Cough

A cough is a sudden expulsion of air

through the large breathing passages that
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]
 Cough

A young boy coughing due to pertussis

causing whooping cough.
 Coughing
0:00 / 0:00

The sound of a person coughing.

Pronunciation pronunciation (help·info
Problems playing this file? See media help.
) Latin: tussis

Specialty Infectious disease

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. Most of the time, irregular coughing
is caused by a respiratory tract infection
but can also be triggered by choking,
smoking, air pollution,[1] asthma,
gastroesophageal reflux disease, post-
nasal drip, chronic bronchitis, lung tumors,
heart failure and medications such as ACE
inhibitors.

Treatment should target the cause; for

example, smoking cessation or
discontinuing ACE inhibitors. Cough
suppressants such as codeine or
dextromethorphan are frequently
prescribed, but have been demonstrated to
have little effect. 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.[2]

Presentation
 

Play media
Shadowgraph videos of the outer airflow during a

cough, comparing unmasked coughing with several

different method of covering one's mouth and nose:
coughing into a fist, a cupped hand, a tissue, a
"coughcatcher" device, a surgical mask, and an N95
mask

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, 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.[3]

Differential diagnosis
A cough in children may be either a normal
physiological reflex or due to an underlying
cause.[4] In healthy children it may be
normal in the absence of any disease to
cough ten times a day.[4] The most
common cause of an acute or subacute
cough is a viral respiratory tract
infection.[4] 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.[4] The
causes of chronic cough are similar in
children with the addition of bacterial
bronchitis.[4]

Infections …
A cough can be the result of a respiratory
tract infection such as the common cold,
acute bronchitis, pneumonia, pertussis, or
tuberculosis. In the vast majority of cases,
acute coughs, i.e. coughs shorter than 3
weeks, are due to the common cold.[5] 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
postinfectious cough. This typically is a
dry, non-productive cough that produces
no phlegm. Symptoms may include a
tightness in the chest, and a tickle in the
throat. This cough may often persist for
weeks after an illness. The cause of the
cough may be inflammation similar to that
observed in repetitive stress disorders
such as carpal tunnel syndrome. The
repetition of coughing produces
inflammation which produces discomfort,
which in turn produces more coughing.[6]
Postinfectious cough typically does not
respond to conventional cough
treatments. Treatment consists of any
anti-inflammatory medicine (such as
ipratropium)[6] to treat the inflammation,
and a cough suppressant to reduce
frequency of the cough until inflammation
clears. Inflammation may increase
sensitivity to other existing issues such as
allergies, and treatment of other causes of
coughs (such as use of an air purifier or
allergy medicines) may help speed
recovery.

Reactive airway disease …

This section does not cite any sources.

Learn more

When coughing is the only complaint of a

person who meets the criteria for asthma
(bronchial hyperresponsiveness and
reversibility), this is termed cough-variant
asthma. Two related conditions are atopic
cough and eosinophilic bronchitis. Atopic
cough occurs in individuals with a family
history of atopy (an allergic condition),
abundant eosinophils in the sputum, but
with normal airway function and
responsiveness. Eosinophilic bronchitis is
also characterized by eosinophils in the
sputum, without airway
hyperresponsiveness or an atopic
background. This condition responds to
treatment with 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.

Chronic bronchitis is defined clinically as a

persistent cough that produces sputum
(phlegm) and mucus, for at least three
months in two consecutive years. Chronic
bronchitis is often the cause of "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,

gastroesophageal reflux disease should be
considered.[4] This occurs when acidic
contents of the stomach come back up
into the esophagus. Symptoms usually
associated with 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
don't 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.[4] 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 …

This section does not cite any sources.

Learn more

A foreign body can sometimes be

suspected, for example if the cough
started suddenly when the patient was
eating. Rarely, sutures left behind inside
the airway branches can cause coughing.
A cough can be triggered by dryness from
mouth breathing or recurrent aspiration of
food into the windpipe in people with
swallowing difficulties.

Angiotensin-converting enzyme
inhibitor
…

Angiotensin-converting enzyme (ACE)

inhibitors are drugs used in diabetics,
heart disease, and high blood pressure. In
5-35%[7] of the people who take it, it can
cause them to have a cough as a side
effect. Cessation of ACE Inhibitor use is
the only way to stop the cough. Such
medicines for hypertension are very
common in use such as ramipril and
quinapril. There are cases of "cough of
unknown origin" who had resolution with
stopping the drug.[8]

Psychogenic cough …
A psychogenic cough, "habit cough" or "tic
cough" coughing for no apparent reason
may be the cause in the absence of a
physical problem. In these instances,
emotional and psychological problems are
suspected. However, other illnesses have
to be ruled out before a firm diagnosis of
psychogenic cough is made.

