Cough
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| Cough Classification and external resources | |
| ICD-10 | R05. |
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| ICD-9 | 786.2 |
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Ongoing Trials on Cough at Clinical Trials.gov Clinical Trials on Cough at Google
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US National Guidelines Clearinghouse on Cough
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Directions to Hospitals Treating Cough Risk calculators and risk factors for Cough
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
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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.[1]
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
- Smoker's cough
- Aspiration
- Congestive heart failure
- Postnasal drip
- Most common cause of chronic cough in nonsmokers
- GERD
- Second most common cause of chronic cough in nonsmokers
- Asthma/reactive airway disease
- ACE inhibitor use
- Pneumonia
- Typical pneumonia is characterized by acute or subacute onset of fever, dyspnea, fatigue, pleuritic chest pain, and cough
- Atypical pneumoniais characterized by more gradual onset, dry cough,headache, fatigue, and minimal lung signs
- Acute bronchitis
- Most commonly caused by viruses
- Postviral bronchitis may last beyond 6 weeks
- Aspirated foreign body
- Lung cancer
- COPD
- Sarcoidosis
- Cryptogenic organizing pneumonia
- Filarial disease
Productive Cough
- Postnasal drip
- Tuberculosis
- COPD
- Lung cancer
- Smoker's cough
- Asthma with secondary infection
- Pneumonia
- Bronchitis
Complete Differential Diagnosis of Cough Sorted by Frequency of Causes
In alphabetical order. [1] [1]
Most Common Causes
Other Causes
- ACE inhibitor use
- Achalasia
- Acute bronchitis
- Adenoiditis
- Alcoholism
- Aortic arch anomalies
- Aspirated foreign body
- Aspiration
- Atopic rhinitis
- Beta-blockers
- Bordetella pertussis
- Bronchial stenosis
- Bronchial web
- Bronchogenic carcinoma
- Bronchogenic cyst
- Cerumenosis
- Cervical mass
- Chlamydia trachomatis
- Chronic bronchitis
- Chronic Obstructive Pulmonary Disease (COPD)
- Ciliary dyskinesia
- Congestive Heart Failure
- Croup
- Cryptogenic organizing pneumonia
- Cystic Fibrosis
- Ear foreign body
- Emphysema
- Esophageal cancer
- Esophageal duplication
- Esophageal immotility
- Filariasis
- Foregut cyst
- Frequent vomiting
- Fungal lung infection
- Hair in the ear canal
- Goiter
- Infection
- Interstitial lung disease
- Laryngotracheal cleft
- Low humidity
- Lung cancer
- Lymphangitis carcinomatosis
- Mediastinal lymphadenopathy
- Mitral stenosis
- Neoplasm
- Occupational inhalation of bronchial irritants
- Opportunistic infections
- Overheating
- Papillomatosis
- Parasitic infection
- Pertussis
- Pneumonia
- Post-bronchitic
- Post-cerebrovascular accident
- Post-viral
- Psychogenic cough
- Pulmonary neoplasm
- Rheumatic heart disease
- Sarcoidosis
- Sinusitis
- Smoker's cough
- Subglottic hemangioma
- Subglottic stenosis
- Tracheal stenosis
- Tracheoesophageal fistula
- Tracheomalacia
- Thoracic aortic aneurysm
- Tuberculosis
- Vocal cord paralysis
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.[1]
See also
References
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
- FamilyDoctor.org – Chronic cough: causes and cures
- Coughing:Quick tips to help stop a coughing fit.
Symptoms and signs: circulatory and respiratory systems (R00-R09, 785-786) | |
|---|---|
| Cardiovascular system | heartbeat: Tachycardia - Bradycardia - Palpitation
blood flow: Heart murmur - Bruit/Carotid bruit - Epistaxis Gangrene |
| Respiratory system and other chest symptoms | Hemoptysis - Cough
abnormalities of breathing (Dyspnea, Orthopnoea, Stridor, Wheeze, Cheyne-Stokes respiration, Hyperventilation, Mouth breathing, Hiccup, Bradypnea, Hypoventilation) Chest pain - Asphyxia - Pleurisy - Respiratory arrest - Sputum - Rales - Hypercapnia |
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nl:Hoest
ja:咳嗽qu:Uhusr:Кашаљ
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
