Cough is a protective reflex that clears the lungs of secretions and foreign materials. It can be acute (<3 weeks), subacute (3-8 weeks), or chronic (>8 weeks). Coughs are classified based on duration and characterized by timing, associated symptoms, sputum production, and presence of blood. Causes include infections, lung diseases like COPD, and conditions like GERD or postnasal drip. Treatment depends on the underlying cause but may include over-the-counter medications, antibiotics, inhalers, or acid blockers.

1. COUGH

2. OUTLINEDefinition
Mechanism
Importance
History
Classification
Physical examination
Tests and diagnosis
Associated symptoms
Complications
Treatment

3. DEFINITION
Cough is an explosive expiration that
provides a normal protective mechanism
for clearing the tracheobronchial tree of
secretions and foreign material, which is
associated with a characteristic sound.

4. MECHANISM

6. The shearing forces that develop
aid in the elimination of mucus
and foreign materials

7. IMPORTANCE
1) Defense mechanism (physiological natural reflex):
Providing a normal protective mechanism for clearing the
tracheobronchial tree free of secretions and foreign material
2) Complication of its force:
Excessive coughing can be exhausting; can be complicated by
vomiting, syncope, muscular pain or rib fractures; and can aggravate
abdominal or inguinal hernias , urinary incontinence and Uterine
prolapse
3) Symptom of disease:
Associated with many medical diseases and conditions

8. 4) Transmit infections to others by air droplets diseases that
are commonly spread by coughing or sneezing include:
− Bacterial Meningitis
− Chickenpox
− Common cold
− Influenza
− Mumps
− Strep throat
− Tuberculosis
− Measles
− Rubella
− Whooping cough

9. HISTORY
1) Onset and Duration:
Acute: < 3weeks
Subacute: 3-8 weeks
Chronic: > 8 weeks
2) Character :
Bovine with Hoarsness: Left recurrent laryngeal nerve palsy
causing left vocal cord paralysis due to CA Lung
Barking with Hoarsness and Stridor: Acute Epiglottitis,
Laryngitis, CA Larynx
Wheezy: COPD, Asthma

10. 3) Timing and associated features:
Nocturnal: Asthma, CHF
Early Morning: Bronchiectasis, Chronic Bronchitis, Asthma
Recumbent: Postnasal drip (PND), CHF,
Gastroesophageal reflux disease (GERD)
Change position (Standing): Bronchiectasis

11. 4) With or without sputum:
Dry cough - without sputum:
Causes of dry cough (Asthma, Viral infection of respiratory
system, Interstitial Lung Disease)
Productive cough - with sputum:
Causes of productive cough (Respiratory Infections, COPD,
Bronchiectasis)
• With or without blood:
Hemoptysis - with blood

12. Hemoptysis (bloody sputum):
If with purulent and long standing sputum:
Chronic bronchitis (small amount of blood)
Bronchiectasis (large amount of sputum)
If with fever, recent, recent onset, SOB:
Pneumonia
If + LOA, LOW, H/O smoking:
Bronchial carcinoma
If sputum is pink in color and frothy:
Pulmonary edema
If sudden onset:
Pulmonary embolism, acute RT infections

13. PHYSICAL EXAMINATION
– PERCUSSION
1) Of chest:
Hyperresonance (COPD)
Dullness (consolidation, pleural thickening)
Stony dull (pleural effusion)
2) Liver dullness
3) Cardiac dullness

14. PHYSICAL EXAMINATION
– AUSCULTATION
1) Decreased breath sounds:
COPD
Pleural effusion
Pneumothorax
Pneumonia
Large neoplasm
Pulmonary collapse

15. 2) Bronchial breath sounds:
Lung consolidation (common)
Localized pulmonary fibrosis
Lung collapse
Pleural effusion
uncommon

16. TESTS AND
DIAGNOSIS
The medical history and physical examination help to
determine which tests should be ordered.
− Imaging tests
CXR: lung cancer and pneumonia
CT: cavities for pockets of infection

17. − Lung function tests:
These simple, noninvasive tests measure how much air your lungs can
hold and how fast you can exhale. This test is required to diagnose
asthma.
− Lab tests:
If the mucus that is coughed up is discolored, the doctor may want to test
a sample of it for bacteria.
− Scope tests:
• cellular abnormalities
• as well as biopsy

18. CLASSIFICATION
OF COUGH
1) Acute Cough: < 3 Weeks Duration
2) Subacute Cough: 3 - 8 Weeks Duration
3) Chronic Cough: > 8 Weeks Duration

19. 1) Acute Cough (Differential Diagnosis):
− Upper respiratory tract infections (URTI):
• Viral syndromes
• Sinusitis
• Pertussis
− URTI triggering exacerbations of chronic lung disease e.g.
Asthma/ COPD
− Pneumonia
− Left ventricular heart failure
− Foreign body aspiration

