Cough

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Coughing
)
"Coughing" redirects here. For the Pokémon, see
Koffing
.
Cough
A young boy coughing due to pertussis.
Coughing
The sound of a person coughing.
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Pronunciation

A cough is a sudden expulsion of air through the large breathing passages which can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound.[1]

Frequent coughing usually indicates the presence of a disease. Many

angiotensin-converting-enzyme inhibitors (ACE inhibitors) and beta blockers.[2]

Treatment should target the cause; for example,

Cough suppressants such as codeine or dextromethorphan are frequently prescribed, but have been demonstrated to have little effect.[citation needed] Other treatment options may target airway inflammation or may promote mucus expectoration. As it is a natural protective reflex, suppressing the cough reflex might have damaging effects, especially if the cough is productive (producing phlegm).[3]

Presentation

N95 mask

Complications

The complications of coughing can be classified as either

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. Chronic or violent coughing can contribute to damage to the pelvic floor and a possible cystocele.[4]

Differential diagnosis

A cough in children may be either a normal physiological reflex or due to an underlying cause.[5] In healthy children it may be normal in the absence of any disease to cough ten times a day.[5] The most common cause of an acute or subacute cough is a viral respiratory tract infection.[5] A healthy adult also coughs 18.8 times a day on average, but in the population with respiratory disease the geometric mean frequency is 275 times a day.[6] In adults with a chronic cough, i.e. a cough longer than 8 weeks, more than 90% of cases are due to post-nasal drip, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease.[5] The causes of chronic cough are similar in children with the addition of bacterial bronchitis.[5]

Infections

A cough can be the result of a

pertussis, or tuberculosis. In the vast majority of cases, acute coughs, i.e. coughs shorter than 3 weeks, are due to the common cold.[7]
In people with a normal chest X-ray, tuberculosis is a rare finding. Pertussis is increasingly being recognised as a cause of troublesome coughing in adults.

After a respiratory tract infection has cleared, the person may be left with a

allergies, and treatment of other causes of coughs (such as use of an air purifier or allergy medicines) may help speed recovery.[10]

Reactive airway disease

When coughing is the only complaint of a person who meets the criteria for asthma (

corticosteroids. Cough can also worsen in an acute exacerbation of chronic obstructive pulmonary disease
.

Asthma is a common cause of chronic cough in adults and children. Coughing may be the only symptom the person has from their asthma, or asthma symptoms may also include wheezing, shortness of breath, and a tight feeling in their chest. Depending on how severe the asthma is, it can be treated with bronchodilators (medicine which causes the airways to open up) or inhaled steroids. Treatment of the asthma should make the cough go away.

smoker's cough". The tobacco smoke causes inflammation, secretion of mucus into the airway, and difficulty clearing that mucus out of the airways. Coughing helps clear those secretions out. May be treated by quitting smoking. May also be caused by pneumoconiosis
and long-term fume inhalation.

Gastroesophageal reflux

In people with unexplained cough,

GERD
include heartburn, sour taste in the mouth, or a feeling of acid reflux in the chest, although, more than half of the people with cough from GERD do not have any other symptoms. An esophageal pH monitor can confirm the diagnosis of GERD. Sometimes GERD can complicate respiratory ailments related to cough, such as asthma or bronchitis. The treatment involves anti-acid medications and lifestyle changes with surgery indicated in cases not manageable with conservative measures.

Air pollution

Coughing may be caused by air pollution including tobacco smoke, particulate matter, irritant gases, and dampness in a home.[5] The human health effects of poor air quality are far reaching, but principally affect the body's respiratory system and the cardiovascular system. Individual reactions to air pollutants depend on the type of pollutant a person is exposed to, the degree of exposure, the individual's health status and genetics. People who exercise outdoors on hot, smoggy days, for example, increase their exposure to pollutants in the air.

Foreign body

A

windpipe in people with swallowing difficulties.[12][13]

Drug-induced cough

Drugs used for treatments other than coughs, such as ACE inhibitors which are often used to treat high blood pressure, can sometimes cause cough as a side effect, and stopping their use will stop the cough.[14] Beta blockers similarly cause cough as an adverse event. [2]

Tic cough

A

tic cough, previously called a habit cough, is one that responds to behavioral or psychiatric therapy after organic causes have been excluded. Absence of the cough during sleep is common, but not diagnostic. A tic cough is thought to be more common in children than in adults.[15]
A similar disorder is the
somatic cough syndrome
previously called the psychogenic cough.

Neurogenic cough

Some cases of chronic cough may be attributed to a sensory neuropathic disorder.[16] Treatment for neurogenic cough may include the use of certain neuralgia medications. Coughing may occur in tic disorders such as Tourette syndrome, although it should be distinguished from throat-clearing in this disorder.

Other

Cough may also be caused by conditions affecting the lung tissue such as

benign or malignant lung tumors or mediastinal masses. Through irritation of the nerve, diseases of the external auditory canal (wax, for example) can also cause cough. Cardiovascular diseases associated with cough are heart failure, pulmonary infarction and aortic aneurysm. Nocturnal cough is associated with heart failure, as the heart does not compensate for the increased volume shift to the pulmonary circulation, in turn causing pulmonary edema and resultant cough.[17] Other causes of nocturnal cough include asthma, post-nasal drip and gastroesophageal reflux disease (GERD).[18] Another cause of cough occurring preferentially in supine position is recurrent aspiration.[17]

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. Capsaicin is what makes chili peppers spicy, and might explain why workers in factories with these fruits can develop a cough.

