COUGH

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Cough - an arbitrary or involuntary (reflex) jerky like forced exhalation. The physiological role of the cough is to cleanse the respiratory tract from secretion and from substances that have got into them from the outside. As a manifestation of a pathological (sometimes - urgent) condition, cough is characterized by suddenness, excruciating persistence of the attack, a significant change in the nature of the sputum produced, and the appearance of unusual impurities in it.

Coughing is not a specific sign of any disease (although it most often occurs with respiratory diseases). It can be caused by the following factors:

1) inflammatory reactions of the respiratory tract (with laryngitis, tracheitis, bronchitis and bronchiolitis) and alveoli (with pneumonia or lung abscess);

2) mechanical irritation - inhalation of dust, impaired bronchial patency due to an increase in their tone or compression (lung or mediastinal tumors, aortic aneurysm, intramural formations - bronchogenic tumors , foreign bodies , contraction of smooth muscles of the respiratory tract in bronchial asthma, decreased elasticity of lung tissue with interstitial Fibrosis of the lungs, pulmonary edema, atelectasis);

3) chemical irritation - inhalation of gases with a strong odor (eg, tobacco smoke);

4) thermal irritation - inhalation of very hot or very cold air.

Cough can be single (with the inhalation of smoke, ingression into the respiratory tract of a foreign body), paroxysmal (in smokers, with bronchial asthma), acute (with acute viral or bacterial infection - laryngitis, tracheitis, bronchitis, pneumonia), chronic (for chronic diseases Trachea, chronic bronchitis, with cardiac pathology).

The audibility of the cough may play a diagnostic role. A sonorous coarse "barking" cough occurs when the epiglottis is involved in the process, for example, with acute laryngitis, whooping cough in children; Barking cough, as a rule, is combined with hoarseness of voice or aphonia. Silent cough is when paralysis or destruction of the vocal folds (combined with aphonia), the presence of tracheostomy, with considerable weakness of the patient. A deaf weakened cough is typical of chronic obstructive bronchitis with developing emphysema.

Cough can be dry or productive. Often a painful dry nasal cough is the first symptom of a tumor of the larynx, trachea, bronchi. Persistent debilitating dry cough occurs when foreign bodies get into the respiratory tract, and cough, appearing at the time of aspiration of a foreign body, sometimes persists for a long time. Attacks of dry cough are observed at the pressure of the tumor of the mediastinum or aneurysmally dilated aorta on the trachea, with stenosis of the trachea. A dry, painful cough that occurs at the height of the inspiration is usually observed with pleural lesions in patients with pleurisy or in the initial stage of pleuropneumonia.

Cough with sputum is observed in diseases accompanied by increased production of bronchial secretion, the formation of exudate in the airways (with bronchitis, pneumonia) or when they receive fluid. The nature of the sputum is diagnostic. Cough with the allocation of meager, viscous, vitreous sputum usually accompanies an attack of bronchial asthma, and also occurs with tracheitis and acute bronchitis (in these diseases, the separation of sputum can be so insignificant that the cough is regarded as dry, but in the future, sputum usually becomes yellowish or greenish, Mucopurulent). In acute focal pneumonia, usually mucopurulent sputum is separated, for pleuropneumonia is characterized by "rusty" sputum, the color of which is due to the admixture of erythrocytes. Sudden secretion with a cough of a large number of purulent, often fetid sputum may indicate a breakthrough in lung abscess in the bronchi. A significant increase in cough and an increase in the amount of sputum secreted, combined with worsening of the condition, chills, sweat, and fever, is observed with exacerbations of chronic suppuration in the lungs (chronic abscess, bronchiectasis). These diseases are characterized by the appearance of coughing attacks when the position of the body changes (for example, coughing attacks in the morning when getting up from bed).

The symptom of an emergency condition may be the appearance of unusual sputum or unusual impurities to sputum. So, the admixture of blood in the sputum should always be alarming, even if only the veins of blood are noted. Hemoptysis can be a manifestation of a lung infarction, tuberculosis, an oncological disease or a stagnation of blood in the lungs (for example, in heart defects). The appearance of a sputum containing an admixture of food products on cough testifies to the formation of the esophageal-bronchial fistula and the entry of the esophagus into the respiratory tract, and the occurrence of coughing attacks can be associated with eating. The presence of bile in the sputum may be the result of a breakthrough into the lung through the diaphragm of the abscess or the suppurated echinococcus of the liver. Sudden discharge of sputum, resembling semolina, happens with actinomycosis of the lungs. The spines that stand out with sputum are the druses of actinomycetes.

Coughing is one of the most frequent complaints and an important symptom of an emergency condition in patients with heart disease. Usually, the cause of cough in these cases is stagnation of blood in the pulmonary vessels with left ventricular failure or with mitral stenosis. Often coughing is one of the early signs of a lack of left ventricle of the heart. In these cases, he appears usually with physical exertion or at night in the horizontal position of the patient. Coughing attacks can be repeated several times a night, causing the patient to sit down, lower his legs. With heart failure, coughing usually occurs with dyspnea and is worse as stasis increases in the small circulation. In the lungs, these patients usually listen to hard breathing and wet rales over the lower-back sections. Effective treatment with vasodilators, diuretics, if necessary with cardiac glycosides, most often eliminates or significantly reduces cough and dyspnea. An excruciating cough is observed with an attack of cardiac asthma and swelling of the lungs. In the latter case, it is accompanied by the release of foamy pink sputum.

Complications of coughing may be a syncope due to an increase in intrathoracic pressure and a decrease in blood flow to the right heart (Bettolepsy), a rupture of emphysematous areas of the lungs (bulls) with the development of pneumothorax and pathological fractures of ribs in myeloma, osteoporosis and metastases of malignant neoplasms into the lungs.

Treatment . When coughing of any nature, the main disease plays a decisive role. Symptomatic therapy: with a dry painful cough, especially worrisome patients at night, inside appoint peripheral antitussive drugs with anesthetic effect on the mucous membrane of the respiratory tract (libexin 0.1-0.2 g - 1 - 2 tablets per reception), the central antitussive action - suppressive cough center (glavent 50 mg, tusuprex 10 - 20 mg or codeine 15 - 30 mg per reception). Cough, which provides effective drainage of the bronchi, should not be suppressed. To improve the drainage of the bronchi inside, expectorants are prescribed (bromhexine 2 tablets - 16 mg 3-4 times a day, acetylcysteine 200 mg 2 to 3 times a day). Symptoms of bronchospasm show inhalations of beta-adrenomimetics (beroteka, salbutamol), with severe bronchospasm - intravenous jet infusion of 10 ml of a 2.4% solution of euphyllin with 10 ml of isotonic sodium chloride solution.