Cough: Difference between revisions

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*[[Allergic bronchopulmonary aspergillosis]]
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*[[Yersinia Pestis Infection]]
*[[Yersinia Pestis Infection]]

Revision as of 13:57, 1 May 2009

Cough
ICD-10 R05
ICD-9 786.2

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Overview

A cough, also known as tussis is a sudden, often repetitive, spasmodic contraction of the thoracic cavity, resulting in violent release of air from the lungs, and usually accompanied by a distinctive sound.

Coughing is an action the body takes to get rid of substances that are irritating the air passages. A cough is usually initiated to clear a buildup of phlegm in the trachea. Coughing can also be triggered by a bolus of food entering the trachea rather than the esophagus due to a failure of the epiglottis. Frequent or chronic coughing usually indicates the presence of a disease. Provided the patient is a non-smoker and has a normal chest X-ray, the cause of chronic cough in 93% of all patients is due to asthma, heartburn or post-nasal drip. Other causes of chronic cough include chronic bronchitis and medications such as ACE inhibitors. Coughing can happen voluntarily as well as involuntarily.

Physiology

A cough is a protective, primitive reflex in healthy individuals. The cough reflex is initiated by stimulation of two different classes of afferent nerves, namely the myelinated rapidly adapting receptors, and nonmyelinated C-fibers with endings in the lungs.

Cause

A persistent cough can be debilitating, socially distressing, and adversely impair quality of life.[1] One of the more common presentations to a medical practitioner is a dry cough. The common causes of chronic dry coughing include post-nasal drip, gastroesophageal reflux disease, asthma, post viral cough and certain drugs such as beta blockers, ACE inhibitors and aspirin. If a cough lasts for more than three weeks, multiple causes are likely and symptoms will abate only when all the causes are treated will the patient be symptom free. Individuals who smoke often have a smoker's cough, a loud, hacking cough which often results in the expiration of phlegm.

Coughing may also be used for psychological or social reasons, such as the coughing before giving a speech. This is known as psychogenic, habit or tic coughing, and may increase in frequency in social situations featuring conflict.[2]

Given its irritant nature to mammal tissues, capsaicin is widely used to determine the cough threshold and as a tussive stimulant in clinical research of cough suppressants.

Complete List of Differential Diagnoses Sorted by Nonproductive vs Productive Nature of Cough

Nonproductive Cough

Productive Cough

Complete Differential Diagnosis of Cough Sorted by Frequency of Causes

In alphabetical order. [3] [4]

Most Common Causes

Other Causes


Complications

The complications of coughing can be classified as either acute or chronic. Acute complications include cough syncope (fainting spells due to decreased blood flow to the brain when coughs are prolonged and forceful), insomnia, cough-induced vomiting, rupture of blebs causing spontaneous pneumothorax, subconjunctival hemorrhage or "red eye", coughing defecation and in women with a prolapsed uterus, cough urination. Chronic complications are common and include abdominal or pelvic hernias, fatigue fractures of lower ribs and costochondritis.

Treatment

Coughs can be treated with cough medicines. Dry coughs are treated with cough suppressants (antitussives) that suppress the body's urge to cough, while productive coughs (coughs that produce phlegm) are treated with expectorants that loosen mucus from the respiratory tract. Centrally acting cough suppressants, such as codeine and dextromethorphan reduce the urge to cough by inhibiting the response of the sensory endings by depolarization of the vagus nerve. A recent study indicates that, because of the presence of theobromine in chocolate, 50 grams of dark chocolate may be an effective treatment for a persistent cough.[1]

Gargling with salt and warm water can also be helpful by reducing phlegm.

During injections

Coughing during an injection can lessen the pain of the needle stick caused by a sudden, temporary rise in pressure in the chest and spinal canal, inhibiting the pain-conducting structures of the spinal cord.[5]

See also

References

  1. 1.0 1.1 Omar S. Usmani, Maria G. Belvisi, Hema J. Patel, Natascia Crispino, Mark A. Birrell, Marta Korbonits, Dezso Korbonits, and Peter J. Barnes (2005). "Theobromine inhibits sensory nerve activation and cough" (pdf). The FASEB Journal. 19: 231–233.
  2. Arella, A. (nd), Coughing as an Indicator of Displacement Behaviour (PDF) (Unpublished thesis)
  3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  4. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  5. Usichenko, TI (2004). "Reducing venipuncture pain by a cough trick: a randomized crossover volunteer study". Anesthesia and Analgesia. 99 (3): 952–3. PMID 14742367. Unknown parameter |coauthors= ignored (help); |access-date= requires |url= (help)

Additional Resource

  • McCool F (2006). "Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 48S–53S. PMID 16428691.Full text

External links

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