What are the main causes of persistent coughing in the morning and at night. How can you effectively treat a chronic cough that worsens during certain times of day. What lifestyle changes and medical interventions can help alleviate coughing symptoms.

Postnasal Drip: A Leading Cause of Chronic Cough

Postnasal drip is a common culprit behind persistent coughing, especially in the morning and at night. This condition occurs when excess mucus from the nose drips down the back of the throat, irritating the upper airway and triggering a cough reflex. Individuals experiencing postnasal drip may also notice additional symptoms:

• Sore throat
• Frequent swallowing
• Sensation of a lump in the throat

Is postnasal drip always a chronic issue? Not necessarily. In many cases, it’s a temporary problem caused by infections like the common cold or flu, or allergic reactions to environmental triggers, including seasonal allergens. However, some individuals may experience chronic postnasal drip due to underlying conditions such as a deviated septum or gastroesophageal reflux. Age can also be a contributing factor, with older adults more prone to this condition.

Effective Treatments for Postnasal Drip

How can you alleviate symptoms of postnasal drip? For infection-related cases, the condition often resolves on its own within a few weeks. If symptoms persist, consider these treatment options:

1. Antibiotics for bacterial infections (if prescribed by a healthcare provider)
2. Increased water intake to thin mucus
3. Using a humidifier in the bedroom to moisten the air
4. Elevating the head slightly while sleeping

Asthma: A Common Trigger for Morning and Night Coughs

Asthma is a chronic respiratory condition characterized by airway inflammation and irritation. This can lead to asthma attacks, during which the airways narrow, making breathing difficult. Many individuals with asthma experience a persistent cough, which may worsen at night or in the early morning hours. In some cases, a chronic cough may be the only symptom of asthma.

Can asthma symptoms be triggered by environmental factors? Yes, many people with asthma find that certain allergens or environmental conditions exacerbate their symptoms. Common triggers include:

• Pollen
• Air pollution
• Extreme weather conditions

Managing Asthma-Related Coughs

What steps can you take to manage asthma-induced coughing? Consider the following approaches:

1. Identify and avoid triggers when possible
2. Use a rescue inhaler for acute asthma attacks (as prescribed)
3. Take regular asthma medication to reduce airway inflammation
4. Work with a healthcare provider to develop a comprehensive asthma management plan

Bronchitis: Inflammation of the Bronchial Tubes

Bronchitis is a condition characterized by inflammation of the bronchial tubes, which play a crucial role in transporting air to and from the lungs. This inflammation can lead to persistent coughing, often accompanied by other symptoms. What causes bronchitis, and how does it manifest?

Bronchitis can be either acute or chronic. Acute bronchitis is typically caused by viral or bacterial infections, often following a cold or flu. Symptoms of bronchitis include:

• Persistent cough, often with mucus production
• Chest discomfort
• Fatigue
• Mild fever and chills

Chronic bronchitis, on the other hand, is a long-term condition that causes recurring inflammation in the bronchial tubes. This form of bronchitis is often associated with smoking or long-term exposure to irritants.

Treating Bronchitis Effectively

How can bronchitis be treated? The approach depends on whether the condition is acute or chronic:

1. For viral bronchitis, rest and supportive care are usually sufficient
2. Antibiotics may be prescribed for bacterial infections or complications like pneumonia
3. Chronic bronchitis treatment focuses on removing inflammation sources (e.g., quitting smoking)
4. Medications to reduce swelling and inflammation in the airways
5. Pulmonary rehabilitation programs to improve lung function

Dry Throat: A Simple Cause of Morning Coughs

Sometimes, the simplest explanations are the most accurate. A dry throat, particularly common in the morning, can lead to persistent coughing. What causes a dry throat, and how does it relate to coughing?

The throat and mouth can become dry overnight due to various factors:

• Insufficient fluid intake
• Sleeping in a dry environment
• Mouth breathing during sleep

This dryness can irritate the tissues at the back of the throat, leading to a scratchy sensation and triggering a cough reflex. Additional symptoms may include:

• Difficulty swallowing
• Hoarse voice
• Burning sensation in the throat

Alleviating Dry Throat and Associated Coughing

How can you combat dry throat and reduce morning coughing? Try these simple remedies:

1. Increase water intake, especially in the morning
2. Use a humidifier in your bedroom to add moisture to the air
3. Practice proper sleep hygiene to reduce mouth breathing

If these measures don’t provide relief, consult a healthcare provider to rule out underlying conditions like Sjögren’s syndrome or side effects from medications such as diuretics.

