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Cough Pathophysiology: Pediatric Respirology Working Group
Cough Pathophysiology: Pediatric Respirology Working Group
in Children Training
Module 1
Cough
Pathophysiology
2
Introduction (2)
Pattern of respiratory disease, children # adult
Same etiology, different impact - respiratory viral infection
adult, mild disease: common cold
children, life threatening: croup, bronchiolitis
Same disease, different main symptoms
adult TB, cough is prominent symptom
pediatric TB, cough is NOT main symptom
Same symptom, lead to different disease;
chronic cough in adult, think TB
chronic & recurrent cough in children, think asthma
3
Definition of cough
4
Physiologic or pathologic (1)
Cough, part of respiratory defense mechanism
In synergy with mucociliary clearence (MC)
Normally, respiratory tract produce secretion up to
30 mL (adult)
Entrapment of foreign material, brought by MC,
swallowed
5
Physiologic or pathologic
(2)
Cough does not always mean abnormal or clinically
significant
Healthy child : cough 10 times/day (up to 34x) in 24
hours
Considered: normal or expected
Usually not become a complain, not aware, not a
problem
6
Physiologic or pathologic
(3)
Cough will be generated if the receptor(s) is
stimulated
Respiratory secretion of MC large enough
stimulates cough receptor, expelled it out
Inhaled food or other foreign material cough out
Cough: prevent aspiration useful physiologic
mechanism in a healthy person
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Physiologic or pathologic
(4)
In pathologic conditions eg respiratory infection
larger & frequent secretion cough frequency &
intensity will
In healthy children, ARI 6-8 times/year
In healthy physiologic condition: mucocilliary
clearance and cough
In disease pathologic condition: frequency and
intensity of cough increased
8
Cough: friend or foe??
Physiologic or pathologic
(5)
Cough will be generated if the receptor(s) is
stimulated
Any disease / disorder in respiratory system will
stimulate cough receptor
Chronic stimulation chronic cough
Recurrent stimulation recurrent cough
Non respiratory disorder also can cause cough:
GERD, CHD
10
Physiologic or pathologic (6)
cough
physiologic pathologic
11
Cough as friend (1)
Medical aspect, cough is very useful
A very important respiratory defense mechanism
Very important in respiratory clearance, especially when
MC is disturbed by disease
Important role of cough: neuromuscular disease, tracheo-
bronchomalacia
Without cough reflex: aspiration serious problems, drown
in our secretion
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Cough as friend (2)
Other function: ALARM
Give us warning that something is wrong
Almost all respiratory disorder and some non respiratory
disorder: cough symptoms
One of the most important cause of cough in children:
SMOKING
Parents aware pathologic search medical advice without
cough symptoms: delayed diagnosis, advance disease
13
Cough as foe (1)
Medical impact of cough is very vast
The most frequent of chief complaint
Reasons:
disturbed feeling
worry that something wrong
fatigue
sleepless
musculoskeletal aching
hoarseness
urinary incontinence
14
Cough as foe (2)
Tuberculosis
Morbili
Rubella
Respiratory infection:
Influenza
Pertussis
15
Cough.
Different from the other respiratory tract reflexes
(sneeze, hiccup)
It can be produced and prevented voluntarily
Not stereotyped in pattern: voiceprint
16
Cough
Sensation of
irritation
Vagus nerve
19
Chang AB. Cough 2003;7:1-15.
Receptor
Distributed under/in the epithelia of respiratory tract
Type of receptor:
Rapid adapting stretch R
Proximal respiratory tract is more sensitive to
mechanical stimuli
Distal respiratory tract is more chemosensitive
C-fibre neurogenic inflammation
20
Widdicombe J. Cough. Blackwell publishing 2003; 17-23
Cough pattern
Depends on the location of the stimulated receptor
In larynx expiration reflex
More distal stimulation inspiration phase
as the beginning phase of the cough
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How do we cough ?
inspiratory compressive expiratory
Inspiratory muscles contraction
Deep inspiration Glottic closure 0.2 Expiratory muscles
(150-200% tidal contraction
Contraction of
volume)
thoracic & abdminal Sudden glottic
Maximal dilation of muscles vs fixed opening
tracheo-bronchial tree diaphragm
Explosive release of
Intrathoracic intrathoracic air
pressure
cmH2O
4.0 40
Flow rates
Subglottic 30
L/s
3.0
pressure
2.0 20
1.0 10
0.0 0
1 2 3
Negative Min flow positive
Flow phase phase Flow phase
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McCool FD. Chest 2006;129:48S-53S.
Cough Ineffectiveness
Altered Cough mechanism
Altered mucus rheology
25
McCool FD. Chest 2006;129:48S-53S.
Conclusion.
Cough, a symptom with many faces
respiratory protective mechanism
sign of disease(s)
disturbing if continuously or rigorously
Pathologic cough increase the intensity and frequency of cough
Pathologic cough pathologic changes in respiratory tract
Cough: a knife with two sides: a friend that could be a foe
Causal treatment
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Thank you.
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