Cough management

Prophylactic, continuous use of antibiotics has no effect on the frequency of exacerbations antibiotics should only be used for treating infectious exacerbations. Antitussives are contraindicated because cough has an important protective role. Opioids may be effective for dyspnea in advanced disease but may have serious adverse effects they may be used to manage symptoms in terminal patients. 

It is also necessary to bear in mind the possible outcome of an exposure. When the worst outcome is likely to be a minor disability, such as an irritating cough or an annoying skin eruption, then the risk is minimal, but it should still be reduced as close to zero as is feasible. On the other hand, when the worst outcome is a major disability, such as debilitating bronchial asthma, liver and kidney disease, destructive blood disease, brain or nerve damage, cancer, or untimely death, then hazard control is absolutely necessary. It becomes essential, then, that you as a manager know what the possible outcomes are, how to establish permissible limits of exposure, and ultimately how to control the real and potential hazard. 

Q15 Which of the following active ingredients is NOT used for the management of cough ... 

Codeine, dextromethorphan and pholcodine are opioid cough suppressants indicated for dry cough. Sedating antihistamines, such as diphenhydramine, tend to have an antitussive action as well. Vitamin C is not used in the management of cough but may be used as a prophylaxis against colds. 

Cough P. and Roenninger S. New Guideline on Quality Risk Management for fhe Pharmaceutical Industry takes shape. The Regulatory Affairs Journal-Pharma 2005 16 91-93. 

Irwin RS, Boulet LP, Cloutier MM, et al. Managing cough as a defense mechanism and as a symptom. A consensus panel report of the American College of Chest Physicians. Chest. 1998 114(suppl) 133S-181S. 

You are the triage nurse in the emergency department on a cold and windy Saturday afternoon. Two women present to the ED with complaints of cough, runny eyes, headache, and report smelling a foul odor. Ten minutes later, three more people arrive with the same complaint. Five minutes later, eight more patients present to the ED with a similar story. Identify how you would manage this situation. 

While decontamination and supportive therapy are the mainstays of treatment, antidotes to counteract HD vapor, aerosol, or liquid exposures do not exist (Yu et al, 2003). Adult decontamination may include bleach solutions however, this method can cause greater toxicity in children. Soap and water are the preferred agents to use for decontamination in children. Supportive care consists of the management of pulmonary and skin manifestations such as the use of cough suppressants and/or topical silver sulfadiazine for bums (Yu et al, 2003 Sidell et al, 1997 Azizi and Amid, 1990). Pediatric dosage and treatment recommendations for vesicant exposures are displayed in Table 61.5. 

Chronic obstructive pulmonary disease is a respiratory condition characterized by irreversible airway obstruction caused by chronic bronchitis or emphysema. The major symptoms of COPD include chronic cough, increased sputum production, and dyspnea. The vast majority of patients with COPD are those who are current or former heavy smokers. Other risk factors for the development of COPD include occupational exposure (dusts, chemicals) and rare genetic disorders (a -antitrypsin deficiency). The medical management of COPD includes pharmacotherapy (bronchodilators, corticosteroids, and antibiotics) in combination with interventions to reduce risk factors for disease progression (e.g., smoking cessation). Some patients require long-term administration of supplemental oxygen. 

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