GERD: When Stomach Acid Causes Respiratory Symptoms

Gastroesophageal reflux disease (GERD) is a condition where stomach acid flows back into the esophagus, causing a range of uncomfortable symptoms. While GERD is primarily associated with digestive issues, it can also lead to respiratory symptoms, including chronic coughing. How does GERD contribute to coughing, particularly in the morning?

In individuals with GERD, stomach acid can travel up the esophagus, especially when lying down. This can result in:

• Burning sensation in the chest (heartburn)
• Irritation of the throat and lungs
• Morning hoarseness
• Persistent cough, often worse in the morning

Managing GERD-Related Coughs

What steps can you take to alleviate GERD symptoms and reduce associated coughing? Consider these approaches:

1. Avoid eating at least 3 hours before lying down
2. Reduce consumption of acidic and spicy foods
3. Elevate the head of your bed slightly
4. Use over-the-counter antacids as needed
5. Consult a healthcare provider for prescription medications or surgical options if symptoms persist

COPD: A Progressive Respiratory Condition

Chronic obstructive pulmonary disease (COPD) is a progressive lung condition that makes breathing increasingly difficult over time. How does COPD develop, and what are its primary symptoms?

COPD occurs when the tiny air sacs in the lungs become damaged, impairing the lungs’ ability to exchange gases and absorb oxygen efficiently. Common symptoms of COPD include:

• Persistent coughing, often with mucus production
• Wheezing
• Shortness of breath, especially during physical activity
• Fatigue and low energy levels

COPD symptoms typically start mild and worsen gradually over time, making early diagnosis and treatment crucial for managing the condition effectively.

Comprehensive COPD Management Strategies

While there’s no cure for COPD, various treatment approaches can help manage symptoms and slow disease progression. What are some effective COPD management strategies?

1. Smoking cessation (for smokers)
2. Regular exercise to improve lung function and overall health
3. Medications to open airways and reduce inflammation
4. Oxygen therapy for advanced cases
5. Pulmonary rehabilitation programs
6. Breathing exercises and techniques

Hypothyroidism: An Unexpected Cause of Chronic Cough

Hypothyroidism, a condition characterized by an underactive thyroid gland, might not be the first thing that comes to mind when considering causes of chronic cough. However, this endocrine disorder can indeed contribute to persistent coughing, especially in the morning. How does hypothyroidism relate to coughing symptoms?

In individuals with hypothyroidism, the thyroid gland produces insufficient amounts of thyroid hormone. This can lead to various symptoms, including some that affect the respiratory system:

• Hoarse voice
• Sensation of something stuck in the throat
• Chronic cough, often worse in the morning due to nighttime dryness

Treating Hypothyroidism-Related Coughs

How can hypothyroidism-induced coughing be addressed? The primary approach involves treating the underlying thyroid condition:

1. Thyroid hormone replacement medication
2. Regular monitoring of thyroid function through blood tests
3. Patience, as it may take several months of treatment to see significant improvement
4. Addressing specific symptoms, such as using a humidifier for throat dryness

It’s important to note that while treating hypothyroidism can alleviate associated coughing, the process may take time. Consult with an endocrinologist for personalized treatment and management strategies.

The Impact of Environmental Factors on Coughing Patterns

While various medical conditions can cause persistent coughing, environmental factors also play a significant role in exacerbating symptoms, particularly during certain times of the day. How do environmental elements influence coughing patterns, especially in the morning and at night?

Air Quality and Its Effect on Respiratory Health

Poor air quality can significantly impact respiratory health and trigger coughing episodes. What are some common air quality issues that contribute to coughing?

• Indoor air pollution from cooking, heating, or cleaning products
• Outdoor air pollution, particularly in urban areas
• Allergens such as pollen, dust mites, or pet dander
• Mold spores in damp environments

These factors can be especially problematic in the morning, as pollutants tend to settle overnight, and in the evening, when temperature inversions can trap pollutants close to the ground.

Temperature and Humidity Fluctuations

How do changes in temperature and humidity affect coughing? Significant fluctuations can irritate the respiratory system:

• Cold, dry air in the morning can irritate airways
• Rapid temperature changes when moving between heated indoor spaces and cold outdoor environments
• Low indoor humidity, especially during winter months when heating systems are in use

Mitigating Environmental Triggers

What steps can individuals take to reduce the impact of environmental factors on their coughing symptoms?

