,book dust,orris-root powder,animal and flower emanations,drugs,gum acacia etc.
  • (b)-Ingestants,ex-eggs,milk,fish,cheese,crabs,drugs,etc.
  • Smoking and Second hand smoke.

RISK FACTORS

  • Heredity
  • Sex Both
  • Mostly start is chilhood or younger age..

PATHOLOGY

During the attacks,lungs are voluminous and emphysematous,filling the entire pleural cavities Area of emphysema alternates with the areas of atelectasis or collapse.If asthma associated with bronchitis,emphysema ensues.

SYMPTOMS

  • Dyspnea
  • Cyanosis,pale.
  • Tachycardia
  • Wheezing Sound during respiration.
  • Anxiety
  • Breathless
  • Chest pain
  • Severe Cough(Occurs at night)(dry or with phlegm)

INVESTIGATION

  • X-Ray Cest
  • CBC
  • ESR
  • Sputum Culture
  • Test By Spirometry
  • Peak flow test
  • Allergy Test
  • Sinus X-ray

COMPLICATIONS

  • Lung infection
  • Status Asthmaticus.
  • Bronchitis or Tuberculosis
  • Emphysema of lungs
  • Bronchiectasis
  • Heart Attack

PROGNOSIS

The individual attacks is good ,except in severe status asthmaticus where there is occasionally a fatal outcome.Spontaneous recovery is fairly common in episodic asthma,particularly in children,but rare in chronic asthma,which often causes permanent pulmonary damage.

PREVENTION

Prevention of cold ,dust,infection,food avoid allergens.Rest in bed in propped up position on a back rest or sitting up in a chair which one is comfortable.Control of infection by appropriate antibiotics.

MANAGEMENT & TREATMENT

  • Anti Inflammatory Drugs Should be use.
  • Psychotherapy make good role.
  • Bronchodilators Uses makes better relief.
  • Inhaler and Inhaled Corticosteroids.
  • Deriphyllin, Theophylline Ampicilin,Azithromycin.
  • Nebulization is first .(Asthalin ,Budecort)
  • In Chronic and Severe conditions O2 applied.
  • Breathing Exercise, Yoga And meditation.
  • Follow the prevention and instructions given by your Doctor.