COUGH - voluntary or involuntary (reflex) jerked forced sonic expiration. The physiological role of coughing is to clean the airways from secretions and from substances trapped in them from the outside. As a manifestation of the pathological (sometimes urgent) condition, a cough is characterized by suddenness, painful persistence of an attack, a significant change in the nature of the sputum released, the appearance of unusual impurities in it.
Cough is not a specific symptom of any disease (although most often occurs with respiratory diseases). The following factors may 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 bronchial patency due to an increase in their tone or compression (a lung or mediastinal tumor, an aortic aneurysm, intramural formations - bronchogenic tumors , foreign bodies , contraction of smooth muscles of the respiratory tract during bronchial asthma, decrease in elasticity of the lung tissue during 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.
Coughing can be single (inhalation of smoke, a foreign body inhaled into the respiratory tract), paroxysmal (in smokers, in bronchial asthma), acute (in acute viral or bacterial infections - laryngitis, tracheitis, bronchitis, pneumonia), chronic (in chronic diseases trachea, chronic bronchitis, with heart disease).
Diagnostic value may play sonorous cough. A sonorous, rough “barking” cough occurs when the epiglottis is involved in the process, for example, in acute laryngitis and whooping cough in children; The barking cough is usually combined with hoarseness or aphonia. Coughing can be silent when paralysis or the destruction of the vocal folds (combined with aphonia), the presence of a tracheostomy, with a significant weakness of the patient. Deaf cough weakened is typical for chronic obstructive bronchitis with advanced pulmonary emphysema.
The cough may be dry or productive. Often, an agonizing dry hacking cough is the first symptom of a laryngeal, tracheal, bronchial tumor . Persistent exhausting dry cough appears when foreign bodies get into the respiratory tract, and the cough, which appeared at the time of aspiration of a foreign body, sometimes persists for a long time. Attacks of dry cough are observed when the pressure of a tumor of a mediastinum or aneurysmatically enlarged aorta on the trachea, with tracheal stenosis. Dry, painful cough that occurs at the height of inhalation is usually observed with pleural lesions in patients with pleurisy or in the initial stage of pleuropneumonia.
Cough with sputum is observed in diseases involving increased production of bronchial secretions, the formation of exudate in the respiratory tract (with bronchitis, pneumonia), or when fluid enters them. The nature of the discharge of sputum has a diagnostic value. A cough with a scanty, viscous, glassy sputum usually accompanies an attack of bronchial asthma, and also occurs with tracheitis and acute bronchitis (for these diseases the sputum may be so small that the cough is considered dry; however, the sputum usually becomes yellowish or greenish, mucopurulent). In acute focal pneumonia, mucopurulent sputum is usually separated, and pleuropneumonia is characterized by “rusty” sputum, the color of which is due to the admixture of erythrocytes. A sudden discharge with cough of a large amount of purulent, often offensive sputum may indicate a lung abscess breakthrough in the bronchus. A significant increase in cough and an increase in the amount of sputum, combined with deterioration, chills, then, temperature increase, is observed during exacerbations of chronic suppurative processes in the lungs (chronic abscess, bronchiectasis). For these diseases is characterized by the occurrence of coughing when you change the position of the body (for example, coughing in the morning when getting up from bed).
Symptom of an emergency condition may be the appearance of unusual sputum or unusual impurities to the sputum. Thus, the admixture of blood in sputum should always be alarming, even if only blood streaks 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 sputum containing food impurities when coughing is indicative of the formation of an esophageal-bronchial fistula and the contents of the esophagus enter the respiratory tract, and the occurrence of coughing episodes may be associated with food intake. The presence in the sputum of bile can be the result of a breakthrough into the lung through the diaphragm of the abscess or suppurative echinococcus of the liver. Sudden sputum resembling semolina occurs in case of actinomycosis of the lungs. The granules released during sputum are the drusen of the actinomycete.
Cough is one of the most frequent complaints and an important symptom of an emergency in patients with heart disease. Usually, the cause of cough in these cases is blood stasis in the pulmonary vessels in left ventricular failure or in mitral stenosis. Often, cough is one of the earliest signs of left ventricular failure. In these cases, it usually appears during exercise or at night in a horizontal position of the patient. Attacks of cough can be repeated several times during the night, forcing the patient to sit down, lower his legs. In heart failure, cough usually occurs along with shortness of breath and increases with increasing stagnation in the pulmonary circulation. In the lungs of these patients are usually heard hard breathing and wet rales over the lower back sections. Effective treatment with vasodilators, diuretics, and, if necessary, cardiac glycosides often eliminate or significantly reduce cough and shortness of breath. A painful cough is observed during an attack of cardiac asthma and pulmonary edema. In the latter case, it is accompanied by the release of foamy pink sputum.
Complications of cough can be fainting due to increased intrathoracic pressure and reduction of blood flow to the right heart (bettolepsy), rupture of emphysematous lung areas (bull) with the development of pneumothorax and pathological rib fractures in myeloma, osteoporosis and metastases of malignant tumors in the lungs.
Treatment . When coughing of any nature, therapy of the underlying disease plays a crucial role. Symptomatic therapy: when dry, painful cough, especially disturbing patients at night, oral preparations of peripheral antitussive action with anesthetic effect on the mucous membrane of the respiratory tract are prescribed inside (libeksin 0.1-0.2 g - 1 - 2 tablets per intake), central antitussive action - suppressive cough center (Glauvent 50 mg, tusuprex 10–20 mg, or codeine 15–30 mg per dose). A cough that provides effective bronchial drainage should not be suppressed. To improve the drainage of the bronchi, expectorants are prescribed orally (Bromhexine 2 tablets - 16 mg - 3-4 times per day, acetylcysteine 200 mg 2 —3 times per day). With symptoms of bronchospasm, inhalations of beta-adrenomimetic drugs (berotec, salbutamol) are shown, and for severe bronchospasm, intravenous injection of 10 ml of a 2.4% solution of aminophylline with 10 ml of isotonic sodium chloride solution is indicated.