File Name: cough types and treatment .zip
- A complete guide to coughs
- Bronchitis - causes, symptoms, treatment
- 5 Acute Cough Types and How to Treat Them Appropriately
When something irritates your throat or airway, your nervous system sends an alert to your brain.
A complete guide to coughs
Cough is the most common symptom in respiratory specialist clinics of tertiary hospitals and outpatient clinics of primary health care facilities. In China, patients with chronic cough account for at least one third of all patients referred to respiratory specialist clinics. Chronic cough without significant abnormal chest radiographic findings is often misdiagnosed as chronic bronchitis or chronic pharyngitis. Misdiagnosis of cough results in unnecessary repetitive testing, such as chest radiographs or computed tomography CT , and widespread abuse of antibiotics or antitussives with little improvement, and potential adverse effects.
Chronic cough impair quality of life badly cause severe economic burden in China 1 - 5. To further standardize the diagnosis and treatment of acute and chronic cough, thus providing guidance for clinical practice, the Panel of Chinese Thoracic Society CTS Asthma Consortium released the first edition of the Chinese Guidelines for Diagnosis and Treatment of Cough Draft in 6.
This document was updated in 7. Compared with these guidelines, the Chinese Cough Guidelines vary slightly in structure and content, according to clinical evidence and practice in China.
Since the release of the Chinese Cough Guidelines, the management of cough in China has been improved. Recently, there have been significant advances in cough research and increased understanding of the pathogenesis, etiology, diagnosis, and management of cough.
To further refine the guidelines and include the latest evidence, in the CTS Asthma Consortium initiated a task force to revise the Chinese Guidelines for Diagnosis and Management of Cough.
For the first time, evidence-based methodology was adopted according to the requirements for guideline development in China. A comprehensive literature review was undertaken and recommendations were made.
This updated revision updated or added the following sections: I introduction of evidence-based methodology for guideline development; II updated and expanded sections as compared to previous versions; III an additional section on the evaluation of cough; IV Traditional Chinese Medicine TCM for the management of cough was added; V the etiology and management of chronic cough in children was introduced; VI a section on uncommon causes of chronic cough; and VII added unexplained cough [refractory cough, cough hypersensitivity syndrome CHS ].
Cough is a defensive reflex for clearance of excessive secretions and foreign bodies from airways. However, severe cough frequently affect quality of life badly. Cough is classified into three types based on the duration: acute, subacute, and chronic cough. Different types of cough have a spectrum of different underlying causes.
Based on chest radiography, chronic cough can be further classified into two subtypes: I presence of pulmonary lesions on radiography for example, pneumonia, tuberculosis, and bronchopulmonary carcinoma , and II lack of overt identifiable abnormalities on radiography. This guideline focus on the latter subtype. In China, a majority of patients with chronic cough are 30—40 years old without significant gender preponderance; however, in European and American countries, most patients with chronic cough are 50—60 years old, with a significantly higher incidence in women than in men Chronic cough is related to air pollution 16 - The involuntary cough reflex is involved in five sections: the peripheral receptors, vagal afferent nerves, central cough neurons, efferent nerves, and effectors diaphragm, throat, chest, and abdominal muscles.
When vagal nerve branches distributed in the upper airway, throat, and esophagus are stimulated, cough can be induced Cough nerve centre is located in the medulla, which is regulated by the cerebral cortex.
Cough hypersensitivity is an important pathophysiological mechanism of chronic cough 21 - 23 related to the activation of transient receptor potentials TRP , including TRPV1 and TRPA1, and airway inflammation, neural pathways, and nerve center 24 - Chronic cough can results in a lot of concomitant disorders, such as incontinence, syncope, insomnia, and anxiety, which involve the cardiovascular, digestive, nervous, urinary, and musculoskeletal systems 2 , A thorough medical history and physical examination are important for physicians to develop a differential diagnosis, select laboratory tests, make a tentative diagnosis and empiric therapy Information regarding the duration of cough; phase; characteristics; triggers; effect of altering body position; and concomitant symptoms should be identified.
Sputum volume, purulence and characteristics; smoking history; occupational or environmental exposure; medication history, including angiotensin converting enzyme inhibitors ACEI or other drugs, can indicate the diagnosis 7 1D. Occupational cough should be considered when patient has an occupational exposure history. Acute cough is often attributable to the common cold and acute tracheobronchitis, while subacute cough is the result of post-infectious cough PIC.
The timing of cough provides additional diagnostic information. Cough variant asthma CVA should be considered for patients with predominantly nocturnal cough.
A dry cough indicates a non-infectious cough, while a wet cough is more commonly seen in patients with an infectious cough. Respiratory infectious disease should be considered in patients with a large amount of sputum production or purulent sputum 7 , 32 2C.
