What is cough
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Summary
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These studies suggest that cough is a complex physiological event that protects the lungs and clears airways, but can also indicate serious disease and contribute to airborne infection.
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Understanding Cough: Mechanisms, Causes, and Management
What is Cough?
Cough is a forced expulsive maneuver, typically against a closed glottis, producing a characteristic sound that is easily recognized. It serves as a protective reflex to clear the airways of secretions and prevent aspiration. The cough reflex involves a deep inspiration, glottal closure, and an explosive expiration. This reflex is essential for protecting the lungs from mechanical, chemical, and thermal injuries.
Types of Cough: Productive vs. Non-Productive
Coughs can be categorized into productive (wet) and non-productive (dry) types. Productive coughs involve the expulsion of mucus or phlegm, while non-productive coughs do not produce sputum and are often a result of airway irritation or inflammation. Dry coughs are commonly associated with acute viral respiratory infections and can last up to 3-4 weeks.
Causes of Cough
Acute and Chronic Cough
Acute coughs are typically short-lived and often result from infections like the common cold or flu. Chronic coughs, lasting more than 8 weeks, can be caused by various factors including smoking, environmental pollutants, and diseases such as asthma, gastro-oesophageal reflux disease (GERD), and chronic obstructive pulmonary disease (COPD). Chronic coughs are often linked to an increased sensitivity to irritants, known as neuronal hypersensitivity.
Pathophysiology and Reflex Mechanism
The cough reflex is initiated by sensory neurons in the airways that respond to irritants. This reflex can be both protective and pathological. While it helps clear the airways, it can also be a sign of serious diseases and contribute to the spread of infections . In some cases, chronic coughs can lead to structural and inflammatory changes in the airways, which may perpetuate the cough even in the absence of the initial cause.
Diagnostic and Management Approaches
Objective Assessment
Modern techniques for assessing cough include automatic cough detectors and counters, which are useful for evaluating the effectiveness of antitussive drugs and other treatments. These tools help in the objective measurement of cough frequency and severity, providing valuable data for clinical management.
Differential Diagnosis
A systematic approach to diagnosing cough involves identifying all contributing factors. Physicians must consider a wide range of potential causes, from common conditions like asthma and GERD to less common ones like pulmonary fibrosis and bronchiectasis. In some cases, no specific cause is identified, leading to a diagnosis of idiopathic cough.
Treatment Strategies
Effective management of cough requires addressing the underlying cause. For instance, treating GERD or asthma can significantly reduce cough symptoms. Additionally, new research into the mechanisms of cough has led to the development of novel non-opioid antitussive drugs, offering new avenues for treatment. Desensitization of the cough pathways is also a crucial aspect of managing chronic cough.
Conclusion
Cough is a complex reflex with both protective and pathological roles. Understanding its mechanisms, types, and causes is essential for effective diagnosis and management. Advances in objective assessment and new treatment options are improving the ability to manage this common yet often debilitating symptom.
Sources and full results
Most relevant research papers on this topic
3
Cough: differential diagnosis and treatment.
3
45 Citations
1987