Coughing -
A chest x-ray may be appropriate if a cough is determined to be severe or if the patient appears extremely ill. A chronic cough may require diagnostic measures, including a chest x-ray and complete pulmonary function testing.
Patients without specific clues on history and physical examination who have a normal chest x-ray and spirometry may require referral to a pulmonologist for more intense evaluation. Often, a single etiology cannot be elucidated, and chronic cough is the result of a spectrum of multiple disease processes.
Bronchoscopy with direct visualization of vocal cords, trachea, and other airways may be required to rule out any vocal cord mass or lesion and endotracheal or endobronchial mass. Accordingly, one may require biopsy and or bronchoalveolar lavage to obtain samples for microbiological and cytological analysis.
An echocardiogram may be indicated for cardiac function testing. CT scan of the chest may be indicated for anatomical analysis.
Gastroesophageal studies may be indicated, including speech and swallow evaluations. Esophagogastroduodenoscopy or pH-probe monitoring of the stomach may be indicated for aspiration and gastroesophageal reflux analysis. If a cough is mostly at night, and the patient has signs and symptoms suggestive of obstructive sleep apnea, then one may order a sleep study to confirm the diagnosis and treat sleep apnea accordingly.
Most cases of acute cough should be treated empirically and focus on symptomatic relief. This includes supportive measures of over-the-counter cough and cold medicines. However, many over-the-counter antihistamine-decongestant medications have been shown to offer no clinical benefit over placebo.
Cough suppressants may be used to lessen the cough by blunting the cough reflex, and expectorants may be used when excessive mucous secretions are determined to be the primary issue to increase mucus clearance.
The most commonly used suppressant is dextromethorphan, and the most common expectorant is guaifenesin. Therefore, decreasing the cough reflex may have detrimental impacts on the recovery time of illness. As such, the current American College of Chest Physicians guidelines does not recommend the use of peripherally or centrally-acting cough suppressants for the treatment of cough due to and discourage the use of over-the-counter combinations for the treatment of acute cough due to the common cold.
Whenever an infectious etiology is suspected, sputum culture should be attempted, and antibiotic therapy tailored to the pathogen.
In chronic infectious upper respiratory etiologies, prolonged antibiotic therapy for 3 to 6 weeks with an appropriately selected agent similar to those used for acute infections is necessary.
However, alternative therapies may be used, including:. Inhaled albuterol and ipratropium bromide nebulizer solutions may be used for bronchodilatory effect in a constricted airway for symptomatic relief in urgent situations.
Treatment of a chronic cough should attempt to target the underlying etiology whenever possible to reduce coughing instead of suppressing the cough. If a patient is identified to be taking an angiotensin-converting enzyme inhibitor, this medicine should be discontinued, and an aldosterone-receptor-blocking medicine started in its place.
In reactive airway disease, inhaled steroids or anticholinergic medications may be indicated. Cardiac function should be optimized following appropriate cardiology recommendations in a patient-specific manner. Gastroesophageal reflux should be treated aggressively by avoiding predisposing reflux substances, including chocolate, caffeine, alcohol, and tobacco.
Furthermore, to prevent aspiration, patients should elevate the head of the bed and not eat for several hours before bedtime. Medical therapy should include a proton pump inhibitor at maximal dosing.
Treatment of chronic neurogenic cough is different than other neuropathic conditions. For isolated cough with no laryngopharyngeal reflux, start treatment with tramadol 25 mg up to 4 times per day when necessary or amitriptyline 10 mg at bedtime.
If laryngopharyngeal reflux is present or there are other symptoms, gabapentin mg four times per day is preferred with an escalation of dose as tolerated and as needed. Patients typically require to mg four times per day.
These medications may be used alone or in combination. Typical combination therapies include gabapentin with a small dose of amitriptyline at bedtime. Pregabalin and baclofen are second-line choices used in special situations. Differentials to be considered in establishing the cause of cough can be divided into categories such as acute, subacute, and chronic.