Chronic bronchitis is characterized by mucoid sputum and the cough is usually aggravated in the winter and spring. Tuberculosis, bronchiectasis, and lung cancer should be considered with bloody sputum or hemoptysis.
Allergic rhinitis and asthma-related cough should be carefully excluded in patients with a personal or family history of allergy. Upper airway cough syndrome UACS should be considered in patients with nasal congestion, runny nose, sneezing, postnasal drip, or post-laryngeal reflux 32 2C. In the presence of acid regurgitation, belching, or retrosternal burning, gastroesophageal reflux-related cough GERC should be considered 32 , 33 2C.
The possibility of obstructive sleep apnea OSA - or GER-related chronic cough should be considered in patients with obesity. A majority of patients with chronic cough have normal findings on a physical examination. Expiratory wheezing suggests the possibility of asthma. Inspiratory wheezing may suggest central airway tumor or bronchial tuberculosis. Cardiac signs, including enlargement of heart border, premature beats, and murmurs should also be evaluated.
The main tests include chest imaging, induced-sputum cytology, spirometry, the bronchial provocation test, fractional exhaled nitric oxide FeNO measurement, and h esophageal pH-multi-channel impedance monitoring.
I Imaging: chest radiographs are routinely recommended for chronic cough 2D. The flow chart for the diagnosis of chronic cough should be followed see supplementary file 1.
If an obvious abnormality is observed on plain films, additional investigation is selected based on the characteristics of the lesion. Chest CT can be used to detect lesions anterior and posterior to the mediastinum; small pulmonary nodules; thickening and calcification of trachea; stenosis of the trachea; and enlargement of mediastinal lymph nodes. The uncommon conditions can be identified by radiography, including broncholithiasis, relapsing polychondritis, and bronchial foreign body can be identified by CT 1D.
High-resolution CT is helpful for the early diagnosis of interstitial pulmonary diseases and atypical bronchiectasis. If sinusitis is suspected, sinus CT is preferred 34 2D.
Repeated radiographs within a short time span should be avoided. II Pulmonary function tests: pulmonary function tests include pulmonary ventilation tests and the bronchial provocation test.
These tests are valuable for the etiologic diagnosis of chronic cough and should be routinely used 35 - 37 1B. Positive findings on the cough provocation test are important in the diagnosis of CVA. Hospitals unable to perform the cough provocation test can monitor the average peak expiratory flow PEF variation overtime 38 , 39 1B. III Induced sputum test: induced sputum test is a safe, well-tolerated, non-invasive method for the etiologic diagnosis of chronic cough and airway inflammation 40 - 43 1C.
Eosinophilia identified by induced sputum is suggestive of eosinophilic bronchitis EB , and can also be seen in patients with CVA 40 1C. Induced sputum cytology can be used to monitor response to inhaled corticosteroids ICS in patients with chronic cough 41 - 43 1C. IV FeNO measurement: this is a novel non-invasive technology for the diagnosis of airway inflammation. However, the sensitivity is not high when FeNO measurement is used for screening of eosinophilic inflammation. V Allergy skin prick tests and serum IgE test: these tests can identify patients predisposed to allergen sensitization and identify specific allergens.
They may be useful in the diagnosis of atopic diseases e. VI The h esophageal pH-multi-channel impedance monitoring: this is the most commonly useful method of diagnosing gastroesophageal reflux.
The grade of reflux is represented as the DeMeester scores. Cough should be recorded in a real-time manner during the monitoring, so that the symptom-associated probability SAP between reflux and cough can be calculated see supplementary file 3 for methods. The non-acid reflux, such as weak acid or weak alkaline reflux, can be detected by esophageal impedance monitoring 2C.
VII Bronchoscopy: bronchoscopy is not routinely recommended for chronic cough except for the diagnosis is not confirmed by routine tests or in patients with a poor response to the treatment for common causes of cough. Bronchoscopy can be used for the diagnosis or exclusion of uncommon airway conditions associated with cough, including lung cancer, foreign body, tuberculosis, and relapsing polychondritis 10 , 58 - 61 2C.
VIII Other examinations: peripheral eosinophilia is indicative of atopic diseases, but in most patients with CVA and EB, the peripheral eosinophil counts are within the normal ranges. The etiological diagnosis of chronic cough should follow the principles as described below 5 1D : I Attention should be paid to the medical history, including ear, nose, and throat, and digestive tract diseases, occupational and environmental exposure, smoking and medication history.
The diagnosis can be determined if clinical signs are alleviated after being away from occupational or environmental exposure. II Selecting investigations, from simple to complex, based on the medical history. Spirometry, the bronchial provocation test, and induced-sputum cytology are recommended as the initial tests for chronic cough 7 , 40 , 63 2B. The measurement of FeNO is recommended as to supplement of the induced sputum test 47 - 53 2C.
