- Chronic cough - types
- Chronic cough - diagnostic tests
- Chronic cough - causes
- Chronic cough treatment
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Chronic cough can be a symptom of many diseases. Although typically chronic cough is associated with respiratory diseases, it may be caused by abnormalities in apparently distant organs. There are many causes of chronic cough. Their correct diagnosis is a prerequisite for effective treatment. Find out what are the types of chronic cough, what tests should be done in its diagnosis and what diseases are most often associated with it.
Coughis a reflex reaction, caused by irritation of the so-called cough receptors. Cough receptors are found primarily in the respiratory tract. Their irritation stimulates the cough center in the brain. The final effect of the cough reflex is a sudden contraction of the expiratory muscles, the walls of the chest, the diaphragm, and the muscular membrane of the respiratory tract. In this way, the contents of the airways rapidly shift to the outside of the chest. It is worth knowing that some of the cough receptors are located outside the respiratory tract - in the middle ear, stomach, pericardium or on the surface of the diaphragm, for example. Therefore, the formation of cough is not always directly related to respiratory diseases.
Chronic cough - types
The classification of coughs is based on the duration of symptoms. It is distinguished by:
- acute cough , lasting no more than 3 weeks
- andchronic coughlasting at least 8 weeks.
- A cough lasting between 3 and 8 weeks is calledsubacute cough .
The second important criterion for coughing is expectoration. When it is present, we speak ofwet coughorproductive cough . No sputum is produced in a dry (unproductive) cough.
Chronic cough can be both dry and wet. The type of cough and its accompanying symptoms may initially indicate the cause of the perceived ailments.
Chronic cough - diagnostic tests
The basis for the diagnosis of chronic cough is a carefully collected history. The conversation with the patient should take into account recent infections, medications taken, exposure to irritants (tobacco) and the presence of chronic diseases.
In the diagnosis of chronic cough, the time of day and the circumstances causing the cough, accompanying symptoms and - in the case of wet cough - the nature of the expectorated secretion are important. In some conditions with chronic cough, the symptoms are so characteristic that the diagnosis can be made almost on the basis of the history alone.
An example of such a disease is whooping cough - an infectious disease caused by the bacillus of whooping cough. The paroxysmal cough phase in whooping cough can last up to 10 weeks. Chronic cough in the course of whooping cough is very characteristic - paroxysmal, exhausting, ending in loud breathing or "foam".
The next step in the diagnosis of chronic cough is a physical examination. In addition to auscultation of the chest, it is necessary to assess the condition of the nasopharynx, lymph nodes around the neck and chest, and to examine the ears with an otoscope.
In the case of chronic cough, diagnostics are usually extended by imaging tests. The first-choice examination is a chest X-ray. X-ray changes are visible in the course of some infections, cancers and chronic lung diseases.
If the X-ray does not show any abnormalities, the doctor may order additional tests. Depending on the patient's clinical condition and history data, a spirometry test, bronchoscopy (examination of the airways with the help of a camera inserted into them) or more detailed imaging examinations of the chest (most often computed tomography) may be useful.
If there is a suspicion that the cough is related to diseases of other organs, imaging of the paranasal sinuses (most often - sinus CT), ECG or echocardiography of the heart, allergy tests or gastroscopy (examination of the esophagus and stomach) may be necessary.
Chronic cough - causes
In order to successfully treat chronic cough, its source must be identified. Chronic cough often occurs with accompanying symptoms that may indicate the cause of the symptoms. The following diseases are presented, the dominant symptom of which may be chronic cough:
Common causes of chronic cough
Chronic cough is usually of great concern to patients. The first associations with chronic cough are serious lung diseases, infectious diseases, and cancer. Meanwhile, the most common cause of chronic cough is a seemingly trivial disease entity - the so-called syndrome of chronic drainage of secretions down the back of the throat.
The cause of this condition is the flow of excessive amounts of secretions from the nasal cavity to the areathroat and the initial part of the respiratory tract. A runny nose irritates the cough receptors located there, leading to the regular stimulation of the cough reflex.
Chronic discharge syndrome often coexists with allergic diseases, mainly allergic rhinitis. A relatively common cause of the problem are ENT disorders, such as chronic sinusitis or curvature of the nasal septum.
In children, the syndrome may accompany adenoid hypertrophy. Therefore, in chronic cough caused by discharge of secretions down the back of the throat, an ENT consultation is recommended.
Chronic cough can be a symptom of long-term respiratory infections. Most respiratory tract infections are acute and accompanying coughing lasts less than 3 weeks. However, it is worth knowing that in the case of many viral infections, post-infectious bronchial hyperreactivity may last up to several weeks.
When infected, the epithelium of the respiratory tract is damaged and it takes time to regenerate. During this period, cough receptors are more sensitive to arousal, so cough may appear many times a day.
Whooping cough is an example of an infectious disease that can cough for weeks. If chronic cough occurs with prolonged fever, night sweats, or haemoptysis, tuberculosis should be considered in the diagnosis.
Taking certain medications
Another common cause of chronic coughing may be taking certain medications. A long-lasting, dry cough is especially common in a very popular group of antihypertensive drugs - the so-called ACE-I inhibitors (including ramipril, captopril, enalapril).
This group of drugs is effective in lowering blood pressure, but has a side effect of increasing the levels of bradykinin in the body. Bradykinin is a substance that causes severe bronchospasm.
