COUGH

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BY

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DR. DANJUMA SULAI, OON

MBBS, MSC Com Hlth (Lon) FRCP (Lon) FMCP (Nig.)

email: danjumasulai@yahoo.com

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COUGH

1. Definition

Intermittent, spasmodic forceful expiration of air following short inspiration. It could be at very sharp speed up to 500 miles/1 hours! It is physiologic (protective mechanism) in response to clear irritation to the Bronchial tree-- (Pharynx Bronchi), interstitial pulmonary--(Fibrosing Lung Disease Pulmonary oedema) and external stimulation of the bronchial tree –like occurs in GERD. Sensory nerve stimulate the cough.

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. Non physiological cough is often voluntary –

like clearing the throat before speech. In some

people it can become a tic (habit).

. There is Cough Centre in Medulla Oblongata

which seems has higher controls also. The whole

respiratory nervous network controlling breathing

is functionally connected to the cough center.

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2. CLASSIFICATION OF COUGH

In clinical terms cough can be described in terms of:

a) Duration

- Acute

- Chronic (greater 6 weeks)

- Acute on chronic

b) Productive or Non Productive

- Sputum expectoration, how much, what colour, consistency.

- Nil or scanty sputum

c) Sound Produced

- Whoop/stridor – Reflects Partial Obstruction

(Bordetella Pertusis).

- Bovine – prolonged low pitched associated with hoarseness of voice e.g. Single vocal cord

paralysis.

3. CAUSES OF COUGH

a) Infections

- Post Viral – pneumonitis – mild, short lived, acute non-productive cough.

- Infections (Bacterial) in Pharynx, larynx, Trachea, Bronchi. Bacterial Productive, color depends on what bacterium. Yellow, green,blue

Pharynx could be secondary to post-nasal drip of chronic sputumyellowdepends

sinusitis. Pneumonia; Tuberculosis.

b) Allergy

Bronchospasm Cough is Asthma. ACE – Inhibitor cough in 10 – 15% of females

c) Irritation by Neighbouring Structure

stimulation by Acids of Esophagus in gastro- esophagus. Reflux (GERD) Disease.

Causes persistent non-productive cough when no epigastric pains can pass for cough of unknown origin.

d. Carcinomatous Growth

- Bronchial or any part of bronchial tree growth

- Primary or secondaries

e) Pulmonary (Interstitial) Changes

- Chronic Obstructive Pulmonary Disease

- Pneumonia (lobar, segmental)

- Broncho pneumonia

- Fibrosing Pulmonary Disease.

- Pulmonary Oedema- Lymphatics, Pulmonary

Venous Congestion.

f) Foreign body in Airways

4. DIAGNOSIS

- Careful Clinical history

- Careful Clinical examination

- Basic Investigation Examination of sputum, Chest X-ray, Full Blood Count, Serology

--CAT SCAN

- Bronchoscopy, laryngoscopy

- Neurology

Relevant Biopsy—Tissue,Node,Lavage

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HICCUP

Hiccup is spasmodic involuntary contraction of the diaphragm occurring as the glottis of the larynx closes in inspiration.

• It is not Cough though spelt “Hiccoughs”

called Synchronous Diaphragmatic Flutter (SDF).

• Caused by:

“Normal” – short lived associated with gas in

tummy due to aerophagy, alcohol drinking

• Intractable Hiccups >48hrs GERD, Renal

Failure, Hypo/Hyper glycaemia.

Irritation of vagus (Phrenic) Nerve.

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TREATMENT OF HICCUP

1. Grand Mothers Method- Culturally varied
2. Correcting the inherent metabolic/surgical disorder.
3. Use of drugs like Chloropromazine, Metochloropromide, Cinnazarine, Haloperidol etc etc.

5. MANAGEMENT

- Mild cough is self limiting

- Remaining well hydrated is essential in All Cough management

- Measures to Aid Expectoration with mucolytic agents, Nebulizers.

- The use of cough suppressants e.g Dehydrocodeine, Detrophan Not encouraged

- Definitive treatment of the Primary Cause of the cough e.g cigarette smoking, Allergens Control, Infections Treatment. Pulmonary

Oedema Left Ventricular dysfunction.

- Bronchoscopy FB removal, lavage

- Tumour shrinkage

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• Managing complications of cough which

include:

- Conjuctival hemorrhage

- Chest pains/costochondritis

- Hernia

- Headaches

- Abdominal pains