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COUGH



COUGH
 Cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes. The cough reflex consists of three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound. .coughing can happen voluntarily as well as involuntarily.

Frequent coughing usually indicates the presence of a disease. Many viruses and bacteria benefit evolutionarily by causing the host to cough, which helps to spread the disease to new hosts.
Causes of cough
An occasional cough is normal-it helps clear foreign substances and secretions from your lungs and prevents infection. But a cough that persists for long periods of time may signal an underlying problem .Some causes of coughs include:
.   Acute sinusitis                                  
.   Allergies
.   Asthma
.   Childhood asthma
.    Choking: First aid (especially in children)
.   Chronic sinusitis
.    common cold
.    COPD
.    Croup (especially in young children)
.    Cystic fibrosis
.    Emphysema
.    GERD
.     Hey fever
.     Heart failure (congestive)
.    Influenza (flu)
.    Laryngitis
.    Lung cancer
.     Medication called angiotensin converting enzyme (ACE) inhibitors
.     pneumonia
.     Postnasal drip
.     Respiratory syncytial virus (RSV)  (especially in young children)
.     Tuberculosis
.     Whooping cough

CLASSIFICATION
A cough can be classified by its duration, character, quality, and timing .The duration can be either acute (of sudden onset) if it is present less than three weeks ,sub-acute if it is present between three and eight weeks, and chronic when lasting  longer than eight weeks.
A cough can be non-productive (when sputum is coughed up). It may occur only at night (Then called   nocturnal cough), during both night and, or just during the day.
A number of characteristic cough exist. While these have not been found to be diagnostically useful in adults, they are of useful in children. A barky cough is part of the common presentation of croup, while a staccato cough has been classically described with chlamydia pneumonia.

A cough in children may be either a normal physiological reflex or due to underlying cause. In healthy children it may be normal in the absence of any disease to cough ten times a day.
Differential diagnosis of cough
Infections
A cough can be a result of respiratory tract infection such as common cold, pneumonia, pertussis, or tuberculosis. Cough shorter than 3 weeks, are due to common cold.
Reactive airway disease
When cough is the only complaint of a person who meets the criteria for asthma( bronchial hyper responsiveness and reversibility) this is termed cough-variant asthma.
Asthma is a common cause of chronic cough in adults and children. Coughing may be the only symptom the person has from their asthma, or asthma symptoms may also include wheezing, shortness of breath, and a tight feeling in their chest.
Gastrosesophageal reflux
This occurs when acidic contents of the stomach comes back up into the esophagus. Symptoms usually associated with GERD includes heartburn, sour taste in the mouth, or feeling of acid reflux in the chest, although, more than half of the people with cough from GERD don’t have any other symptoms.An esophageal monitor can confirm the diagnosis of GERD.
Air pollution
Coughing may be caused by air pollution including tobacco smoke, particulate matter, irritant gases, and dampness in the home.
Foreign body
A foreign body can be suspected if cough started suddenly when the person is eating. A cough can be triggered by dryness from mouth breathing or recurrent aspiration of food into windpipe in people with swallowing difficulties.
ACE inhibitors
Angiotensin-converting enzyme inhitors are drugs use in diabetics, heart disease, and high blood pressure, one of its side effect is dry cough, Ceassation of ACE inhibitor use is the only way to stop the cough.e.g Captopril, ramipril.
Psychogenic cough
A psychogenic cough( “habit cough” or “tic cough”) may be the cause in the absence of a physical problem.In these instances emotional and psychological problems are suspected.
Coughing is not always involuntary, and can be used in social situations.Coughing can be used to attract  attention,release internal psychological tension, or become maladaptive displacement behavior.
Pathophysiology
A cough is a protective reflex in healthy individuals which is influenced by psychological factors. The cough reflex is initiated by stimulation of two different classes of afferent nerves namely the myelinated rapidly adapting receptors and nonmyelinated C-fibres with endings in the lungs.However it is not certain that stimulation of nonmyelinated C-fibres leads to cough with a reflex :this stimulation may cause mast cells degranulation(through an asso-assonic reflex) and edema which may work as a stimulus for rapidly adapting receptors.


Treatment
The treatment of cough in children is based on the underlying cause with the use of cough medicines supported by little evidence and thus not recommended by the American Academy of Pediatrics
A trial of antibiotics or inhaled corticosteroids may be tried in children with a chronic cough in an attempt to treat protracted bacterial bronchitis or asthma respectively .

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