Cough and congestion
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Understanding Cough and Congestion: Causes, Diagnosis, and Management
Common Causes of Cough and Nasal Congestion
Viral Infections and the Common Cold
Cough and nasal congestion are frequently associated with the common cold, a benign, self-limited viral infection. Symptoms include sneezing, rhinorrhea, nasal congestion, cough, and malaise. The common cold is primarily caused by viruses such as rhinovirus, RSV, and coronavirus, and it is the most frequent acute illness in the industrialized world2. Adults typically experience two to three episodes annually, while children may have up to five2.
Allergic Rhinitis and Seasonal Allergies
Allergic rhinitis, an inflammatory condition of the nasal mucous membranes, often results in symptoms such as rhinorrhea, nasal congestion, nasal itching, sneezing, and cough. Mometasone furoate nasal spray (MFNS) has been shown to be effective in reducing these symptoms, including cough, in patients with seasonal allergic rhinitis5. Positive skin tests for allergens like trees and dust mites can also indicate allergic rhinitis1.
Chronic Conditions and Environmental Factors
Chronic cough can be a significant cause of morbidity and is often associated with conditions such as asthma, gastroesophageal reflux disease (GERD), and chronic sinusitis. Environmental and occupational exposures can also contribute to chronic cough, either as isolated symptoms or as manifestations of more significant diseases4 9. Chronic cough is characterized by neuronal hypersensitivity and can seriously impair quality of life4.
Diagnostic Considerations
Differential Diagnosis
The differential diagnosis for cough and congestion is broad, ranging from non-emergent causes like rhinitis to life-threatening conditions such as pulmonary embolism. Careful assessment is necessary to avoid misidentification and inappropriate discharge of potentially lethal conditions2. For instance, a 50-year-old woman with progressive dyspnea, cough, and nasal congestion was evaluated for various conditions, including allergic and nonallergic rhinitis, asthma, and systemic inflammatory diseases, before a biopsy revealed an unexpected diagnosis1.
Classification of Cough
Cough is classified into acute, subacute, and chronic based on its duration. Acute cough lasts less than three weeks and is often due to respiratory infections. Subacute cough lasts between three to eight weeks and is commonly postinfectious. Chronic cough, lasting more than eight weeks, is frequently due to conditions like upper airway cough syndrome (UACS), asthma, GERD, and nonasthmatic eosinophilic bronchitis6.
Management Strategies
Symptomatic Relief
Treatment for cough and congestion is usually targeted at symptomatic relief. For instance, MFNS has been shown to significantly improve both daytime and nighttime cough severity scores in patients with seasonal allergic rhinitis5. However, available medications for symptomatic management of cough are often inadequate due to a lack of proven efficacy and undesirable side effects3.
Addressing Underlying Causes
Effective management of cough involves identifying and treating the underlying cause. For example, chronic cough associated with GERD may require acid suppression therapy, while cough due to asthma may be managed with inhaled corticosteroids4. In children, the evaluation of cough should consider age-specific disorders, including congenital anomalies and foreign body aspiration10.
Preventing Complications
Cough can lead to a wide range of complications, from trivial issues like lightheadedness to severe conditions such as cervical artery dissection. Therefore, suppression of cough should not be neglected, especially in patients at risk of complications8.
Conclusion
Cough and nasal congestion are common symptoms with a wide range of potential causes, from viral infections and allergic rhinitis to chronic conditions and environmental exposures. Accurate diagnosis and effective management require a thorough understanding of the underlying causes and appropriate treatment strategies. By addressing both symptomatic relief and the root causes, healthcare providers can significantly improve patient outcomes and quality of life.
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Most relevant research papers on this topic
A 50-year old woman with nasal congestion, cough, and dyspnea.
We present a 50-year-old woman with progressive dyspnea, cough, and nasal congestion. Evaluation revealed positive skin tests (IgE) to trees and dust mites, early glottic closure on spirometry, and sinus opacities on CT. Diagnostic considerations included allergic and nonallergic rhinitis, asthma, aspirin-exacerbated respiratory disease, vocal cord dysfunction, chronic sinusitis secondary to gastroesophageal reflux disease, and systemic inflammatory and immunologic diseases, including vasculitis. Progresson of her symptoms prompted further investigation, and a biopsy yielded an unexpected diagnosis.
Case ReportCough, Cold, and Congestion
The common cold is a common viral infection with symptoms of sneezing, nasal congestion, and cough, often caused by viruses.
Management of Cough
Cough management can improve therapeutic effectiveness and patient quality of life by identifying the cause of the cough, implementing breathing maneuvers, and addressing potential side effects.
The global epidemiology of chronic cough in adults: a systematic review and meta-analysis
Chronic cough has a high global epidemiological burden, impairing quality of life and requiring a standard definition for further studies.
Meta-Analysis
Rigorous Journal
Highly CitedRelief of cough and nasal symptoms associated with allergic rhinitis by mometasone furoate nasal spray.
Mometasone furoate nasal spray effectively and well-tolerated relieves daytime cough and nasal symptoms associated with seasonal allergic rhinitis.
RCTHighly CitedClassification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report
CHEST's 2006 Cough Guidelines and management algorithms for acute, subacute, and chronic cough in adults are useful in diagnosing and treating patients globally, despite low quality evidence.
Systematic ReviewHighly CitedManaging Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report.
CHEST guidelines for children show some high-quality evidence in managing chronic cough, but more research is needed for non-specific cough management in primary healthcare.
Systematic ReviewHighly CitedThe Wide-Ranging Spectrum of Cough-Induced Complications and Patient Harm.
Cough-induced complications range from minor to severe, affecting various systems and affecting patients' quality of life.
Systematic ReviewOccupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report.
This paper highlights the need for further documentation of occupational and environmental causes of chronic cough in adults, as current assessment methods are inadequate for this population.
Systematic Review