20. Red flags in acute cough
Symptoms:
− Haemoptysis
− Breathlessness
− Fever
− Chest Pain
− Weight Loss

21. Signs:
− Tachypnoea
− Cyanosis
− Dull chest
− Bronchial Breathing
− Crackles
THINK pneumonia, lung cancer, LVF
GET a CHEST X-Ray

22. 2) Subacute Cough:
− Postinfectious:
A cough that begins with an cute respiratory tract infection
and is not complicated * by pneumonia
• * Not complicated = normal lung exam normal chest
X-ray
• Resolve without treatment
• Cause: PND or tracheobronchitis
• Indication for CXR: with automated biopsy needle (ABN)
lung exam
− Sinusitis
− Asthma

23. 3) Chronic Cough (Differential Diagnosis):
− SMOKER (Abnormal Chest X-ray):
• COPD: Chronic Bronchitis, Emphysema
• CA Lung
− NON-SMOKER (Normal Chest X-ray):
• Drug (ACEI- Angiotensin Converting Enzyme Inhibitor- Captopril)
• PND-Post Nasal Drip
• Asthma-Cough Variant Asthma
• GERD - Gastroesophageal regurgitation disease

24. ASSOCIATED
SYMPTOMS
Fever, recent symptoms, SOB
− Pneumonia
Postnasal drip, sinus congestion, headache
− UACS (Upper Airway Cough Syndrome)
− When asked to cough, they clear the throat

25. Wakes a patient up:
− Cardiac failure, GERD, Asthma
Worse in morning:
− COPD
h/ o stroke, neurogenic dysphagia :
− Aspiration pneumonia
Wheezing:
− Asthma (episodic wheezing)
− FB/ Tumor (monophonic wheezing – intraluminal obstruction)

26. Burning chest pain:
− GERD
Pleuritic chest pain:
− PE, Pneumonia
LOA, LOW, h/ o smoking:
− Lung carcinoma
Appears after meal/ drinking:
− GERD
− Tracheo-esophageal fistula (rare)
Joint pain, dry eyes, LN enlargement:
− SLE, SJOGREN (with interstitial lung dss)

27. COMPLICATIONS
Cardiovascular:
− Arterial hypotension
− Loss of consciousness
− Rupture of subconjunctival, nasal and anal veins
− Dislodgement/malfunctioning of intravascular catheters
− Bradyarrhythmias, tachyarrhythmias

28. Neurologic:
− Cough syncope
− Headache
− Cerebral air embolism
− CSF rhinorrhea
− Acute cervical radiculopathy
− Malfunctioning ventriculoatrial shunts
− Seizures
− Stroke due to vertebral artery dissection

29. Gastrointestinal:
− Gastroesophageal reflux events
− Hydrothorax in peritoneal dialysis
− Malfunction of gastrostomy button
− Splenic rupture
− Inguinal hernia
Genitourinary:
− Urinary incontinence
− Inversion of bladder through urethra
Musculoskeletal:
− From asymptomatic elevations of serum creatine
phosphokinase to rupture of rectus abdomens muscles
Rib fractures

30. Respiratory:
− Pulmonary interstitial emphysema, with potential risk of
− pneumatosis intestinalis, pneumomediastinum,
pneumoperitoneum, pneumoretroperitoneum, pneumothorax,
subcutaneous
− emphysema
− Laryngeal trauma
− Tracheobronchial trauma (e.g., bronchitis, bronchial rupture)
− Exacerbation of asthma
− Intercostal lung herniation

31. Coughs can be treated in a variety of ways, depending on the
cause of the cough. For most healthy adults, most treatments
will involve self-care.
TREATMENT:

32. Self-Treatment
A cough that is cased by virus cannot be treated with antibiotics. You can,
however, soothe it in the following ways:
− Use decongestant sprays to unblock the nose and ease breathing
− Elevate your head with extra pillows when sleeping
− Use cough drops to soothe the throat
− Avoid irritations, including smoke and dust

33. − Gargle hot saltwater regularly to remove mucus and soothe the
throat
− Keep hydrated by drinking plenty of water
− Add honey or ginger to hot tea to relieve the cough and clear the
airway

34. AntihisMedications used to treat cough may include:
tamines and decongesta:
These drugs are standard treatment for allergies and postnasal .
Inhaled asthma drugs:
The most effective treatments for asthma-related cough are inhaled
medications that reduce inflammation and widen the airways.
Antibiotics:
If a bacterial infection is causing the cough, antibiotics will be prescribed.

35. Acid blockers:
When lifestyle changes don't take care of acid reflux, patient may be
treated with medications that block acid production. Some people need
surgery to resolve the problem.
Cough suppressants:
If the reason for your cough can't be determined, the doctor may
prescribe a cough suppressant, especially if the cough is interfering with
your sleep.

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