Cough: Difference between revisions

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==References==
==References==
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==Additional Resource==
==Additional Resource==

Revision as of 12:40, 4 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] M.Umer Tariq [3]

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 [4] 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


Complete Differential Diagnosis of the Causes of Cough

(By organ system)

Cardiovascular

Aortic arch anomalies, Atrial myxoma, Beriberi Heart Disease, Congestive Heart Failure, Hypotension, Mitral stenosis, Right Ventricular Outflow Tract Obstruction, Superior Vena Cava Syndrome, Thoracic Aortic Aneurysms,


Chemical / poisoning

Abrin, Cadmium poisoning, Polymer fume fever,

Dermatologic No underlying causes
Drug Side Effect

Abacavir , Abatacept , ABVD, ACE inhibitor, Acetylmorphone, Acyclovir , Adalimumab , Adefovir , Albuterol , Alefacept , Alfuzosin , Aliskiren , Amiodarone , Amlodipine and Benazepril , Amphotericin B , Anagrelide , Anastrozole , Atazanavir , Benazepril, Bepridil , Bevacizumab , Bitolterol , Bortezomib , Brimonidine , Budesonide, Busulfan , Captopril, Carvedilol , Cetuximab , Cevimeline, Chlorambucil , Cladribine , Clobutinol, Clofarabine , Clofedanol, Co-trimoxazole , Cromolyn Sodium , Cytarabine , Dacarbazine , Dactinomycin , Darbepoetin Alfa , Diborane, Docetaxel , Domiodol, Dornase alfa, DTPA, Efalizumab , Efavirenz , Emtricitabine , Enalapril , Enfuvirtide, Epinastine , Eplerenone , Epoetin Alfa , Eprosartan , Erlotinib , Estradiol Topical , Etanercept , Fexofenadine , Floxuridine , Fludarabine Phosphate , Fluorouracil , Fluticasone and Salmeterol , Fluvastatin , Fosamprenavir , Fosinopril , Gabapentin , Gefitinib , Gemcitabine Hydrochloride , Glyburide and Metformin , Granisetron , Histrelin , Ibandronate , Ifosfamide , Iloprost, Imipramine, Insulin Human (rDNA Origin) , Interferon beta-1a Intramuscular , Isoproterenol , Ketorolac, Lamivudine , Lamotrigine , Letrozole , Levalbuterol , Lisinopril , Lomustine , Mechlorethamine , Melphalan , Mercaptopurine , Mesalamine , Metaproterenol , Methotrexate , Metoprolol, Mitomycin , Moexipril , Moxifloxacin , Mycophenolic acid, Natalizumab , Nateglinide , Nedocromil , Nicotine nasal spray , Nilutamide , Nitrofurantoin , Omeprazole , Oxaliplatin , Oxcarbazepine , Paclitaxel, Pamidronate , Peginterferon alfa-2a , Pemetrexed , Penbutolol , Pentamidine, Perindopril, Pegaspargase , Pimecrolimus topical , Pirbuterol acetate , Plicamycin , Primaquine , Procarbazine , Prograf, Quinapril, Ramelteon , Ramipril, Ribavirin , Risedronate , Risperidone , Rosiglitazone , Rosuvastatin , Salmeterol , Saquinavir , Sevelamer , Sirolimus , Sodium stibogluconate, Spironolactone , Sulindac , Tacrolimus, Tamsulosin , Thioguanine , Thiotepa , Tipranavir , Tocainide , Topotecan Hydrochloride , Trandolapril, Trimetrexate Glucuronate , Vinorelbine Tartrate , Vorinostat , Zanamivir , Ziprasidone ,



Ear Nose Throat

Acute viral nasopharyngitis (common cold), Adenoid hypertrophy, Allergic rhinitis, Atopic rhinitis, Croup, Goiter, Laryngitis, Laryngopharyngeal Reflux Disease, Laryngotracheal cleft, Pharyngitis, Post-nasal drip, Strep throat, Subglottic hemangioma, Subglottic stenosis, Tonsillolith,

