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COUGH

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Cough - voluntary or involuntary (reflex) jerk - shaped forced sonorous exhalation. The physiological role of cough is to cleanse the airways of secretions and of substances that enter them from the outside. As a manifestation of a pathological (sometimes urgent) condition, the cough is characterized by suddenness, excruciating tenacity of the attack, a significant change in the nature of the sputum, and the appearance of unusual impurities in it.

Coughing is not a specific symptom of any disease (although it most often occurs with respiratory diseases). The following factors can cause it:

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 patency of the bronchi 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 with bronchial asthma, decreased lung tissue elasticity with interstitial pulmonary fibrosis, pulmonary edema, atelectasis);

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

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

A cough can be single (when inhaling smoke, getting into the respiratory tract of a foreign body), paroxysmal (in smokers, with bronchial asthma), acute (in case of acute viral or bacterial infection - laryngitis, tracheitis, bronchitis, pneumonia), chronic (in case of chronic diseases trachea, chronic bronchitis, with cardiac pathology).

The diagnostic value may play the sound of coughing. A sound coarse "barking" cough occurs when the epiglottis is involved in the process, for example, with acute laryngitis, whooping cough in children; a barking cough is usually combined with hoarseness or aphonia. Silent is a cough with paralysis or destruction of the vocal folds (combined with aphonia), the presence of a tracheostomy, with significant weakness of the patient. A deaf, weakened cough is typical of chronic obstructive bronchitis with developed emphysema.

A cough may be dry or productive. Often, an excruciating dry coughing cough is the first symptom of a tumor in the larynx, trachea, and bronchi. A persistent debilitating dry cough appears when foreign bodies enter the respiratory tract, moreover, coughing, which appears at the time of aspiration of a foreign body, sometimes persists for a long time. Attacks of dry cough are observed with a pressure of a tumor of the mediastinum or aneurysmically expanded aorta on the trachea, with tracheal stenosis. Dry painful cough that occurs at the height of 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 secretions, the formation of exudate in the respiratory tract (with bronchitis, pneumonia) or when fluid enters them. The nature of sputum discharge is of diagnostic value. Cough with the release of scanty, viscous, vitreous sputum usually accompanies an attack of bronchial asthma, and also occurs with tracheitis and acute bronchitis (in these diseases, sputum separation can be so slight that the cough is regarded as dry; however, later on the sputum usually becomes yellowish or greenish, mucopurulent). In acute focal pneumonia, as a rule, mucopurulent sputum is separated, pleuropneumonia is characterized by "rusty" sputum, the color of which is due to an admixture of red blood cells. Sudden discharge with a cough of a large amount of purulent, often fetid sputum may indicate a breakthrough of the lung abscess in the bronchus. A significant increase in cough and an increase in the amount of sputum secreted, combined with worsening condition, chills, sweat, and fever, is observed during exacerbations of chronic suppurative processes in the lungs (chronic abscess, bronchiectasis). These diseases are characterized by the occurrence of coughing attacks when the body position changes (for example, coughing attacks in the morning when getting out of bed).

A symptom of an emergency may be the appearance of unusual sputum or unusual impurities to sputum. So, an admixture of blood in sputum should always be alarming, even if only streaks of blood are noted. Hemoptysis can be a manifestation of pulmonary infarction, tuberculosis, cancer, or stagnation of blood in the lungs (for example, with heart defects). The appearance of cough of sputum containing an admixture of food products indicates the formation of an esophageal-bronchial fistula and the ingestion of the contents of the esophagus into the respiratory tract, while the occurrence of coughing fits may be associated with eating. The presence of bile in the sputum can be the result of a breakthrough into the lung through the diaphragm of an abscess or suppuration of echinococcus of the liver. The sudden release of sputum, reminiscent of semolina, occurs with actinomycosis of the lungs. The grains that stand out with sputum are Actinomycete Druze.

Coughing is one of the most frequent complaints and an important symptom of an emergency in patients with heart disease. Typically, the cause of cough in these cases is blood stasis in the pulmonary vessels with left ventricular failure or with mitral stenosis. Often, coughing is one of the earliest signs of left ventricular failure. In these cases, it usually appears during physical exertion or at night in a horizontal position of the patient. Coughing fits can be repeated several times during the night, causing the patient to sit down, lower his legs. With heart failure, cough usually occurs with shortness of breath and intensifies as stagnation increases in the pulmonary circulation. In the lungs of these patients, harsh breathing and moist rales above the lower back are usually heard. Effective treatment with vasodilators, diuretics, and if necessary cardiac glycosides most often eliminates or significantly reduces cough and shortness of breath. A painful cough is observed with an attack of cardiac asthma and pulmonary edema. In the latter case, it is accompanied by the release of foamy pink sputum.

Cough complications may include fainting due to increased intrathoracic pressure and a decrease in blood flow to the right heart (betolepsy), rupture of emphysema lung sections (bullae) with the development of pneumothorax and pathological fractures of the ribs in myeloma, osteoporosis and metastases of malignant neoplasms in the lungs.

Treatment . When coughing of any nature, the therapy of the underlying disease plays a decisive role. Symptomatic therapy: with a dry, painful cough, especially disturbing patients at night, peripheral antitussive drugs are prescribed inside with anesthetic effect on the mucous membrane of the respiratory tract (libexin 0.1-0.2 g - 1 - 2 tablets per reception), central antitussive action - suppressing the cough center (glauvent 50 mg, tusuprex 10 - 20 mg or codeine 15 - 30 mg per reception). A cough that provides effective bronchial drainage should not be suppressed. To improve the drainage of the bronchi, expectorants are prescribed inside (Bromhexine 2 tablets - 16 mg 3-4 times a day, acetylcysteine 200 mg 2-3 times a day). In case of symptoms of bronchospasm inhalation of beta-adrenergic agonists (berotek, salbutamol) is indicated, with severe bronchospasm - intravenous jet administration of 10 ml of 2.4% solution of aminophylline with 10 ml of isotonic sodium chloride solution.