This document discusses cough and difficulty breathing. It defines cough and describes the pathophysiology and receptors involved in the cough reflex. It lists various causes of acute, subacute and chronic cough and treatments. It also defines dyspnea as difficult, labored or uncomfortable breathing and describes the pathophysiology as an imbalance between the perceived need to breathe and ability to breathe, with carbon dioxide build up and oxygen deprivation causing dyspnea. It mentions considering family history, smoking history, exposure and treatment history in evaluating cough and breathing difficulty.

1. Cough and difficult in
breathing
Name:- Bokkisham
Durgadevi
Group:- Gm20_116

2. Cough Definition
it is a sudden and variable expiratory thrust
of air from the lungs through the air passages
associated with phonation, which
momentarily interrupts the physiological
pattern of breathing Without an effective
cough reflex, there is a risk of retaining
airway secretions and aspirated material
predisposing to infection， atelectasis， and
respiratory compromise

3. Rapid inspiration
Closure of the glottis 3. Contraction of
the abdominal and expiratory thoracic
muscles 4. Abrupt increase in pleural
and intrapulmonary pressures 5.
Opening of glottis and expulsion of
burst of air from mouth

4. Pathophysiology of cough
Cough reflex initiated by chemical/mechanical stimuli This is carried by the afferents
which are type c and type 1 fibers and innervate pharynx, larynx ,large airways ,
terminal bronchiole and lung parenchyma Afferents travel via vagus and superior
laryngeal nerve NTS in brain stem is the cough center Efferents travel via vagus,
phrenic, spinal motor nerves to the larynx, trachea, bronchi, diaphragm producing
cough
Cough receptors- rapid acting receptors (RAR), slow acting receptors (SAR), C fibers,
and other cough receptors are Mechanosensitive and chemosensitive. Impulses from
these receptors are all carried by the vagus nerve
. •The receptors have nerve terminals under or within the epithelium concentrated at
points of airway branching. •They are polymodal and respond to a wide variety of
chemical n mechanical irritants, & by many inflammatory n immunologic mediators
like histamine, bradykinin, PGs n substance-P.
There occurs increase in sensitivity of RARs n C-fibers by allergen challenge, viral
infections, cigarette smoke and a variety of inflammatory mediators. RARs can also
be sensitized by mucus in the airways, underlying smooth muscle contraction n
mucosal edema.
. Voluntarily a person is capable of suppressing the reflex cough for some time Cough
can also be voluntarily induces (motor and pre motor areas of brain) Neuro
transmitters involved in voluntary control of cough are seratonin, gaba, dopamine,
nmda(N-methyl-D-aspartate ) etc The central nervous pathways for cough show
interactions and plasticity
. Efforts should be made to identify the cause of cough A cough lasting than more
than 3 wks require a detailed evaluation Cough associated with or without sputum is
more important than the amount of sputum and the presence or absence of sputum

5. Acute(<3) weeks
Tracheobronchitis Bronchopneumonia
Viral pneumonia Acute-on-chronic
bronchitis Pertussis Pulmonary
embolism Foreign body aspiration
Sudden onset – bronchial asthma
,asthmatic bronchitis , whooping cough,
foreign body ,LVF with PE

6. Subacute(3-8 weeks)
trachiobronchitis , pertussis , post viral
tussive syndrome

7. Chronic >8 weeks
Upper airway cough syndrome • Asthma •
Gastro oesophageal reflux disorder • Post
viral cough • Chronic bronchitis •
Bronchiectasis, cystic fibrosis • Ace inhibitor
induced Cough • Environmental irritants.

8. Treatment
Topical administration of corticosteroid
drops in the head- down position is the best
treatment, often with the concomitant use of
antihistamines. severe symptoms- short
course of oral steroids, followed by topical
therapy. A topical anticholinergic spray to the
nose (such as ipratropium bromide).
Antibiotic therapy is necessary in the
presence of acute sinusitis involving bacterial
infection with the presence of mucopurulent
secretions that has persisted for at least 10
days.

9. Dyspenia
breathing is difficult, laboured or
uncomfortable subjective awareness of need
for increased respiratory effort ventilatory
demands > ventilatory capacity

10. Pathophysiology of
Dyspenia
Dyspnea results when there is an imbalance
between the perceived need to breathe and
the perceived ability to breathe. CO2 build
up and oxygen deprivation were the critical
factors that result in dyspnea. Elevation in
CO2 levels appear to stimulate dyspnea
more than do low oxygen levels

11. Family history
allergy, collagen vascular disease. Addiction
history– smoking history, cocaine, opiate
overdose .Exposure to indoor pollutants
Treatment history—radiation(radiation
pneumonitis developing 6 weeks to 6 months
after radiation) , drugs( amiodarone,
nitrofurantoin, busalfan, adenosine ,
anorexigens, etc ) .

14. Thank you