Endocrine Goiter,
Environmental

Caplan's Syndrome, Chronic beryllium disease (CBD), Hay fever, Low humidity, Occupational exposure of irritants Passive smoking, Sick building syndrome, Silicosis, Smoking,

Gastroenterologic

Achalasia, Esophageal atresia, Esophageal cancer, Esophageal dysmotility, Gastroesophageal reflux disease, Mallory-Weiss syndrome,


Genetic

Cystic fibrosis, Juvenile Myelomonocytic Leukemia (JMML),

Hematologic No underlying causes
Iatrogenic

Chest tube, Thoracentesis, Transfusion-associated graft versus host disease,

Infectious Disease

Adenoviridae, Aphthovirus, Ascaris infection, Aspergillosis, Blastomycosis, Bordetella pertussis, Byssinosis, Chickenpox, Chlamydophila pneumoniae, Cladosporium, CMV Pneumonitis, Coccidioidomycosis, Community-acquired pneumonia, Cryptococcosis, Fasciolosis, Filariasis, Gnathostomiasis, Histoplasmosis, Human ehrlichiosis, Infectious mononucleosis, Influenza, Lady Windermere syndrome, Lassa fever, Legionellosis, Measles, Melioidosis, Miliary tuberculosis, Mucor stolonifer, Mycoplasma pneumoniae, Nocardiosis, Paprika splitter's lung, Paracoccidioidomycosis, Papillomatosis, Paragonimus Infection, Pneumocystis jirovecii pneumonia, Psittacosis, Q Fever, Rhinovirus, Saccharopolyspora rectivirgula, Schistosomiasis, Sporotrichosis, Strep throat, Thermoactinomyces sacchari, Thermoactinomyces vulgaris, Trichinosis, Tuberculosis, Tularemia, Typhoid fever, Upper respiratory tract infection, Yersinia Pestis Infection,


Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic

Beriberi Heart Disease, Cholesterol pneumonia,


Obstetric/Gynecologic

Bronchogenic cyst, Pulmonary sequestration, Esophageal atresia, Peripartum cardiomyopathy,

Oncologic

Cervical mass, Esophageal cancer, Kaposi's sarcoma, Laryngeal cancer, Lymphangitis carcinomatous, Mediastinal tumor, Mesothelioma, Papillomatosis, Thymoma,


Opthalmologic No underlying causes
Overdose / Toxicity

Ganciclovir , Nickel carbonyl, Valganciclovir , Salicylate sensitivity,


Psychiatric Psychogenic cough,
Pulmonary

Acute bronchitis, Acute Chest Syndrome, Allergic bronchopulmonary aspergillosis, Asthma, Atelectasis, Atypical pneumonia, Aspergillosis, Blastomycosis, Bronchial stenosis, Bronchial web, Bronchiectasis, Bronchiolitis, Bronchitis, Bronchogenic cyst, Chronic Obstructive Pulmonary Disease, Ciliary dyskinesia, Cystic fibrosis, Goodpasture's syndrome, Hamman-Rich syndrome, Idiopathic Pulmonary Fibrosis, Interstitial pneumonia, Lady Windermere syndrome, Lung abscess, Pleurisy, Pleuropulmonary blastoma, Pulmonary alveolar proteinosis, Pulmonary Embolism, Pulmonary hypertension, Severe acute respiratory syndrome, Tracheal stenosis, Tracheitis, Tracheoesophageal fistula, Tracheomalacia,


Renal / Electrolyte

Congenital nephrotic syndrome, Rapidly progressive glomerulonephritis,


Rheum / Immune / Allergy Sarcoidosis,
Sexual No underlying causes
Trauma Post cerebrovascular accident,
Urologic No underlying causes
Miscellaneous

Alcoholism, Aspirated foreign bodies, Cerumenosis, Choking, Chronic Fatigue Syndrome, Ear foreign body, Hair in the ear canal,


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

Template:Circulatory and respiratory system symptoms and signs Template:Common Cold

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

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