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Cough adversely affects personal and work-related interactions, disrupts sleep, and often causes discomfort of the throat and chest wall Most people seeking medical attention for acute cough desire symptom relief; few are worried about serious illness Cough results from stimulation of mechanical or chemical afferent nerve receptors in the bronchial tree Effective cough depends on an intact afferent efferent reflex arc, adequate expiratory and chest wall muscle strength, and normal mucociliary production and clearance

public static void PrintValues(IEnumerable<Int32> myCollection) { IEnumerator<Int32> myEnumerator = myCollection.GetEnumerator( ); while (myEnumerator.MoveNext( )) { Console.Write("{0} ", myEnumerator.Current); }

Distinguishing acute (< 3 weeks) and persistent (> 3 weeks) cough illness syndromes is a useful first step in evaluation In healthy adults, most acute cough syndromes are due to viral respiratory tract infections Postinfectious cough lasting 3 8 weeks has also been referred to as subacute cough to distinguish this common, distinct clinical entity from acute and chronic

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cough Additional features of infection such as fever, nasal congestion, and sore throat help confirm the diagnosis Dyspnea (at rest or with exertion) may reflect a more serious condition, and further evaluation should include assessment of oxygenation (pulse oximetry or arterial blood gas measurement), airflow (peak flow or spirometry), and pulmonary parenchymal disease (chest radiography) The timing and character of the cough have not been found to be very useful in establishing the cause of acute or persistent cough syndromes, although cough-variant asthma should be considered in adults with prominent nocturnal cough Uncommon causes of acute cough illness should be suspected in those with heart disease (congestive heart failure [CHF]) or hay fever (allergic rhinitis) and those with environmental risk factors (such as farm workers) Cough due to acute respiratory tract infection resolves within 3 weeks in the vast majority of patients (over 90%) Pertussis infection should be considered in previously immunized adults with persistent or severe cough lasting more than 2 3 weeks and approaches a prevalence of 20% when cough has persisted beyond 3 weeks When angiotensin-converting enzyme (ACE) inhibitor therapy, acute respiratory tract infection, and chest radiograph abnormalities are absent, up to 90% of cases of persistent cough are due to postnasal drip, asthma, or gastroesophageal reflux disease (GERD) A history of nasal or sinus congestion, wheezing, or heartburn should direct subsequent evaluation and treatment, though these conditions frequently cause persistent cough in the absence of typical symptoms Bronchogenic carcinoma is suspected when cough is accompanied by unexplained weight loss and fevers with night sweats, particularly in persons with significant tobacco or occupational exposures Persistent cough accompanied by excessive mucus secretions suggests chronic bronchitis in a smoker, or bronchiectasis in a patient with a history of recurrent or complicated pneumonia; chest radiographs are helpful in diagnosis Dyspnea at rest or with exertion is not commonly reported among patients with persistent cough The report of dyspnea requires assessment for other evidence of chronic lung disease or CHF.

Cough, Fever, Tachycardia, and Crackles Cough Only with Normal Vital Signs Dullness to Percussion Crackles Fever Tachycardia 0 10 20 30 40 50 60 70 80 90 100 Revised Probability, %

Because the Queue class is enumerable, you can pass it to the PrintValues( ) method, which takes an IEnumerable interface. The conversion is implicit. In the PrintValues method, you call GetEnumerator, which is the single method required by all IEnumerable classes, as we mentioned earlier in the chapter. GetEnumerator( ) returns an IEnumerator, which you then use to enumerate all the objects in the collection. MoveNext( ) is a method of IEnumerator, so no matter what collection type you re using, you can always call MoveNext( ) to retrieve the next value. Current is the property of IEnumerator that represents the current value, so you can output the current value in the queue by outputting myEnumerator.Current. When there are no more values in the collection, MoveNext( ) returns false, which ends the while loop. Note that we re using a while loop here to demonstrate how IEnumerator works; in practice, you d probably use a foreach loop instead.

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