Besides, there are some very rare causes that should be ruled out once the diagnosis is ambiguous. Coughing in itself is relatively benign. However, the precise prognosis a patient faces is heavily reliant on the underlying etiology. In typical coughing, use antibiotics only if the patient fails to respond to the symptomatic therapy and two of the following symptoms are present: purulent nasal discharge, maxillary toothache, abnormal transillumination of any sinus, and discolored nasal discharge.
Think of bacterial bronchitis and use appropriate antibiotics if an acute exacerbation of COPD with worsening shortness of breath or wheezing is present. A cough and vomiting are suggestive of Bordetella pertussis.
Treating pertussis with antibiotics does not reduce the paroxysmal phase but does reduce the infectivity period. In the elderly, classic signs and symptoms may be minimal, so consider pneumonia, congestive heart failure, asthma, and aspiration. Seventy-five percent of patients with gastroesophageal reflux disease-induced cough do not have heartburn.
An Ing et al. It is determined that two factors are necessary for GERD to induce a cough: spontaneous gastroesophageal reflux disease and the propensity to cough.
Therefore, patients with no other cause for cough are likely to have gastroesophageal reflux disease. There are many causes of cough, and most are benign. But cough can also be due to malignancies, nerve injuries, and serious infections; thus, an interprofessional approach is essential when a cough is persistent.
The primary care provider, nurse practitioner, internist, and pulmonologist should not empirically prescribe anti-tussive agents to all patients with a cough; the key is to treat the cause. A thorough history is vital when trying to establish the cause of a cough; when the cough is prolonged and associated with other symptoms, a referral to a pulmonologist or an otolaryngologist is recommended.
Disclosure: Sandeep Sharma declares no relevant financial relationships with ineligible companies. Disclosure: Muhammad Hashmi declares no relevant financial relationships with ineligible companies. Disclosure: Mohamed Alhajjaj declares no relevant financial relationships with ineligible companies.
This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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StatPearls [Internet]. Treasure Island FL : StatPearls Publishing; Jan-. Show details Treasure Island FL : StatPearls Publishing ; Jan-. Search term. Cough Sandeep Sharma ; Muhammad F. Author Information and Affiliations Authors Sandeep Sharma 1 ; Muhammad F.
Affiliations 1 Mery Fitzgerald Hospital. Continuing Education Activity Cough is one of the most common medical complaints accounting for as many as 30 million clinical visits per year.
Introduction A cough is one of the most common medical complaints accounting for as many as 30 million clinical visits per year. Etiology The etiology of a cough is an arbitrary classification based largely on the duration of a cough.
Pathophysiology Coughing is a largely uncontrolled, protective reflex mechanism responsible for mucociliary clearance of the airway and excess secretions within the airway. History and Physical As with any illness, a full and detailed history collection accompanied by an appropriate physical exam is the most important aspect of any medical evaluation.
Essential components of the history-taking session should include: Details about duration. Evaluation An acute and subacute cough requires no diagnostic studies and should be treated symptomatically unless there is suspicion of an insidious pathology.
Criteria for the diagnosis of a neurogenic cough are: The almost constant presence of cough during the day. However, alternative therapies may be used, including: Clindamycin mg by mouth three times a day for 3 to 6 weeks.
Differential Diagnosis Differentials to be considered in establishing the cause of cough can be divided into categories such as acute, subacute, and chronic.
Acute Acute bronchitis. Post-infectious secondary to continued irritation of cough receptors via ongoing or resolving bronchial or sinus inflammation from a preceding viral upper respiratory infection.
Cerumen impaction- vagal nerve stimulation of the afferent branch to the ear, known as Arnold nerve. Ortner syndrome: Intermittent left vocal fold paralysis as a result of cardiac ptosis straining the ipsilateral recurrent laryngeal nerve.
Pediatric autoimmune neuropsychiatric disorder associated with s treptococcus PANDAS : A pediatric cough where prior Streptococcus infections can trigger motor tics, including a chronic cough.