The h esophageal pH-multi-channel impedance monitoring is an important method for the diagnosis of GERC, but it is recommended as the second-line test because it is time-consuming and costly 2D.
Bronchoscopy is valuable in the diagnosis of uncommon causes of chronic cough. IV Diagnosis and management can be implemented simultaneously or sequentially. If certain tests are unavailable, the treatment should be based on the clinical characteristics and the therapeutic response Further evaluation should be considered if patients fail to respond to the treatment 2C.
With typical symptoms of rhinitis, sinusitis, or postnasal drip, treatment for UACS should be initially prescribed. If patients present with symptoms related to gastroesophageal reflux cough after eating food, treatment for GERC should be given empirically.
V Response to the treatment is the prerequisite for confirming etiologic diagnosis. VI When the treatment is ineffective, the following factors should be evaluated: diagnosis, therapeutics, and occupational or environmental exposure 2C. The assessment of cough includes: the visual analogue scale VAS , cough symptoms score, quality of life questionnaire, cough frequency monitoring, and the cough provocation test.
These tests are used to monitor the disease status and treatment efficacy 29 , Patients mark a point on a straight line corresponding to their perception of the severity of cough. The score ranges from 0—10 cm 0— mm , with 0 representing minimal severity and 10 representing extreme severity. Compared with the cough symptoms score, the intervals between grades with the VAS are smaller, which is helpful for longitudinal comparison before and after treatment 29 , 70 , This is a quantitative scoring system of cough used to assess the severity of cough and efficacy of treatment.
Daytime and nighttime scoring is done, however it may be difficult to discriminate between grades 29 , 70 , 71 see Table 3 for details. These questionaires are important in the assessment of cough severity and efficacy of treatment 29 , 71 - The cough symptoms score, VAS, and quality of life questionnaire are subjective assessment tools. Cough frequency monitoring is used for evaluation of cough severity and treatment efficacy 82 - There is diversity in tolerance of patients to coughing, and cough frequency does not definitively correlate with cough severity.
Since cough frequency monitors are not available in China, their clinical applications are limited.
Bronchitis - causes, symptoms, treatment
Everyone has suffered from a cough. However, not every cough justifies a visit to the urgent care for examination by doctors. Understanding why and how you cough can help you know what to do to relieve your cough on your own and recognize when your cough signifies something serious. Coughing is a natural reflex by your body to irritation in your respiratory system. When it coughs, your body is attempting to use a burst of air to dislodge the source of the irritation. In this respect, a cough is similar to a sneeze.
Patient information : See related handout on chronic cough , written by the authors of this article. Initial evaluation of the patient with chronic cough i. Patients who are taking an angiotensin-converting enzyme inhibitor should switch to a medication from another drug class. The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, alone or in combination. If upper airway cough syndrome is suspected, a trial of a decongestant and a first-generation antihistamine is warranted. The diagnosis of asthma should be confirmed based on clinical response to empiric therapy with inhaled bronchodilators or corticosteroids.
Patients presenting to a retail clinic with acute cough could have one of several conditions. Because the majority of retail clinic visits are related to cough, cold, and flu, advanced practice clinicians should be prepared to accurately determine the type of cough in order to provide the best treatment. A cough that comes from the chest is often triggered by excessive mucus. If the patient reports irritation from the cough, clinicians can recommend an expectorant cough medication containing guaifenesin to help loosen the mucus for easier coughing. Clinicians can recommend a demulcent to coat the throat and relieve irritation in the upper respiratory tract.
For more information on these vaccines, see the ATS. Patient Information Series at bobsnail.org Is there one treatment that will stop my cough?While.
5 Acute Cough Types and How to Treat Them Appropriately
Coughing is an automatic reaction to try to clear your airways. The cough reflex protects the airways of your lungs. However, it is important to seek medical attention if you have a cough that lasts for more than three weeks.
Cough is the most common symptom in respiratory specialist clinics of tertiary hospitals and outpatient clinics of primary health care facilities. In China, patients with chronic cough account for at least one third of all patients referred to respiratory specialist clinics. Chronic cough without significant abnormal chest radiographic findings is often misdiagnosed as chronic bronchitis or chronic pharyngitis. Misdiagnosis of cough results in unnecessary repetitive testing, such as chest radiographs or computed tomography CT , and widespread abuse of antibiotics or antitussives with little improvement, and potential adverse effects. Chronic cough impair quality of life badly cause severe economic burden in China 1 - 5.
Chronic cough is long-term coughing , sometimes defined as more than several weeks or months. The term can be used to describe the different causes related to coughing, the 3 main ones being; [ dubious — discuss ] upper airway cough syndrome , asthma and gastroesophageal reflux disease. It occurs in the upper airway of the respiratory system.
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