Psychogenic cough is thought to be more

common in children than in adults. A
possible scenario: psychogenic cough
develops in a child who has a chronically ill
brother or sister.[9]

Neurogenic cough …

Some cases of chronic cough may be

attributed to a sensory neuropathic
disorder.[10] 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
bronchiectasis, cystic fibrosis, interstitial
lung diseases and sarcoidosis. Coughing
can also be triggered by 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.[11] Other
causes of nocturnal cough include
asthma, post-nasal drip and
gastroesophageal reflux disease
(GERD).[12] Another cause of cough
occurring preferentially in supine position
is recurrent aspiration.[11]

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, such as coughing before giving a
speech. Coughing is not always
involuntary, and can be used in social
situations. Coughing can be used to
attract attention, release internal
psychological tension, or become a
maladaptive displacement behavior. It is
believed that the frequency of such
coughing increases in environments
vulnerable to psychological tension and
social conflict. In such environments,
coughing may become one of many
displacement behaviors or defense
mechanisms.

Pathophysiology

Coughing is viewed as a public health issue.

A cough is a protective reflex in healthy
individuals which is influenced by
psychological factors.[4] 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. However it is not certain that the
stimulation of nonmyelinated C-fibers
leads to cough with a reflex as it is meant
in physiology (with its own five
components): this stimulation may cause
mast cells degranulation (through an asso-
assonic reflex) and edema which may
work as a stimulus for rapidly adapting
receptors.

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.[13]

Further workup may include labs, x-rays,

and spirometry.[4]

Classification …

A cough can be classified by its duration,

character, quality, and timing.[4] The
duration can be either acute (of sudden
onset) if it is present less than three
weeks, subacute if it is present between
three or eight weeks, and chronic when
lasting longer than eight weeks.[4] 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.[4]
A number of characteristic coughs exist.
While these have not been found to be
diagnostically useful in adults, they are of
use in children.[4] A barky cough is part of
the common presentation of croup.[14] A
staccato cough has been classically
described with neonatal chlamydial
pneumonia.[15]

Treatment
This section is missing information about
treatment in adults. Learn more
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.[16]

According to the American Academy of

Pediatrics the use of cough medicine to
relieve cough symptoms is supported by
little evidence and thus not recommended
for treating cough symptoms in children.[4]
There is tentative evidence that the use of
honey is better than no treatment or
diphenhydramine in decreasing
coughing.[17] It does not alleviate coughing
to the same extent as dextromethorphan
but it shortens the cough duration better
than placebo and salbutamol.[17] A trial of
antibiotics or inhaled corticosteroids may
be tried in children with a chronic cough in
an attempt to treat protracted bacterial
bronchitis or asthma respectively.[4] There
is insufficient evidence to recommend
treating children who have a cough that is
not related to a specific condition with
inhaled anti-cholinergics.[18]
Epidemiology
A cough is the most common reason for
visiting a primary care physician in the
United States.[4]

Other animals
Marine mammals such as dolphins cannot
cough.[19] Domestic animals such as dogs
and cats can cough, because of diseases,
allergies, dust or choking.[20] In particular,
cats are known for coughing before
spitting up a hairball.[20]

In other domestic animals, horses can

cough because of infections, or due to
poor ventilation and dust in enclosed
spaces.[21]