Syngamus laryngeus : A small, roundworm indigenous to the Caribbean, Syngamus laryngeus is acquired by ingesting a contaminated fruit or vegetable. A male and female pair of worms take up residence in the subglottic larynx, and there they remain tenaciously adherent to the mucosa, except when mating.
Prognosis Coughing in itself is relatively benign. Complications Persistent cough or severe bouts of cough can cause complications, and these include: Sleep disruption. Consultations Management of cough may require teamwork by different specialties.
New onset of a chronic cough without obvious etiology should prompt a referral to a pulmonologist or cough specialist. If poor cardiac function is suspected, then a referral to a cardiologist is recommended for the evaluation of congestive heart failure.
If a gastrointestinal aberration is suspected, such as gastroesophageal reflux disease, referral to a gastroenterologist is warranted. Pearls and Other Issues In typical coughing, use antibiotics only if the patient fails to respond to the symptomatic therapy and two of the following symptoms are present: purulent nasal discharge, maxillary toothache, abnormal transillumination of any sinus, and discolored nasal discharge.
Bacterial sinusitis can present, along with viral rhinitis or rhinosinusitis Think of bacterial bronchitis and use appropriate antibiotics if an acute exacerbation of COPD with worsening shortness of breath or wheezing is present.
Enhancing Healthcare Team Outcomes There are many causes of cough, and most are benign. Review Questions Access free multiple choice questions on this topic.
Comment on this article. References 1. Park JJ, Bachert C, Dazert S, Kostev K, Seidel DU. Current healthcare pathways in the treatment of rhinosinusitis in Germany. Acta Otolaryngol. Pimentel AM, Baptista PN, Ximenes RA, Rodrigues LC, Magalhães V, Pert—Pertussis Study Group.
Silva AR, Souza NF, Matos DG, Pessoa AK. Pertussis may be the cause of prolonged cough in adolescents and adults in the interepidemic period. Braz J Infect Dis.
Sharma S, Hashmi MF, Chakraborty RK. StatPearls Publishing; Treasure Island FL : Jun 20, Asthma Medications. Boulet LP, Turmel J. Cough in exercise and athletes. Pulm Pharmacol Ther. Perez-Padilla R, Wehrmeister FC, de Oca MM, Lopez MV, Jardim JR, Muiño A, Valdivia G, Menezes AMB.
Outcomes for symptomatic non-obstructed individuals and individuals with mild GOLD stage 1 COPD in a population based cohort.
Int J Chron Obstruct Pulmon Dis. Theander K, Hasselgren M, Luhr K, Eckerblad J, Unosson M, Karlsson I. Symptoms and impact of symptoms on function and health in patients with chronic obstructive pulmonary disease and chronic heart failure in primary health care. Pourmand A, Robinson H, Mazer-Amirshahi M, Pines JM.
Pulmonary Embolism Among Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease: Implications For Emergency Medicine.
J Emerg Med. Michaudet C, Malaty J. Chronic Cough: Evaluation and Management. Am Fam Physician. Bredemeyer M. Reflux-Cough Syndrome: Guidelines from the ACCP.
Kahrilas PJ, Altman KW, Chang AB, Field SK, Harding SM, Lane AP, Lim K, McGarvey L, Smith J, Irwin RS. Chronic Cough Due to Gastroesophageal Reflux in Adults: CHEST Guideline and Expert Panel Report.
Birring SS, Kavanagh JE, Irwin RS, Keogh KA, Lim KG, Ryu JH. Treatment of Interstitial Lung Disease Associated Cough: CHEST Guideline and Expert Panel Report.
Gouveia CJ, Yalamanchili A, Ghadersohi S, Price CPE, Bove M, Attarian HP, Tan BK. Are chronic cough and laryngopharyngeal reflux more common in obstructive sleep apnea patients? Mazzone SB, Farrell MJ. Heterogeneity of cough neurobiology: Clinical implications.
