The main function of coughing is airway clearance.
Excess secretions and foreign bodies clear
from the lungs by a combination of coughing and the muco-cilliary escalator (upward beating of
bronchial cilia that move mucus and entrapped foreign bodies to be expectorated or swallowed).
Cough can be described as either productive (chesty) or non-productive (dry, tight, tickly). The
most common cause of acute cough is viral upper respiratory tract infection (URTI) in all ages.
Viral coughs typically present with sudden onset associated fever. Sputum production is minimal
and symptoms are often worse in the evening. Associated cold symptoms are also present. These
symptoms usually last between 7 and 10 days. During of longer than 14 days might suggest post-
viral cough or possibly indicate a bacterial secondary infection. Coughs can be either acute or
chronic:
o An acute cough lasts less than 3 weeks
o Chronic cough lasts more than 8 weeks
Etiology
A five-part cough reflex is responsible for cough production:
o Receptors located mainly in the pharynx, larynx, trachea and bifurcations of the large
bronchi are stimulated via mechanical, irritant or thermal mechanisms
o Neural impulses are then carried along afferent pathways of the vagal and superior
laryngeal nerves
o Which terminate at the cough center in the medulla
o Efferent fibers of the vagus and spinal nerves carry neural activity to muscle of the
diaphragm, chest wall and abdomen
o These muscle contracts, followed by the sudden opening of the glottis and create the cough
Sputum color
o Mucoid (clear and white) No infection
o Yellow, green or brown (indicates infection)
o Hemoptysis, rust color (pneumonia) pink tinged (left ventricular failure) dark red
(carcinoma)
The patient can produce sputum with bright red blood. This is due to the force of coughing
causing a blood vessel to rupture. This is non-serious.
Nature of sputum
o Thin and frothy (left ventricular failure)
o Thick, mucoid to yellow (asthma)
o Offensive foul-smelling (bronchiectasis or lung abscess)
Age of the patient
o Children will most likely be suffering from an URTI
o With increasing age, conditions such as bronchitis, pneumonia and carcinoma become
more prevalent
Onset of cough
o Worse in the morning- postnasal drip, bronchiectasis or chronic bronchitis
o Postnasal drip- a sinus or nasal discharge that flows behind the nose and into the throat
(1) Acute cough (laryngo-tracheo-bronchitis) croup
Croup is usually caused by a virus infection, most often a parainfluenza virus. Croup refers to an
infection of the upper airway, which obstructs breathing and causes a characteristic barking cough.
The cough and other symptoms of croup are the result of swelling around the vocal cords (larynx),
windpipe (trachea) and bronchial tubes (bronchi). When a cough forces air through this narrowed
passage, the swollen vocal cords produce a noise similar to a seal barking. Likewise, taking a
breath often produces a high-pitched whistling sound (stridor). Croup typically occurs in younger
children. Most at risk of getting croup are children between 6 months and 3 years of age. The peak
incidence of the condition is around 24 months of age. It occurs in boys more than girls. It is more
common in autumn and winter months. Croup usually isn't serious and most cases can be treated
at home.
Symptoms
o Croup often begins as a typical cold. If there is enough inflammation and coughing,
a child will develop a loud barking cough
o Worse at night
o Fever and a hoarse voice are common
o Symptoms of croup usually last for three to five days
Diagnosis
o Observing the patient's breathing, listening to the patient's chest with a stethoscope
and examining the patient's throat
o Sometimes X-rays or other tests are used to rule out other possible illnesses
Treatment
o Because crying and agitation worsen airway obstruction (sing lullabies, or read
quiet stories. Offer a favorite blanket or toy. Speak in a soothing voice)
o If symptoms persist beyond three to five days or worsen (doctor may prescribe a
type of steroid (glucocorticoid) to reduce inflammation in the airway, i.e.,
Dexamethasone)
o Epinephrine is also effective in reducing airway inflammation
Lifestyle and home remedies
o Stay calm
o Moisten the air
o Offer fluids. For babies, water, breast milk or formula is fine. For older children,
soup or frozen fruit pops may be soothing
o Hold the child in a comfortable upright position
o Try a fever reducer (acetaminophen)
Complications
The airway swells enough to interfere with breathing
(2) Chronic cough
It is also called Chronic bronchitis. Chronic bronchitis (CB) is the most common cause of chronic
cough in adults. Chronic bronchitis, which is a form of chronic obstructive pulmonary disease
(COPD), is an ongoing inflammation of the airways leading to the lungs (bronchi). It is
characterized by a cough, mucus production, shortness of breath, and wheezing that persist for
longer than three months. It has been defined as coughing up sputum on most days for three or
more consecutive months over the previous 2 years. It is caused by chronic irritation of the airways
by inhaled substances, especially tobacco smoke. In non-smokers the causes of CB are postnasal
drip, asthma or gastro-esophageal reflux. CB starts with a non-productive cough that later becomes
a mucopurulent productive cough. It typically occurs in patients over the age of 40 and is more
common in men.
Symptoms:
o Cough
o Production of mucus (sputum), which can be clear, white, yellowish-gray or green
in color — rarely, it may be streaked with blood
o Fatigue
o Shortness of breath
o Slight fever and chills
o Chest discomfort
Diagnosis:
o Chest X-ray
o Sputum tests
o Pulmonary function test (blow into a device called a spirometer, which measures
how much air the lungs of the patient can hold and how quickly can get the air out
of your lungs)
Treatment
o Cough medicine (cough suppressants at bedtime)
o Antibiotics during flare-ups to reduce the risk of complications
o Bronchodilators (albuterol sulfate, formoterol, ipratropium and salmeterol)
o Inhaler and other medications to reduce inflammation and open narrowed passages
in the lungs (fluticasone and budesonide)
o Both a bronchodilator and a corticosteroid (budesonide-formoterol and fluticasone-
salmeterol)
o Pulmonary rehabilitation- Chest physical therapy (a breathing exercise program in
which a respiratory therapist teaches the patient how to breathe more easily and
increases the patient's ability to exercise)
o Medication to help with smoking cessation (varenicline or bupropion
hydrochloride)
o Oxygen therapy if blood oxygen levels are low
Lifestyle and home remedies:
o Avoid lung irritants (do not smoke)
o Use a humidifier
o Consider a face mask outside (If cold air aggravates the cough and causes shortness
of breath, put on a cold-air face mask before you go outside)
Prevention
o Avoid cigarette smoke
o Get vaccinated (flu vaccine and pneumonia vaccine)
o Wash your hands
o Wear a surgical mask
