Cough

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Etiology 3 Epidemiology 4 Pathology 5 History 6 Clinical-manifestations 7 Laboratory 8 Diagnostic-procedures 9 Radiology 10 Complications 11 Management 12 More General Terms 13 References

More Specific Terms

• chronic cough

Etiology

• generally a reflex response to stimuli that irritate the larynx, trachea or large bronchi

• external stimuli* including asthma

• dust
• foreign body
• hot or cold air
• smoke

• internal stimuli

• inflammation of the respiratory mucosa

• bronchitis
• pneumonia
• upper respiratory tract infection

• compression of the airway

• tumor
• enlarged peribronchial lymph node

• post-nasal drip*
• gastroesophageal reflux disease*

• left-sided heart failure
• pharmacologic agents:

• ACE inhibitors*
• inhaled drugs
• mycophenolate
• propofol
• aspirin, NSAIDs
• beta-blockers
• antibiotics

• amphotericin B
• erythromycin
• sulfonamides
• aminoglyocosides

• chemotherapeutic agents [5]
  

• * common causes of chronic cough

Epidemiology

• most common complaint in outpatient medicine

Pathology

• afferent arm of cough reflex

• trigeminal nerve
• glossopharyngeal nerve
• superior laryngeal nerve
• vagus nerve

• efferent arm of cough reflex

• recurrent laryngeal nerve
• spinal nerves

• lesions in the nose, ears, pharynx, larynx, bronchi, lungs, pleura & abdominal viscera may cause cough

History

• duration, rate of onset, fever/ chills, sputum (quality), dyspnea, pleuritic chest pain, orthopnea, sore throat, rhinorrhea, headache, stiff neck, ear pain, nausea/vomiting, diarrhea, arthralgia, myalgia, smoking, recent antibiotics, exposure to tuberculosis or asbestos, travel, ill contacts, pneumococcal & influenza vaccination

Clinical-manifestations

• cough due to upper respiratory tract infection may persist from weeks to several months

Laboratory

• sputum examination for eosinophilia

Diagnostic-procedures

• provocation inhalation testing with methacholine for suspected asthma

Radiology

• chest X-ray is generally of low yield

Complications

• cough syncope

• increased intrathoracic pressure
• decreased cardiac output & cerebral perfusion

• rib fractures
• pneumothorax
  
• disease interaction(s) of cough with stress urinary incontinence

Management

• antihistamine (1st generation)/ decongestants, i.e. ( brompheniramine/pseudoephedrine) 1st line agent for cough due to common cold [8]

• may be useful for cough due to post-nasal drip [8]

• opiates (i.e. codeine) have proven antitussive effects
• haloperidol is an effective antitussive agent [5]
• cough due to GERD may respond to omeprazole
• NSAIDs may be useful by reducing inflammation [8]
• inhaled ipratropium for cough that persists 3-8 weeks after upper respiratory tract infection
• inhaled corticosteroids if ipratropium fails
• dextromethorphan has mild antitussive effects
• sugar, honey, cough drops can relieve cough by increasing saliva which coats the larynx & relieves irritation [10]
• little evidence that other agents have antitussive effects

• guaifenesin, terpin hypdrate, benzoate, cough drops

• treatment of asthma

More General Terms

• sign/symptom

References

1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
2. Guide to Physical Examination & History Taking, 4th edition, Bates B, JB Lippincott, Philadelphia, 1987
3. Ferri's Clinical Advisor, Instant Diagnosis and Treatment, Ferri FF (ed), Mosby, Philadelphia, 2003
4. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 719
5. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
6. Chang AB et al, Systematic review and meta-analasys of randomized controlled trials of gastroesophageal reflux interventions for chronic cough-associated with gastro-oesophageal reflux. BMJ 2006, 332: 11 PMID: [1]
7. Irwin RS; American College of Chest Physicians (ACCP). Assessing cough severity and efficacy of therapy in clinical research: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 Suppl):232S-237S. <PubMed> PMID: [2] <Internet> [3]
8. Prescriber's Letter 13(10): 2006 Pharmacologic Treatment of Cough: Evidence-Based Guidelines Detail-Document#: [4] (subscription needed) [5]
9. Prescriber's Letter 14(1): 2007 Pharmacologic treatment of cough: Evidence-based guidelines Detail-Document#: [6] (subscription needed) [7]
10. Prescriber's Letter 15(1): 2008 Alternatives to OTC Cough and Cold Medication for Children Detail-Document#: [8] (subscription needed) [9]
11. National Guideline Clearinghouse Prolonged cough in children ngc-guideline: [10]
    - An empiric integrative approach to the management of cough: ACCP evidence-based clinical practice guidelines. (American College of Chest Physicians) ngc-guideline: [11]
    - Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. ngc-guideline: [12]
    - Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. ngc-guideline: [13]
    - Chronic cough due to asthma: ACCP evidence-based clinical practice guidelines. ngc-guideline: [14]
    - Chronic cough due to bronchiectasis: ACCP evidence-based clinical practice guidelines. ngc-guideline: [15]
    - Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. ngc-guideline: [16]
    - Chronic cough due to chronic interstitial pulmonary diseases: ACCP evidence-based clinical practice guidelines. ngc-guideline: [17]
    - Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. ngc-guideline: [18]
    - Chronic cough due to lung tumors: ACCP evidence-based clinical practice guidelines. ngc-guideline: [19]
    - Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines. ngc-guideline: [20]
    - Chronic cough due to nonbronchiectatic suppurative airway disease (bronchiolitis): ACCP evidence-based clinical practice guidelines. ngc-guideline: [21]
    - Chronic cough due to tuberculosis and other infections: ACCP evidence-based clinical practice guidelines. ngc-guideline: [22]
    - Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. ngc-guideline: [23]
    - Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. ngc-guideline: [24]
    - Cough and the common cold: ACCP evidence-based clinical practice guidelines. ngc-guideline: [25]
    - Cough in the immunocompromised host: ACCP evidence-based clinical practice guidelines. ngc-guideline: [26]
    - Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. ngc-guideline: [27]
    - Cough: occupational and environmental considerations: ACCP evidence-based clinical practice guidelines. ngc-guideline: [28]
    - Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. ngc-guideline: [29]
    - Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. ngc-guideline: [30]
    - Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines. ngc-guideline: [31]
    - Peritoneal dialysis and cough: ACCP evidence-based clinical practice guidelines. ngc-guideline: [32]
    - Postinfectious cough: ACCP evidence-based clinical practice guidelines. ngc-guideline: [33]
    - Uncommon causes of cough: ACCP evidence-based clinical practice guidelines. ngc-guideline: [34]
    - Unexplained (idiopathic) cough: ACCP evidence-based clinical practice guidelines. ngc-guideline: [35]
    - Cough. In: Pulmonary (acute & chronic). Work Loss Data Institute ngc-guideline: [36]

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