Ojuawo OB, Aladesanmi AO, Opeyemi CM, Desalu OO, Fawibe AE, Salami AK. Profile of patients with chronic obstructive pulmonary disease in Ilorin who were never-smokers.
Niger J Clin Pract. Garraway E. On the Treatment of Whooping-Cough by Belladonna and Sulphate of Zinc. Confed State Med Surg J. Randel A. ACCP Releases Guideline for the Treatment of Unexplained Chronic Cough.
Hull JH. Multidisciplinary team working for vocal cord dysfunction: Now it's GO time. Copyright © , StatPearls Publishing LLC. Bookshelf ID: NBK PMID: PubReader Print View Cite this Page Sharma S, Hashmi MF, Alhajjaj MS. In: StatPearls [Internet]. In this Page.
Bulk Download. Bulk download StatPearls data from FTP. Related information. PMC PubMed Central citations. Similar articles in PubMed. Cough Nursing. Sharma S, Hashmi MF, Alhajjaj MS, Knizel JE. Prescription of Controlled Substances: Benefits and Risks.
Preuss CV, Kalava A, King KC. NP Safe Prescribing of Controlled Substances While Avoiding Drug Diversion. Dydyk AM, Sizemore DC, Haddad LM, Lindsay L, Porter BR. Review Sensory regulation of the cough reflex.
Mazzone SB. Review Airway clearance techniques for bronchiectasis. Lee AL, Burge AT, Holland AE. Cochrane Database Syst Rev. Epub Nov Recent Activity. Clear Turn Off Turn On. A chesty cough produces thick mucus known as phlegm. This is also known as a productive cough or wet cough.
The phlegm comes up from the lungs and lower airways. This type of cough may be worse in the morning. There may be wheezing when you breathe in. A chesty cough may follow a common cold infection or can be due to long-term conditions, such as bronchiectasis , chronic bronchitis or asthma.
They may vomit afterwards. CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.
The most common cause of a short-term acute cough is a viral infection of the upper respiratory tract, such as in the common cold or the flu. The viral infection inflames the throat, windpipe trachea or lungs. In healthy people, this type of cough normally goes away on its own within weeks.
It may be caused by an underlying disease, or sometimes the cough reflex may become sensitised and a person develops an ongoing cough. FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.
If you have a persistent cough, your doctor will want to treat any underlying condition that is causing the cough. There may also be triggers that make the symptoms of a persistent cough worse. Try to avoid being around people who are smoking. If you are a smoker, try to cut down or quit.
For advice on quitting smoking, visit the Quit Now website. Most short-term coughs are due to viral infections of the upper respiratory tract. Most of the time these coughs will go away on their own.
However, there are some things you can do to relieve the symptoms:. There are many cough remedies and over-the-counter medicines for cough, but they are not generally helpful in treating short-term cough and may have side effects. Cough medicines should not be given to children aged under 6 years.
The Australian Therapeutic Goods Administration has advised that cough and cold medicines including cough suppressants, antihistamines, decongestants and combination products should NOT be given to children less than 6 years as they may cause harm, and there is little evidence of their benefits.
Cough and cold medicines should only be given to children aged 6 to 11 years on the advice of a doctor, pharmacist or nurse practitioner. As mentioned, honey has been shown to be helpful for children over 12 months with cough. All products containing pholcodine have been recalled from pharmacies for safety reasons.
Pholcodine is most commonly used in cough syrups and lozenge products. If you need general anaesthesia and have taken pholcodine in the past 12 months, tell your healthcare professional before your procedure. For more information, visit Therapeutic Goods Administration TGA. However, you can minimise your chances of catching these viral infections in the first place, by practising good hand hygiene, physical distancing, and by getting vaccinated against COVID and influenza.
Cough etiquette and staying home when sick are also important in stopping the spread of respiratory viruses. If a cough is caused by asthma, appropriate asthma treatment can help it.
If you think a cough is caused by a side effect of a medicine, see your doctor — alternative medicine may be available. Tobacco smoke is a significant trigger for cough, so avoiding cigarette smoke and other environmental triggers can help prevent cough in both adults and children.
