Cough Types

1. Semiotics and Main syndrome of
RS affections in children

2. Cough
After maximal inspiration, the air is
suddenly released through the
partially closed glottis, because of
forceful contraction of the
expiratory muscles. This produces a
bout of cough. The cough reflex is
controlled by a center in the
medulla. Irritation of the pharynx,
larynx, trachea, bronchi and pleura
transmit the afferent impulses
through the vagus or
glossopharyngeal nerves. Efferent
pathways are in the nerve supply to
the larynx and respiratory muscles.

3. Cough
• Cough is an important defense mechanism of
the respiratory system helps to bring out the
infected secretions from the trachea and
bronchi. Cough should not be suppressed in
younger children as retention of secretions in
their lungs may result in atelectasis and
pulmonary complications. On the other hand,
persistent cough interferes with the sleep and
feeding. It fatigues the child and may result in
vomiting.

4. • Cough on larynx lesions: usually it is dry, coarse, bark. It is
so particular that gives possibilities to define the larynx
lesions from a distance.
• Cough on tracheitis is coarse
• Cough on bronchitis may be dry (on the beginning) may be
wet, with sputum
• Cough on bronchial asthma is dry on the beginning,
irritable, then it is wet with thick sputum
• Cough in pneumonia is also dry on the beginning, then it is
wet.
• If the pleura is involved in the pathological process the
cough is painful
• Cough in pertussis has their own particularities: it is
paroxysmal with reprises (prolonged, high-pitched
inhalation), accompanied by redness of face and vomiting.
Paroxysms mostly occur at night time.

5. Diagnostic Approach to Chronic
Cough
• Chronic cough can be quite distressing. The
diagnosis can be made in most cases by a
careful analysis of the following: (i) age of the
child; (ii) nature of cough and sputum; (iii)
relationship to the time or posture; (iv)
presence of wheezing or strider; (v) effect of
season; (vi) response to previous therapy; (vii)
state of nutrition; (viii) physical signs in the
chest; and (ix) clubbing of fingers.

6. • Staccato paroxysms of cough suggest
whooping cough or Chlamydia infection.
Barking or brassy cough associated with
changes inthe voice indicate laryngotracheal
disease. In case of post-nasal drip, cough
appears to be like an attempt to clear the
throat and described as a hawking cough.
Cough of psychogenic nature has a honking
character
Type of cough

7. Sputum
• Purulent sputum indicates the presence of
suppurative lung disease. Although sputum is
mucoid in cases of asthma, yellowish sputum
may be present in some cases due to the
presence of a large number of eosinophils in
it. Hemoptysis indicates the possibility of
bronchiectasis, tuberculosis, mitral stenosis,
cystic fibrosis or foreign body in the bronchus.

8. Acute cough
• Upper respiratory tract infection. Common cold,
postnasal discharge due to sinusitis (in older
children), rhinitis, hypertrophied tonsils and
adenoids, pharyngitis, laryngitis and
tracheobronchitis.
• Nasobronchial allergy and asthma.
• Bronchiolitis, pneumonia, empyema and
pulmonary suppuration.
• Measles and whooping cough.
• Foreign body inthe air passages.
• Non-pulmonary cause: CHF.

9. Chronic recurrent cough
• Inflammatory disorders of airway (cough variant asthma).
Asthma and Loeffler’s syndrome, infections, inhalation of
environmental irritants such as tobacco smoke, dust.
• Suppurative lung disease. Bronchiectasis, cystic fibrosis,
foreign body retained in bronchi, immune deficiency, lung
abscess.
• Anatomic lesions.Congenital malformations, sequestrated
lobe, bronchomalacia, tumors, tracheal stenosis, H-type
tracheo-esophageal fistula (TEF), vaccular ring,
tracheomalacia.
• Irritative. Post-nasal discharge, sinusitis, gastroesophageal
reflux disease, irritation of extra-auditory canal.
• Psychogenic. Habit cough.
• Interstitial lung disease.
• Compression of airways: LN, Mediastinal mass.

10. RESPIRATORY NOISES
• Various types of sounds originating from
respiratory system may be heard without the
help of stethoscope. The intensity and pitch of
these sounds alter depending on their site of
origin within the respiratory tract. The general
dictum is that the pitch of the sound keeps on
increasing and the intensity keeps on decreasing
as one goes down lower into the respiratory
tract. For example, snoring is a highly intensive
but low pitched sound because it results from the
region of oropharynx. On the other hand wheeze
is a high pitched, less intense sound originating
from lower airway obstruction. Various sounds as
given below are recognized.

11. Stridor
• Stridor indicates upper respiratory obstruction
and is usually accompanied by hoarseness,
brassy cough, dyspnea, retraction of the chest
during inspiration and restlessness. Accessory
muscles of respiration are usually working.
Etiology of stridor is discussed at length in the
previous chapter

12. WHEEZING
• Wheezing refers to high pitch whistling sounds
audible without auscultation by the stethoscope.
Wheezing causes considerable anxiety to the
parents. Partial obstruction of the bronchi and
bronchioles leading to narrowing produces
wheezing. Sufficient air must flow through the
narrowed airway to produce the wheezing sound.
This may be due to causes within the lumen or in
the walls of the bronchi. Pressure from outside
the bronchi may also be responsible in some
cases.

13. Respiratory Sounds
Sound Causes Character
1 Snoring Oropharyngeal
obstruction
Inspiratory, low-pitched
irregular.
2 Grunting By partial closure of
glottis
Expiratory, occurs in hyaline
membrane disease.
3 Rattling Secretions in
trachea/bronchi
Inspiratory, coarse. This sound
can also be felt by placing hands
over the chest.
4 Stridor Obstruction
larynx/trachea
Inspiratory sound, may be
associated with an expiratory
component.
5 Wheeze Lower airway
obstruction
Continuous musical sound
predominantly expiratory in
nature.