ACE-I can cause chronic cough in up to 25% of patients. If you notice a nagging, dry cough after starting ACE-I, it is worth informing your doctor about it. You can then replace the drug with another one that works in a similar way, but does not cause chronic cough.
Prolonged cough may be the main symptom of chronic respiratory diseases. Chronic, dry cough is typically associated with bronchial asthma. Bronchospasm in the course of asthma can indeed trigger the cough reflex.
Coughing attacks in asthma typically occur at night after exercise as wellunder the influence of irritating substances. However, typical symptoms are not enough to diagnose asthma - a spirometry test is necessary to confirm that the air flow through the respiratory tract is limited.
If your chronic cough is wet and accompanied by expectoration of sputum, think about other respiratory diseases. The most common of these is COPD, a chronic obstructive pulmonary disease that occurs primarily in smokers.
The main symptoms of COPD are shortness of breath and morning cough accompanied by the coughing up of mucus.
Coughing up large amounts of sputum, often purulent, can be a symptom of bronchiectasis. An example of a chronic lung disease associated with cough, diagnosed mainly in children, is cystic fibrosis.
The presence of chronic coughing may raise the suspicion of lung cancer. If the patient has lung cancer risk factors (age>60 years old, many years of smoking), it is necessary to deepen the diagnosis.
The characteristic symptoms that can accompany lung cancer are chronic fatigue, hemoptysis and weight loss. In the presence of such symptoms, it is essential to take a chest X-ray.
Few people are aware that chronic cough may be associated with certain diseases of the gastrointestinal tract. The cough is one of the so-called esophageal symptoms of gastro-oesophageal reflux disease.
During episodes of gastroesophageal reflux, small amounts of gastric contents may be released into the respiratory tract. There is periodic irritation of the cough receptors, resulting in chronic cough.
Usually, in the course of gastro-oesophageal reflux disease, apart from coughing, there are also other symptoms: heartburn, burning sensation behind the breastbone and periodic indigestion. Symptoms of gastro-oesophageal reflux disease may worsen when you lie down and eat certain foods. If your chronic cough is due to gastro-oesophageal reflux disease, successful treatment will relieve your symptoms.
Cough is a natural defensive reaction of our body - it protects the respiratory tract against pollution and harmful substances. When looking for the cause of chronic dry cough, it is worth considering exposure to irritating factors.
An example of such a situation is the common smoker's cough - a natural defense reflex, the purpose of which is to clear the respiratory tract of the components of tobacco smoke.
Similar symptoms may occur in patients at high riskair pollution or smog. If exposure to toxic substances is the cause of chronic cough, antitussive drugs should not be used. It is worth remembering then that such a cough has a protective function for our respiratory tract.
The respiratory system is anatomically closely related to the heart and circulatory system. Within our lungs there is the so-called a small bloodstream that pushes blood between the heart and lungs. The main function of the small bloodstream is to ensure that the blood is oxygenated. Failure of the heart to function as a blood-pumping pump can cause blood stagnation in the lungs.
One of the main symptoms of this condition is shortness of breath and a cough, occurring mainly when lying down. It is therefore worth remembering that a chronic cough may accompany, among others, heart failure.
Causes of chronic coughing in a child
Children are a special population of patients with chronic cough. Of course, many of the aforementioned diseases may occur in the pediatric population - respiratory system infections, bronchial asthma and gastroesophageal reflux disease.
Foreign body aspiration should always be included among the causes of chronic cough in this age group. A foreign body getting stuck (most often peanuts, small parts of toys, or pieces of solid food) can cause chronic coughing, coughing up sputum, and asymmetric auscultation changes (on one side of the chest).
A bronchoscopic examination is necessary for the diagnosis and, above all, the effective treatment of foreign body aspiration.
Chronic cough treatment
In order to successfully treat chronic cough, it is necessary to carefully diagnose its causes. The mainstay of treatment for chronic cough is effective treatment of the underlying disease. Diseases underlying chronic cough, such as bronchial asthma, chronic obstructive pulmonary disease, gastro-oesophageal reflux disease, and allergic diseases, often have a long-term course.
The condition for disease control is regular medication and adherence to medical recommendations. For smoking-induced cough, recovery therapy may be worth considering. If, on the other hand, your cough is caused by a respiratory infection, you may need antibiotics. In the case of some infections, it is worth being patient - full healing of the respiratory tract epithelium and return to normal functioning may take even several weeks.
In addition to the treatment of causal factors, symptomatic therapy can be used in many cases of chronic cough. Before starting treatment,the nature of the cough (dry / wet) should be established. Antitussive drugs are the mainstay of symptomatic treatment in dry cough. Many of them act at the level of the central nervous system, inhibiting the cough center located in it.
The most common drugs in this group are butamirate, dextromethorphan, and opioid derivatives (including codeine). However, it is worth remembering that cough medications should not be used in wet coughs.
Coughing up secretions helps to clear the respiratory tract, so in the case of such a cough, we should support the body in this process. The main group of drugs used in wet cough are mucus-thinning agents (the so-called mucolytics) - including acetylcysteine and ambroxol.
Very beneficial effect of expectorant inhalations from saline (s alt "pulls" water inside the bronchi, which reduces the density of the mucus in them). In chronic respiratory diseases, regular physical therapy (patting the respiratory cage, breathing exercises) is also important to help remove secretions from the bronchial tree.
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