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Cough and sputum
A cough is one of the most common presentations of respiratory pathology. The timing, onset, precipitating factors and progression of a cough should be noted along with the amount and appearance of sputum produced. The most common patterns are shown in Table 3.1.
Haemoptysis (coughing up of blood from the lungs) may be caused by a number of conditions. It is usually streaky, rusty coloured and mixed with sputum. It should be distinguished from haematemesis (vomiting of blood) which may appear bright red or like coffee grounds.
· The most common cause is acute infection, particularly with underlying chronic obstructive airways disease.
· Other important causes are bronchial carcinoma and tuberculosis – these should be looked for, unless in a young, non-smoking patient with an acute infection.
· Pulmonary oedema in cardiac failure causes pink, frothy sputum and pulmonary infarction such as pulmonary embolism may cause haemoptysis.
· Other less common causes include Goodpasture’s syndrome, vasculitis such as microscopic polyarteritis, cystic fibrosis and clotting abnormalities.
Massive haemoptysis may be caused by bronchiectasis, bronchial carcinoma or tuberculosis.
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