Respiratory problemsCough Choking on food and foreign bodies Asthmatic access
- Persistent cough
- Diagnosis and therapy
- What to do
- What the doctor can do
- Suffocation from food and foreign bodies
- Asthmatic access
Cough is a defense reflex of our body in response to an irritating action on the trachea or bronchi; it begins with a deep inhalation, followed by a forced, explosive exhalation, which has the purpose of expelling the irritating agent. A coughing fit can be caused by inhaled dust or other foreign elements, such as a food particle; more frequently, however, the cough is caused by the secretions of the nasal or bronchial passages that irritate the trachea (especially when it occurs repeatedly for a certain period of time).
Cough is not a disease but a symptom, or a signal of alteration of the respiratory system or organs unrelated to it. It can be an infectious form (from viruses or bacteria), an allergic form (from mites, pollens and often also food), a simple inflammatory form, or it can be the indicator of alterations of other organs or systems, as in the case cough resulting from heart problems, a phenomenon that is often found in elderly patients, or gastroesophageal reflux, in the presence of hiatal hernia. Based on its characteristics, cough can be defined as dry (with short but repeated accesses, often originating from inflammation of the larynx, tonsils or trachea), barking (persistent, not accompanied by phlegm, indicative of pressure on the respiratory tract, as in the case of an increase in the volume of the thyroid, thymus, or caused by a tumor of the lung or esophagus); productive (accompanied by expectoration of phlegm, due to inflammation of the airways with excess production of bronchial secretions). More useful for diagnosis is the distinction between acute, subacute and chronic (or persistent) cough. By convention cough is defined:
- acute, when it lasts less than 3 weeks;
- subacute, when it lasts for 3-8 weeks;
- chronic, if it persists beyond 8 weeks.
The acute form usually tends to self-limit until it disappears, and is frequently linked to pathologies such as the common cold, allergic rhinitis, bacterial sinusitis or flare-ups of bronchitis; the chronic one often represents a problem that is not easy to solve: it is calculated that there are over 100 diseases that can trigger this symptom.
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Chronic or persistent coughing is a constantly growing medical and economic problem throughout the industrialized world. However, many of the people who are concerned with it consider cough more a nuisance disorder than a potentially serious symptom.
By far the most frequent causes of chronic cough are the syndrome called postnasal-drip, which consists of a dripping of nasal secretions into the respiratory tract through the retropharynx (for primitive pathology of the nose or paranasal sinuses); asthma (where cough is sometimes the only symptom, in the absence of bronchospasm and dyspnea) and gastroesophageal reflux. Retronasal drip syndrome is particularly difficult to diagnose because there are no tests that can reveal it. Less frequent causes are chronic bronchitis (from smoking or other irritants), cough from taking ACE inhibitors and eosinophilic bronchitis. Rare causes may be the presence of a tumor or sarcoidosis not evident in radiological investigations, and left ventricular failure without dyspnea. It should also be said that in many cases there is more than one factor involved, which can be the reason for therapeutic failures (or only partial successes) if one of the causes remains unknown. An effective therapeutic approach requires the recognition of the underlying disease and the possibility of removing the responsible irritative stimulus, for example the cessation of smoking, the removal of any foreign bodies, the use of antacid drugs in the gastroesophageal reflux, the surgical closure of esophagus fistulas -tracheal, treatment of asthma and left ventricular failure etc. Cough should never be neglected as it can be an indicator of serious diseases: it should not be forgotten that, although not a specific symptom, cough has a significant association with lung cancer, especially in heavy smokers. A severe, persistent, inexplicable cough in patients over the age of 40, even with a normal chest radiogram, is an absolute indication for many authors for bronchoscopy for an early diagnosis of lung cancer.
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Diagnosis and therapy
The compilation of an articulated questionnaire that collects all the information relating to the patient (family, physiological, occupational, behavioral), combined with the history of the cough characteristics, is the first step in the diagnostic process. From the information on the symptoms, from their subsequent analysis and in light of a complete medical examination, it is already possible to formulate a diagnosis for the causes of the cough for a good number of patients, without the need for further investigations.
A good response to therapy is confirmation of a correct diagnosis. When it is necessary to continue investigations, it is essential to follow diagnostic paths of recognized validity.
Chest x-ray and spirometric examination are the most frequent tests; their evaluation is very important, also to exclude other diseases. Preliminary investigations can then be completed by bronchoscopy tests, allergy tests, bronchoscopy etc. Even if one is oriented towards an extrapulmonary cause, the specific assessments for the other organs and systems must be carried out by evaluating the degree of invasiveness and the cost-benefit ratio of the individual examination from time to time.
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What to do
Cough, especially if persistent, can also represent an important disturbing element, such as to prevent the normal performance of daily activities. The solution to the problem must be referred to the doctor, but here are a few simple tips to put in place, at least until the medical therapy begins to take effect.
- Worry from the first signs of tingling in the throat: it is easier to soothe an inflammation in the early stages.
- Drink a lot, so as to rehydrate the throat dried by coughing fits. In the most annoying cases, take hot drinks, such as milk or herbal teas, enriched with honey, for its emollient effect.
- In winter, protect neck and ears with scarves and hats.
- Take vitamin C through citrus and citrus juices, to defend and strengthen the immune system.
- After brushing your teeth, which must always be thorough, rinse your mouth and throat with a disinfectant mouthwash.
- Make sure to stay in well-humidified environments.
- Refrain from smoking.
- Fleeing stress, which among other negative effects also has the effect of weakening the immune system.
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What the doctor can do
Given the wide range of pathologies that can be at the origin of the cough, it is clear that the only radical therapy of this symptom, capable of eradicating it, is the etiological one, that is, directed to the underlying disease. Symptomatic therapy, based on the use of cough suppressants, finds a rational indication in those cases in which a violent and uncontrolled cough prevents the patient's normal activity, or represents a risk factor for complications such as rib fractures, pneumothorax, hemoptysis from effort etc. Cough is not a disease but a symptom, therefore every effort must be made by the doctor to establish the cause and set up a specific drug treatment in the shortest possible time, bearing in mind that regardless of the underlying disease that caused it, the cough can itself be the cause of possible complications.
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