Content Objective: Cough

By the end of the Family Medicine Clerkship, the medical student will be able to:

1. Conduct a patient interview and appropriate focused physical examination to identify the common and important causes of cough, particularly
   
   • Acute causes
     • Infectious (viral/bacterial)
     • Exacerbation of Asthma
     • Exacerbation of COPD
     • Post-viral cough
     • Exacerbation of CHF
   • Chronic causes (including screening for red flags, e.g. weight loss, hemoptysis)
     • Post-nasal drip
     • GERD
     • Asthma
     • COPD/smoking
     • Infection (eg. tuberculosis)
     • Medication (i.e. ACE Inhibitor)
     • Congestive Heart Failure (NYHA Classifications)
     • Neoplasm
2. Include an appropriate environmental, occupational, and travel history as part of the patient interview in a patient presenting with cough.
   
   
3. Propose a relevant initial investigation plan (e.g. chest xray, spirometry) for a patient with cough.
   
   
4. Recognize a patient with respiratory distress (e.g. hypoxia, tachypnea, etc.) and seek immediate help.
   
   
5. Suggest a preliminary/initial management plan for patients with cough, particularly for the acute and chronic causes listed above, avoiding unnecessary use of antibiotics.


6. Explain underlying pathophysiology of asthma to patients and/or family members.
   
   • in relation to acute & recurrent episodes and prophylaxis principles
   • in relation to mechanism of action for relevant meds
   • in relation to red flags of impending asthma crisis
7. Assess asthma control at follow-up.
   
   
8. Identify modifiable triggers for patients with asthma.


9. Describe the different asthma medication delivery methods (and relevant compliance/educational issues.)
   
   
10. Describe major medication categories for asthma, including mechanism of drug action, particularly SABA and ICS, their benefits and risks.
    
    
11. Counsel patients on the benefits of smoking cessation.
    
    
12. Describe major medication categories for COPD, including mechanism of drug action, particularly SABA and LABA, their benefits and risks.

Mandatory Clinical Encounter

• Cough

Resources*

• Chronic Cough Webinar - see Brightspace for slides
• Benich JJ, Carek PJ. Evaluation of Patient with a chronic cough. Am Fam Physician 2011; 84(8):887-892.
• Asthma in Adults - Recognition, Diagnosis and Management, BCGuidelines.ca 2015
• Asthma in Children - Diagnosis and Management, BCGuidelines.ca 2015
• CPS position statement “Diagnosis and management of asthma in preschoolers 2015”
• LearnFM, Asthma clinical cards
• Asthma, TOP guideline 2018
• COPD, BCGuidelines.ca 2017
• Canadian Thoracic Society Guideline Library

* Where a specific resource is not listed for a particular objective, please refer to recommended general texts/websites. Resources have often been selected from the Clinical Practice Guidelines and Protocols in British Columbia and Alberta’s Towards Optimized Practice Clinical Practice Guidelines. These are often concise summaries of national guidelines.