See also
Cough reflex
Sneeze

References
1. Chung KF, Pavord ID (April 2008).
"Prevalence, pathogenesis, and causes
of chronic cough". Lancet. 371 (9621):
1364–74. doi:10.1016/S0140-
6736(08)60595-4 . PMID 18424325 .
2. Pavord ID, Chung KF (April 2008).
"Management of chronic cough".
Lancet. 371 (9621): 1375–84.
doi:10.1016/S0140-6736(08)60596-6 .
PMID 18424326 .
3. "Cystocele (Prolapsed Bladder) |
NIDDK" . National Institute of Diabetes
and Digestive and Kidney Diseases.
Retrieved 2017-12-02.
4. Goldsobel AB, Chipps BE (March
2010). "Cough in the pediatric
population". J. Pediatr. 156 (3): 352–
358.e1.
doi:10.1016/j.jpeds.2009.12.004 .
PMID 20176183 .
5. Dicpinigaitis PV, Colice GL, Goolsby
MJ, Rogg GI, Spector SL, Winther B
(2009). "Acute cough: a diagnostic and
therapeutic challenge" . Cough. 5: 11.
doi:10.1186/1745-9974-5-11 .
PMC 2802352 . 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."
. Braman SS (January 2006).
"Postinfectious cough: ACCP
evidence-based clinical practice
guidelines". Chest. 129 (1 Suppl):
138S–146S.
doi:10.1378/chest.129.1_suppl.138S .
PMID 16428703 .
7. Dicpinigaitis PV (January 2006).
"Angiotensin-converting enzyme
inhibitor-induced cough: ACCP
evidence-based clinical practice
guidelines". Chest. 129 (1 Suppl):
169S–173S.
doi:10.1378/chest.129.1_suppl.169S .
PMID 16428706 .
. Kostas Koliopoulos, Cardiologist:
"Cases of Cough of unknown origin,
due to use of ACE medication for
hypertension", data on file, Preveza,
Greece, 2010
9. Irwin RS, Glomb WB, Chang AB
(January 2006). "Habit cough, tic
cough, and psychogenic cough in adult
and pediatric populations: ACCP
evidence-based clinical practice
guidelines". Chest. 129 (1 Suppl):
174S–179S.
doi:10.1378/chest.129.1_suppl.174S .
PMID 16428707 .
10. Gibson PG, Ryan NM (August 2011).
"Cough pharmacotherapy: current and
future status". Expert Opinion on
Pharmacotherapy. 12 (11): 1745–
1755.
doi:10.1517/14656566.2011.576249 .
PMID 21524236 .
11. NCBI » Bookshelf » Clinical Methods »
The Pulmonary System » Cough and
Sputum Production By Sattar Farzan.
Extracted from the book Clinical
Methods, 3rd edition The History,
Physical, and Laboratory
Examinations. Edited by H Kenneth
Walker, MD, W Dallas Hall, MD, and J
Willis Hurst, MD. Boston: Butterworths;
1990. ISBN 0-409-90077-X
12. "C.Chronic Cough" . Archived from the
original on 2010-10-01. Retrieved
2010-10-10. National Lung Health
Education Program > C. Chronic
Cough] The Snowdrift Pulmonary
Foundation, Inc. 2000. ISBN 0-
9671809-2-9
13. Noah Lechtzin. "Cough in Adults" .
Merck Manuals. Retrieved 2017-04-07.
Last full review/revision July 2016
14. Bjornson CL, Johnson DW (July 2007).
"Croup in the paediatric emergency
department" . Paediatr Child Health.
12 (6): 473–477.
doi:10.1093/pch/12.6.473 .
PMC 2528757 . PMID 19030411 .
15. Miller KE (April 2006). "Diagnosis and
treatment of Chlamydia trachomatis
infection". Am Fam Physician. 73 (8):
1411–6. PMID 16669564 .
1 . Thompson, M.; Vodicka, T. A.; Blair, P.
S.; Buckley, D. I.; Heneghan, C.; Hay, A.
D. (11 December 2013). "Duration of
symptoms of respiratory tract
infections in children: systematic
review" . BMJ. 347 (dec11 1): f7027.
doi:10.1136/bmj.f7027 .
PMC 3898587 . PMID 24335668 .
17. Oduwole, O; Udoh, EE; Oyo-Ita, A;
Meremikwu, MM (10 April 2018).
"Honey for acute cough in children" .
The Cochrane Database of Systematic
Reviews. 4: CD007094.
doi:10.1002/14651858.CD007094.pu
b5 . PMC 6513626 . PMID 29633783 .
1 . Chang, A. B.; McKean, M.; Morris, P.
(2004). "Inhaled anti-cholinergics for
prolonged non-specific cough in
children". The Cochrane Database of
Systematic Reviews (1): CD004358.
doi:10.1002/14651858.CD004358.pu
b2 . ISSN 1469-493X .
PMID 14974067 .
19. Woodard, James C.; Zam, Stephen G.;
Caldwell, David K.; Caldwell, Melba C.
(29 August 2016). "Some Parasitic
Diseases of Dolphins". Pathologia
Veterinaria. 6 (3): 257–272.
doi:10.1177/030098586900600307 .
PMID 5817449 .
20. "Is It Normal for Cats To Cough?" . Pet
Health Network. Retrieved 2018-04-23.
21. "Coughing in horses explained" . Your
Horse Magazine. Retrieved
2018-04-23.
As of this edit , this article uses content
from "Acute cough: a diagnostic and
therapeutic challenge" , which is licensed
in a way that permits reuse under the
Creative Commons Attribution-ShareAlike
3.0 Unported License, but not under the
GFDL. All relevant terms must be followed.

Further reading
Carroll, Thomas L., ed. (2019). Chronic
Cough. Plural Publishing.
 ISBN 9781635500707.
LCCN 2018055141 .

External links
Classification ICD-10: R05 • D

ICD-9-CM: 786.2 •

MeSH: D003371 •

DiseasesDB: 17149

External resources MedlinePlus:

003072 •

eMedicine:
ENT/1048560
 Cough
at Wikipedia's sister projects

Definitions
  from
Wiktionary
Media
from
 
Wikimedia
Commons
News from
 
Wikinews
 Quotations
  from
Wikiquote
Texts from
 
Wikisource
Textbooks
  from
Wikibooks
Resources
  from
Wikiversity
Retrieved from
"https://en.wikipedia.org/w/index.php?
title=Cough&oldid=946446356"

Last edited 30 days ago by KH-1

Content is available under CC BY-SA 3.0 unless

otherwise noted.