Chest cough
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Understanding Chest Cough: Causes, Classifications, and Management
Classification of Chest Cough: Acute, Subacute, and Chronic
Chest cough can be classified into three main categories based on duration: acute, subacute, and chronic. Acute cough lasts less than three weeks and is most commonly caused by respiratory infections, often viral, as well as exacerbations of underlying conditions like asthma, COPD, and pneumonia. Subacute cough, lasting between three to eight weeks, is frequently due to postinfectious cough and exacerbations of conditions such as asthma, COPD, and upper airway cough syndrome (UACS). Chronic cough, persisting for more than eight weeks, is typically associated with UACS from rhinosinus conditions, asthma, gastroesophageal reflux disease (GERD), nonasthmatic eosinophilic bronchitis, and sometimes a combination of these conditions.
Physiology and Pathophysiology of Cough
The physiology and pathophysiology of cough involve complex mechanisms. Cough patterns, behaviors, and morphologic features have been extensively studied to understand their mechanical and physiological characteristics. Recent insights have highlighted the importance of acoustic characteristics and cough triggers, as well as the cough hypersensitivity patient phenotype. Understanding these features can aid in the clinical assessment and management of cough by providing a more informed interpretation of cough measurements.
Demographic and Clinical Considerations
Cough characteristics can vary significantly across different age groups and patient demographics, impacting clinical diagnosis and care. Factors such as age, underlying health conditions, and the physical properties of mucus can alter cough mechanics and efficiency. This variability necessitates a tailored approach to cough management, considering the specific clinical context of each patient.
Management of Unexplained Chronic Cough (UCC)
Unexplained chronic cough (UCC) significantly impairs quality of life and requires effective assessment and treatment strategies. Studies have shown that gabapentin can improve cough-related quality of life, while inhaled corticosteroids (ICS) and esomeprazole have been found ineffective for UCC without features of gastroesophageal acid reflux. Speech pathology-based cough suppression has also been suggested as a treatment option for UCC.
Complications Associated with Coughing
Coughing can lead to a wide range of complications, categorized primarily by organ system. These include cardiovascular, gastrointestinal, musculoskeletal, neurological, and respiratory complications, among others. Some complications can result in serious morbidity or even death, particularly in patients with comorbid conditions. Identifying the frequency and strength of association of these complications with cough is crucial for developing specific recommendations to avoid them.
Chronic Cough Due to Chronic Bronchitis
Chronic bronchitis is a common cause of chronic cough, leading to significant impairment in quality of life. Effective treatment strategies are needed to manage chronic cough due to chronic bronchitis and prevent acute exacerbations. However, the evidence supporting the management of chronic cough due to chronic bronchitis is limited and of low quality, highlighting the need for further research in this area.
Cough in Athletes
Athletes often experience cough, particularly after exercise. Common causes include asthma, exercise-induced bronchoconstriction, respiratory tract infections, and upper airway cough syndrome (UACS). Environmental exposures related to the sport training environment can also contribute to cough in athletes. While the evidence to guide treatment is weak, current guidelines for the general population should be applied, considering the specific training context and anti-doping regulations.
Conclusion
Chest cough, whether acute, subacute, or chronic, involves complex mechanisms and can significantly impact quality of life. Understanding the classifications, physiology, and pathophysiology of cough, along with demographic and clinical considerations, is essential for effective management. While there are established guidelines and treatment options, further research is needed to address gaps in knowledge and improve patient outcomes.
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