Coughing may also be used for social reasons, and as such is not always involuntary. A voluntary cough, often written as "ahem", can be used to attract attention or express displeasure, as a form of

metacommunication.[19][20]

Airway clearance

Further information: Airway clearance therapy

Coughing, and huffing are important ways of removing mucus as sputum in many conditions such as cystic fibrosis, and chronic bronchitis.

Pathophysiology

Coughing is viewed as a public health issue.

A cough is a protective

afferent nerves, namely the myelinated rapidly adapting receptors, and nonmyelinated C-fibers with endings in the lung.[21]

Diagnostic approach

The type of cough may help in the diagnosis. For instance, an inspiratory "whooping" sound on coughing almost doubles the likelihood that the illness is

pertussis
.

Blood may occur in small amounts with severe cough of many causes, but larger amounts suggests bronchitis, bronchiectasis, tuberculosis, or primary lung cancer.[22]

Further

x-rays, and spirometry.[5]

Classification

A cough can be classified by its duration, character, quality, and timing.

chronic when lasting longer than eight weeks.[5] A cough can be non-productive (dry) or productive (when phlegm is produced that may be coughed up as sputum). It may occur only at night (then called nocturnal cough), during both night and day, or just during the day.[5]

A number of characteristic coughs exist. While these have not been found to be diagnostically useful in adults, they are of use in children.[5] A barky cough is part of the common presentation of croup.[23] A staccato cough has been classically described with neonatal chlamydial pneumonia.[24]

Treatment

The treatment of a cough in children is based on the underlying cause. In children half of cases go away without treatment in 10 days and 90% in 25 days.[25]

According to the

protracted bacterial bronchitis or asthma respectively.[5] There is insufficient evidence to recommend treating children who have a cough that is not related to a specific condition with inhaled anti-cholinergics.[27]

Because coughing can spread disease through infectious aerosol droplets, it is recommended to cover one's mouth and nose with the forearm, the inside of the elbow, a tissue or a handkerchief while coughing.[28]

Epidemiology

A cough is the most common reason for visiting a primary care physician in the United States.[5]

Other animals

A coughing deer hind

Marine mammals such as

cats can cough, because of diseases, allergies, dust or choking.[30] In particular, cats are known for coughing before spitting up a hairball.[30]

In other domestic animals,

horses can cough because of infections, or due to poor ventilation and dust in enclosed spaces.[31] Kennel cough in dogs
can result from a viral or bacterial infection.

Deer can cough similarly to humans as a result of respiratory tract infections, such as parasitic bronchitis caused by a species of Dictyocaulus.[32]

References

  1. ^
    S2CID 7810980
    .
  2. ^ a b Guidelines, Therapeutic (2021). Cough. Therapeutic Guidelines Ltd.
  3. S2CID 30806409
    .
  4. ^ "Cystocele (Prolapsed Bladder) | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2017-12-02.
  5. ^
    PMID 20176183
    .
  6. PMID 23277523
    .
  7. PMID 20015366
    . In the vast majority of cases, acute cough is due to acute viral upper respiratory tract infection (URTI), i.e., the common cold.
  8. ^
    PMID 16428703
    .
  9. ^ "Cystic fibrosis - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Retrieved 2022-05-24.
  10. ^ "UpToDate". www.uptodate.com. Retrieved 2022-05-24.
  11. PMID 22081767
    .
  12. ^ "Cough". Mayo Clinic. Retrieved 2022-03-27.
  13. ^ "Why You Cough". WebMD. Retrieved 2022-03-27.
  14. PMID 16428706
    .
  15. PMID 16428707
    .
  16. S2CID 24560981
    .
  17. ^
    ISBN 0-409-90077-X
  18. ISBN 0-9671809-2-9
  19. ^ "ahem". Onomatopoeia List. August 10, 2013. Archived from the original on April 4, 2023. Retrieved April 11, 2022.
  20. ISBN 9789027221797
    . Retrieved 25 July 2019.
  21. PMID 27279650
    .
  22. Merck Manuals
    . Retrieved 2017-04-07. Last full review/revision July 2016
  23. PMID 19030411
    .
  24. PMID 16669564
    .
  25. PMID 24335668
    .
  26. ^
    PMID 29633783
    .
  27. PMID 14974067
    .
  28. ^ "Coughing and Sneezing". US Centers for Disease Control and Prevention. 2020-04-24. Retrieved 2020-09-14.
  29. S2CID 26842976
    .
  30. ^ a b "Is It Normal for Cats To Cough?". Pet Health Network. Retrieved 2018-04-23.
  31. ^ "Coughing in horses explained". Your Horse Magazine. Archived from the original on 2020-07-28. Retrieved 2018-04-23.
  32. S2CID 25720548
    .

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Further reading

External links
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