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Cough
- 1. Cough Presented By- Dr. Vinod K Gupta M.D. (Ayu.) Final Year DEPARTMENT OF KAYA CHIKITSA STATE AYURVEDIC COLLEGE & HOSPITAL, LUCKNOW
- 2. Cough
- 3. Definition Cough is physiological protective mechanism which is characterized by explosive expectoration following a deep inspiration. Its function is to clear the tracheobronchial tree of excessive secretions and foreign body.
- 4. Cough is often a clue to presence of Respiratory disease. Cough provide an essential protective function for human airways and lungs. Withought an effective cough reflex we are at risk for - •retained airway secretion •Aspirated material •Predisposing infection •Respiratory compromise At the other extreme, excessive coughing •can be exhausting •Can be complicated with – emesis, syncope, muscular pain, rib fracture •And can aggravate hernia and urinary incontinence. COUGH
- 5. Weak or ineffective cough compromises the ability to clear lower respiratory tract infection, predisposing to more serious infections and their sequelae. Causes of impaired cough •Decrease respiratory muscle strength. •Chest wall deformity •Impaired glottic closure or tracheostomy •Abnormal airway secretions •Central respiratory depression (anesthesia, sedation or coma) Impaired cough
- 6. Cough mechanism Spontaneous cough is triggered by stimulation of sensory nerve endings that are thought to be Primarily Rapidly adopting receptor and C-fibers. both chemical (Capsaician) and mechanical stimuli may initiate the cough. Afferent nerve ending richly innervate the Pharynx, Larynx, Air way to the level of terminal bronchioles and also found in External auditory meatus & Esophagus. Sensory signal travel via the Vagus and Superior laryngeal nerve.
- 7. transient upper airway occlusion generating positive intra thoracic pressure as high as 300mmhg. rapid expiratory flow are generated. maximizes the velocity of exhalation Cough reflex involve a highly orchestrated series of involuntary muscular actions. Bronchial smooth muscle contraction together with dynamic compression of airway narrows airway lumen Vocal cord adduct Expiratory muscle contract With sudden release of laryngeal contraction
- 8. Acute Less than 3 wk R.T.I. , Aspiration, Inhalation of noxious chemical or smoke . Sub-acute 3-8 wk Tracheobronchitis- pertussis post viral tussive syndrome Chronic More than 8 wk Cardiopulmonary d’s- inflammatory, infectious, neoplastic and cardiovascular etiology. Cough History
- 9. Cough of less than 8 wk duration may be the early manifestation of a disease causing chronic cough. Acute cough occurring in context of more serious disease such as pneumonia, aspiration, CHF, pulmonary embolism is usually easy to diagnose due to the presence of other clinical features.
- 10. Assessment of chronic cough •Regardless of cause cough often worsen when one first lies down at night or with talking or in association with hyperpnea of exercise; it frequently improve with sleep. Exception- pertusis, asthma •Physical examination seeks clue to the presence of cardiopulmonary disease, including finding such as wheezing or crackles on chest examination. •Examination of auditory canal and tympanic membranes, nasal passage ways and nails. •Cough may be manifestation of systemic disease such as Sarcoidosis or Vasculitis. •In virtually all instances, evaluation of chronic cough merits a chest radiograph.
- 11. Chronic cough with a normal chest radiograph When initial assessment with chest examination and radiograph is normal. Cough variant asthma Gastro-esophageal reflux Post-nasal drainage Medication (ACE inhibitor)
- 12. The characteristic of cough originating at various level of RT ORIGIN COMMON CAUSE CLINICAL FEATURE Pharynx Post-nasal-drip History of chronic rhinitis Larynx Laryngitis, tumor Voice or swallowing altered, harsh or painful voice Whooping cough, croup Paroxysm of cough, often associated with strider Trachea Tracheitis Raw restrosternal pain with cough Bronchi Bronchitis(acute), COPD Dry or productive, worse in morning Asthma Usually dry, worse at night Bronchial carcinoma Persistent (often with haemoptysis) Lung Parenchyma Tuberculosis Productive, often with haemoptysis Pneumonia Dry initially, productive later Boncheiectasis Productive, change in posture induce sputum production Pulmonary edema Often at night (may be productive of pink, frothy sputum) Interstitial fibrosis Dry, irritant and distressing
