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Cough
Cough is a common symptom characterized by a sudden expulsion of air from the lungs to clear the airways. It can be acute (lasting less than 3 weeks) or chronic (lasting 8 weeks or longer).
Causes
Common causes of cough include:
- Respiratory tract infections (viral or bacterial)
- Postnasal drip
- Asthma
- Gastroesophageal reflux disease (GERD)
- Chronic obstructive pulmonary disease (COPD)
- Smoking
- Medications (e.g., ACE inhibitors)
Less common causes may include:
- Bronchiectasis
- Lung cancer
- Pulmonary fibrosis
- Heart failure
- Tuberculosis
| Acute Cough | Chronic Cough |
|---|---|
| Respiratory Diseases | Respiratory Diseases/Lung Diseases |
| Sinusitis | Asthma bronchiale |
| Adenoids, Tonsillitis | COPD |
| Rhinosinusitis, Laryngotracheobronchitis: usually viral infection or allergic | Bronchial carcinoma |
| Acute or recurrent aspiration | |
| Aspiration | Systemic Diseases with Diffuse Lung Parenchymal Involvement |
| Often seen in children 1-3 years | Granulomatoses, Collagenoses, Vasculitides |
| Inhalation Intoxication | Reactive Airways Dysfunction Syndrome (RADS: after short-term massive inhalation of fumes, smoke, or gases, usually as an occupational hazard) |
| Accidents, fires | Vocal Cord Dysfunction (VCD: intermittent inspiratory, possibly expiratory, adduction of vocal cords, often seen in younger women) |
| Post-infectious Cough | Lung/Pleura Diseases |
| Pneumonia | |
| Vocal Cord Dysfunction | Pleuritis |
| Intermittent inspiratory, possibly expiratory | Pulmonary embolism |
| Pneumothorax | |
| Lung Diseases/Pleura | Extrapulmonary Diseases |
| Pneumonia | Acute left heart failure |
| Pleuritis | Bradycardia with AV block II, III |
| Pulmonary embolism | Chronic left heart failure |
| Pneumothorax | Endocarditis |
| Gastroesophageal reflux; cough triggered by microaspiration | |
| Extrapulmonary Diseases | Medications-related Cough |
| Acute left heart failure | Cough due to medication side effects (ACE inhibitors, Amiodarone, Beta-blockers, Methotrexate, etc.) |
| Bradycardia with AV block II, III | |
| Endocarditis | |
| Gastroesophageal reflux; cough triggered by microaspiration |
Diagnosis
Diagnostic approach includes:
- Detailed medical history and physical examination
- Chest X-ray
- Pulmonary function tests (spirometry)
- CT scan of chest and/or sinuses (in select cases)
- 24-hour esophageal pH monitoring (for suspected GERD)
- Bronchoscopy (if endobronchial pathology is suspected)
Treatment
Treatment depends on the underlying cause:
- Respiratory infections: Supportive care, antivirals, or antibiotics if indicated
- Asthma: Inhaled corticosteroids and bronchodilators
- GERD: Proton pump inhibitors or H2 blockers
- Postnasal drip: Antihistamines, nasal corticosteroids
- COPD: Bronchodilators, inhaled corticosteroids, smoking cessation
- ACE inhibitor-induced cough: Medication change
For symptomatic relief:
- Stay hydrated
- Use a humidifier
- Try honey or lozenges for throat irritation
- Avoid irritants like smoke
Chronic cough can significantly impact quality of life. If symptoms persist despite treatment, referral to a specialist may be necessary for further evaluation and management.