Cough natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], M.Umer Tariq [3] Abiodun Akanmode,M.D.[4]


The mechanics of cough as described under cough pathophysiology demonstrate the role of various body systems and organ in the production of a cough. The various complications associated with cough can be categorized according to systems involved also,Cough complications can also be acute or chronic.


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.The table below shows the various complications of cough. [1]

Variants. Symptoms.
Cardiovascular. Arterial hypotension[2],Bradyarrhythmias[3],tachyarrhythmias,loss of consciousness,Rupture of subconjunctival, nasal, and anal veins
Constitutional symptoms. Excessive sweating, anorexia, exhaustion.
Gastrointestinal. GERD,Hepatic cyst rupture,Herniations,Malfunction of gastrostomy button,Mallory-Weiss tear,Splenic rupture
Genitourinary. Inversion of bladder through urethra.Urinary incontinence[4].
Musculoskeletal Diaphragmatic rupture,Rib fractures [5],Sternal wound dehiscence[6]
Neurological. Acute cervical radiculopathy[7],Cerebral air embolism[8],Cough syncope [9],Dizziness,Headache,Seizures,Stroke due to vertebral artery dissection
Ophthalmologic. Spontaneous compressive orbital emphysema of rhinogenic origin
Psychosocial. Fear of serious disease,Lifestyle changes,Self-consciousness.
Respiratory. Exacerbation of asthma[10],Herniations of the lung,Hydrothorax in peritoneal dialysis,Laryngeal trauma,pneumatosis intestinalis[11], pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, pneumothorax, subcutaneous emphysema,bronchitis,bronchial rupture.
Skin. Petechiae,purpura[1].


  1. 1.0 1.1 Irwin RS (2006). "Complications of cough: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 54S–58S. doi:10.1378/chest.129.1_suppl.54S. PMID 16428692 PMID: 16428692 Check |pmid= value (help).
  2. SHARPEY-SCHAFER EP (1953). "The mechanism of syncope after coughing". Br Med J. 2 (4841): 860–3. doi:10.1136/bmj.2.4841.860. PMC 2029864. PMID 13094038 PMID: 13094038 Check |pmid= value (help).
  3. Francis CK, Singh JB, Polansky BJ (1972). "Interruption of aberrant conduction of atrioventricular junctional tachycardia by cough". N Engl J Med. 286 (7): 357–8. doi:10.1056/NEJM197202172860707. PMID 5008557 PMID: 5008557 Check |pmid= value (help).
  4. French CT, Fletcher KE, Irwin RS (2004). "Gender differences in health-related quality of life in patients complaining of chronic cough". Chest. 125 (2): 482–8. doi:10.1378/chest.125.2.482. PMID 14769728 PMID: 14769728 Check |pmid= value (help).
  5. DERBES VJ, HARAN T (1954). "Rib fractures from muscular effort with particular reference to cough". Surgery. 35 (2): 294–321. PMID 13135901 PMID: 13135901 Check |pmid= value (help).
  6. Abid Q, Podila SR, Kendall S (2001). "Sternal dehiscence after cardiac surgery and ACE inhibitors [correction of ACE type 1 inhibition]". Eur J Cardiothorac Surg. 20 (1): 203–4. doi:10.1016/s1010-7940(01)00761-8. PMID 11423299 PMID: 11423299 Check |pmid= value (help).
  7. Torrington KG, Adornato BT (1984). "Cough radiculopathy--another cause of pain in the neck". West J Med. 141 (3): 379–80. PMC 1021843. PMID 6506676 PMID: 6506676 Check |pmid= value (help).
  8. Ulyatt DB, Judson JA, Trubuhovich RV, Galler LH (1991). "Cerebral arterial air embolism associated with coughing on a continuous positive airway pressure circuit". Crit Care Med. 19 (7): 985–7. doi:10.1097/00003246-199107000-00029. PMID 2055089 PMID: 2055089 Check |pmid= value (help).
  9. Irwin RS, Curley FJ (1991). "The treatment of cough. A comprehensive review". Chest. 99 (6): 1477–84. doi:10.1378/chest.99.6.1477. PMID 2036833 PMID: 2036833 Check |pmid= value (help).
  10. Young S, Bitsakou H, Carić D, McHardy GJ (1991). "Coughing can relieve or exacerbate symptoms in asthmatic patients". Respir Med. 85 Suppl A: 7–12. doi:10.1016/s0954-6111(06)80246-5. PMID 2034840 PMID: 2034840 Check |pmid= value (help).
  11. Naggar CZ (1976). "Pneumatosis intestinalis following common upper-respiratory-tract infection". JAMA. 235 (20): 2221–2. PMID 946849 PMID: 946849 Check |pmid= value (help).

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