COUGH

DR GOH AIK PING

 Cough

• 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.
 Mechanism
About 2.5L of air is inspired

Epiglottis closes, vocal cord shut tightly to entrap the air within
the lung

Abdominal muscles contract forcefully, pushing against the

diaphragm

Internal intercostal muscles also contract forcefully

Vocal cords and epiglottis suddenly open widely, air is expelled

at velocities ranging from 75 to 100 miles/hr
• The shearing forces that develop aid in the elimination
of mucus and foreign materials
 Importance

• Defense mechanism (physiological natural reflex):

• Providing a normal protective mechanism for clearing the tracheobronchial tree,
free of secretions and foreign material

• 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

• Symptom of disease:
• Associated with many medical diseases and conditions
• 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
 History Taking

• Onset and Duration:

• Acute: < 3 weeks
• Subacute: 3 weeks – 8 weeks
• Chronic: > 8 weeks

• Character:
• Bovine with Hoarseness: Left recurrent laryngeal nerve palsy causing left vocal cord
paralysis due to CA Lung
• Barking with Hoarseness and Stridor: Acute Epiglottitis, Laryngitis, CA Larynx
• Wheezing: COPD, Asthma
• Timing and associated features:
• Nocturnal: Asthma, Congestive heart failure
• Early morning: Bronchiectasis, Chronic bronchitis, Asthma
• Recumbent: Post Nasal Drip, CHF, GERD

• With or without sputum:

• Dry cough: Asthma, viral infection, interstitial lung disease
• Productive cough: Respiratory infection, COPD, bronchiectasis

• With or without blood:

• Hemoptysis: chronic bronchitis, bronchiectasis, pneumonia, CA, pulmonary
edema, pulmonary embolism
Common Causes of COUGH
• Upper/lower respiratory tract infection
• Common Cold / Allergic rhinitis
• Smoking
• Chronic bronchitis
• Pulmonary tuberculosis
• Asthma
• Gastroesophageal reflux
• Pneumonia
• Congestive heart failure
• Bronchiectasis
• Use of drugs (e.g.:ACEI)
 Treatment

• 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
 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 lozenges to soothe the throat
• Avoid irritations, including smoke and dust
• 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
 Pharmacological Treatment
• Anti – Tussives
• Bronchodilators
• Pharyngeal Demulcents – Lozenges, cough drops
• Expectorants
• Mucolytic
• Anti-Histamines
 Classification of Drugs

Peripherally acting Peripherally& centrally Centrally acting

Benzonatate
Opioids Non Opioids
Pharyngeal
Expectorants
demulcents

Mucokinetics Mucolytic
 Peripherally Acting
Pharyngeal demulcents
• Lozenges
• Glycerin
• Liquorice
• Linctus containing syrup.

Expectorants:-
1. Mucokinetics 2. Mucolytic
– Vasaka
• Ammonium chloride
– Bromhexine
• Sodium citrate
– Ambroxal
• Potassium Iodide – Dornase alfa
• Guaifenesin – Acetyl cysteine
• Ipecacuanha
 Centrally Acting
• Non Opioids
• Opioids

• Codeine • Noscapine
• PHOLCODINE • Dextromethorphan
• Pipazethate
• Morphine • Chlophedinol
• Ethylmorphine • Oxeladin
Centrally and peripherally acting

• Benzonatate
Pholcodine 10mg is equipotent to Codeine
15mg in suppressing cough
1. Full product information - Duro-Tuss Regular and Duro-Tuss Forte.
4. Core pholcodine product information (Online). Dec 2005 (cited 2013 Mar 18): Available from URL: http://www.tga.gov.au/rtf/forms/otc-template-pi-pholcodine.rtf
7. Gibbon CJ, et al, editors. South African Medicines Formulary. 8th Ed. Cape Town. South African Medical Association. 2008. p. 516, 527.
8. Chen ZR, Bochner F, Somogyi A. Pharmacokinetics of pholcodine in healthy volunteers: single and chronic dosing studies. Br J Clin Pharmac 1988;26:445-453.
9. Full product information - Duro-Tuss Expectorant.
10. Prescribing medicines in pregnancy. An Australian categorization of risk of drug use in pregnancy. Australian Drug Evaluation Committee. 4th ed. Australia: TGA; 1999.p.38.
Other Medication used to treat cough may include:
• Antihistamines and decongestant: These drugs are standard
treatment for allergies and postnasal drip
• 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.
• 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.
 Summary

• Differentiate acute from chronic cough

• Reviewed the most common causes as well as uncommon

causes of chronic cough

• Identified treatment strategies