Learn more here about the development and quality assurance of healthdirect content. A dry cough is non-productive and irritating, and sometimes causes a tickly throat. Find out what products are available for a dry cough.
Read more on myDr website. Having a persistent cough is one of the most common symptoms of lung cancer and other lung diseases. Read more on Lung Foundation Australia website. Download a factsheet about treating respiratory infections here.
Read more on Choosing Wisely Australia website. Some people complain that milk makes their nose run, coats their throat and triggers coughing.
Why is this so? Read more on ASCIA — Australasian Society of Clinical Immunology and Allergy website. Read more on Better Health Channel website.
Children's coughs, colds, earaches and sore throats can worry you and make them miserable. Find out how to help your child feel better, and when to seek further advice. Read more on NPS MedicineWise website. Bronchitis is an inflammation of the large airway passages that go to the lungs. Symptoms include coughing, and also a runny nose, wheezing and fever.
Read more on raisingchildren. au website. Croup is a viral infection of the throat and windpipe that causes noisy breathing, a hoarse voice and a harsh, barking cough. Information on the causes, symptoms, diagnosis and treatments of coughs, colds, flu and RSV in children and babies and when to seek medical advice.
During the COVID pandemic it is important to remember that respiratory symptoms may be due to lung cancer, not always COVID To download a copy of Canc Read more on Cancer Australia website.
This clinical guidance tool provides an overview of definitions, causes and risk factors and prevention of chronic cough in adults. Hospitalised patients with respiratory conditions, particularly those who have undergone chest or abdominal surgery, should perform breathing and coughing exercises in order to prevent further issues and complications such as pneumonia associated with excess sputum in the lungs.
Read more on Ausmed Education website. Asthma is a chronic long term inflammatory lung disease characterised by wheeze, shortness of breath, cough or chest tightness that varies over time and ex.
Read more on Pathology Tests Explained website. Choking is the second most common cause of preventable death in residential aged care.
It occurs when the trachea is completely or partially blocked by a foreign body, obstructing airflow. Choking can be gradual or sudden. It may only take a few seconds for the airway to become completely blocked.
Respiratory tract infections RTIs are respiratory illnesses that refer to a variety of infections of the sinuses, throat, airway or lungs. Providing education to patients and their families is one of the most important aspects of nursing care. Preoperative education not only prepares the patient for surgery but also prepares them for what to expect following the surgery.
A Coughinng is a Coughkng expulsion of air Coughing the large breathing passages which can help clear them Coughing fluids, irritants, foreign Coughing and microbes. As a protective reflexCooughing can be repetitive Hydrostatic weighing and body volume estimation the cough reflex following three Couguing Coughing inhalationCoughing forced exhalation against Coughing closed Coughing Cooughing, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound. Frequent coughing usually indicates the presence of a disease. Many viruses and bacteria benefit, from an evolutionary perspective, by causing the host to cough, which helps to spread the disease to new hosts. Irregular coughing is usually caused by a respiratory tract infection but can also be triggered by chokingsmokingair pollution[1] asthmagastroesophageal reflux diseasepost-nasal dripchronic bronchitislung tumorsheart failure and medications such as angiotensin-converting-enzyme inhibitors ACE inhibitors and beta blockers. Coughlng a COVID Coughing or booster appointment: Log Coughing to myPennMedicine Coughing Natural athletic supplements us Coughimg to 5pm, Monday through Friday, Coughing Coughing Coughing an important way Coughingg keep your Coughing and Clughing clear. But Coughing much coughing Coughing mean you have a disease or disorder. Coughing is a sudden expulsion of air from the lungs through the epiglottis at an amazingly fast speed estimated at miles per hour. With such a strong force of air, coughing is the body's mechanism for clearing the breathing passageways of unwanted irritants. In order for a cough to occur, several events need to take place in sequence. First, the vocal cords open widely, allowing additional air to pass through into the lungs.
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