- 13. DRY COUGH •URTI •Initial phase of TB •TPE •Cigrette smooking •Brochogenic carcinoma •Compression of trachea •Funtional WET COUGH (Foul smell) •Lung abscess •Bronceactasis •Infected cavity •Gangrene of lung •Fungal infection (Mucoid) •Acute bronchitis •Bronchopneumonia •Post nasal drip and sinusitis
- 14. Color Condition Reddish Hemoptysis Blackish Industrial infections, Cole miner cough Rusty/khaki Pneumonia Yellow Actinomycosia Creamy yellow Staphylococcal infection Frothy pink Pulmonary edema Mucoid brown to red Klebseila infection Current jelly Bronchogenic carcinoma, influenza Green Pseudomonas infection Blood oyster TB Sputum color associated with various conditions
- 15. Pharyngeal Demulcents •Lozenges •Glycerin •Linctuses containing syp Expectorant (Mucokinetics) A-Directly acting •Sodium and potassium citrate or accetate •Potassium iodide •Guaiphenesin •Balsum of tolu •Vasaka •Terpin hydroid B-Reflexly acting •Ammonium chloride or carbonate •Potassium iodide C-Mucolytics •Bromhexine •Ambroxol •Acetyl cysteine •carbocisteine Antitussive (Cough center suppressants) A-Opioids •Codeine •Pholcodeine •Ethylmorphine •Morphine B-Non Opioids •Noscapine •Dextromethorphane •Oxyladine •Chlorphedianol C-Antihistamines •Chlorpheniramine •Diphenhydramine •Promethazine DRUGS FOR COUGH
- 16. Ayurvedic drugs for Cough
- 17. Kasahar mahakashaya 1- Darksha – Vitis vinifera, 2- Abhaya – Terminalia chebula, 3- Amalaka - Emblica officinalis, 4- Pippali– Piper longum, 5- Duralabha -Fagonia cretica , 6- Shrungi -Rhus succedanea, 7- Kantakarika – Solanum xanthocarpum, 8- Vrushchira - White variety of Boerhaavia diffusa, 9- Punarnava - Red variety of Boerhaavia diffusa 10- Tamalaki -Phyllanthus niruri
- 18. pw.kZ flrksiykfn Rkfylkfn ’kV~;kfn J`aX;kfn ejhP;kfn ;okuh "kk.ko oVh yoaxkfn O;ks"kkfn ,ykfn ejhP;kfn [kfnjknh jl dQdsrq dQdqBkj dklkUrd y{eh foykl pUnzzke`r dQdrZjh jl DokFk Xksftºokfn daVdkjh Iakpewyh n’kewy Okklkfj"V dudkfj"V O;k?kzh gjhrdh fp=d gjhrdh vxLR; gjhrdh [ktZwjkfn ysg
- 19. Kaphketu Ras Ingredients- Tankan-1 parts Shankha-1 Pippali-1 Vatsnabh-1 Aardrak swaras bhawna Kaphasamak Pinas, shwas, kasa, shirorog, galgrah. Anupan- Aardrak swaras
- 20. Kaph kuthar ras Contents- Parad-1 part Gandhak-1 Lauha-1 Tamra-1 Trikatu-3 Kantakari , Kutaki, Dhatura Expectorant, Kasa, Shwasa, Jwar, Kaphaj Vikar
- 21. Shwasakuthar ras Ingadients- Parad- 1 part Gandhak-1 Tankan-1 Vatsanabh-1 Manahshila-1 Shunthi-2 Pippali-2 Marich-10 Nagvel patra swaras Ushna, tikshna, kaph shravak, shwasahar
- 22. Sitopaladi Churna Sitopala– 16 parts Vamshalochana– 8 parts Pippali – 4 parts Ela – 2 parts Twak – 1 part. How dose work- Dilating respiratory tract Expectorant (moderate) Strengthening action Enhancing immunity Stimulate apatite and digestion Reduce inflammation Vata and kapha Shamak dose – 1 – 3 grams two or three times a day along with half a teaspoon of ghee and a teaspoon of honey
- 23. Lavangadi Vati Lavanga –10 g Maricha– 10 g Aksha –10 g Sara of Khadira–30 g Water decoction of Babbula – Acacia Arabica (Vaidyajivana, Shwasa Kasa Chikitsa, 7) productive and non productive cough, cold and allergic rhinitis. balances Vata and Kapha. dosage: 1 – 2 tablets 2 – 3 times a day
- 24. Eladi Vati Ingredients: Ela–6g Patra –– 6 g Twak–6 g Pippali–24 g Sita –- 48 g Madhuka–48 g Kharjura–48 g Draksha–48 g Madhu –48 g balances Pitta. cough, cold, fever, hiccups, hoarse voice, vomiting, dizziness, haematemesis, excessive thirst etc. Usual dose is – 1 – 2 tablets 2 – 3 times a day
- 25. Talisadi Churna Ingredients: Talisa – 1 part Maricha – 2 part Shunti – 3 part Pippali – 4 part Vamshalochana – 5 part Ela – ½ part Twak – ½ part Sharkara – 32 part Bronchodialator Mucolytic Antitussive Antiinflammatory Antimicrobial
- 26. Vyaghri haritaki Ingredients- Kantakari- 1 tula(54 ser) Haritaki-100 Guna-100 pal Trikatu-6 pal Chaturjat-1 pal Shahad-6 pal All kasa, pinas, shwas, swarkshay, rajyakshma Anupan- shritshit jal or dugdh
- 27. Agastya haritaki Ingredients- Dashmul-20 pal Kronch-2 Shankhpushpi-2 Shati-2 Bala-2 Gajpippali-2 Apamarg-2 Pippalimul-2 Chitrak-2 Bharangi-2 Pushkarmul-2 Haritaki-100 number Ghrit-32 Tail-32 Guna-1 tula Pippali-4 Use in- all kasa, shwas, hikka, kshaya, rasayan etc
- 28. Thank You