1. Use air purifiers with HEPA filters to remove airborne particles
2. Maintain optimal indoor humidity levels (between 30-50%)
3. Regularly clean and vacuum to reduce dust and allergens
4. Use hypoallergenic bedding to minimize nighttime triggers
5. Monitor local air quality reports and limit outdoor activities on high-pollution days

The Role of Sleep Position in Morning Coughs

Sleep position can significantly influence the likelihood and severity of morning coughs. How does the way we sleep affect our respiratory system, and what positions are most beneficial for reducing coughing symptoms?

The Impact of Lying Flat

Sleeping in a completely flat position can exacerbate coughing for several reasons:

• Increased postnasal drip due to mucus accumulation
• Higher risk of acid reflux for those with GERD
• Reduced lung expansion, potentially worsening symptoms for those with respiratory conditions

Optimal Sleep Positions for Reducing Coughs

What sleep positions can help minimize morning coughing? Consider these options:

1. Elevated head position: Use extra pillows or an adjustable bed to keep the head slightly raised
2. Left-side sleeping: This position can help reduce acid reflux symptoms
3. Semi-upright position: For severe cases, sleeping in a recliner might provide relief

Experimenting with different sleep positions can help individuals find the most comfortable and effective arrangement for their specific situation.

The Importance of Proper Diagnosis for Chronic Coughs

While understanding potential causes and management strategies for chronic coughs is valuable, proper medical diagnosis remains crucial. Why is professional medical evaluation so important for persistent coughing, especially when it’s worse in the morning or at night?

Distinguishing Between Similar Symptoms

Many respiratory conditions share similar symptoms, making self-diagnosis challenging and potentially misleading. A healthcare provider can:

• Conduct a thorough physical examination
• Review medical history and lifestyle factors
• Order appropriate diagnostic tests (e.g., lung function tests, chest X-rays, allergy tests)
• Differentiate between acute and chronic conditions

Identifying Underlying Health Issues

Chronic coughing can sometimes be a symptom of more serious underlying health conditions. Professional evaluation can help:

• Rule out or diagnose conditions like lung cancer or heart disease
• Identify less common causes of chronic cough, such as bronchiectasis or sarcoidosis
• Assess the potential impact of medications on cough symptoms

Developing an Effective Treatment Plan

Once a proper diagnosis is made, healthcare providers can develop a tailored treatment plan. This may include:

1. Prescription medications specific to the underlying condition
2. Referrals to specialists (e.g., pulmonologists, allergists, ENT doctors)
3. Lifestyle modification recommendations
4. Follow-up care to monitor progress and adjust treatment as needed

Remember, while self-care measures can provide temporary relief, persistent coughing that significantly impacts quality of life warrants professional medical attention. Early diagnosis and treatment can prevent complications and improve overall respiratory health.

8 possible causes and treatments

Postnasal drip occurs when excess mucus from the nose drips down the back of the throat, leading to an upper airway cough. Other symptoms of postnasal drip include:

• sore throat
• swallowing frequently
• feeling a lump in the throat

Sometimes, postnasal drip is a temporary issue when a person has an infection, such as a cold or flu, or allergies to something in the environment, including seasonal allergies.

In other cases, postnasal drip can be a more chronic problem.

People with chronic congestion from a deviated septum or gastroesophageal reflux may experience frequent postnasal drip. Advancing age may also increase the risk.

Treatment options

If an infection is causing postnasal drip, it will usually disappear on its own. If it lasts longer than a few weeks, a person may need antibiotics to clear a bacterial infection.

The following remedies may also help:

• drinking lots of water
• sleeping in a room with a humidifier
• sleeping with the head slightly elevated

Asthma causes chronic airway inflammation and irritation. This can trigger asthma attacks, during which the airway narrows and a person struggles to breathe. They may also have a wheezing or whistling sound coming from their chest.

An individual may also have chronic respiratory problems, such as a cough. Some people may notice this cough is worse at night or in the morning.

In certain types of asthma, a chronic cough is the only symptom.

Treatment options

Some people with asthma find that allergens or other triggers cause their cough. This can include pollen, air pollution, or certain weather conditions. Avoiding or limiting exposure to these triggers can be helpful.

A doctor may also prescribe a rescue inhaler for asthma attacks or asthma medicine to reduce inflammation in the airway.

Bronchitis refers to inflammation in the bronchial tubes, which help air travel to the lungs.

Sometimes, a bacterial or viral infection can cause this condition — these infections can occur after a cold or flu.

Symptoms include:

Viral bronchitis usually goes away on its own. People may require antibiotics to treat any complications of bronchitis, such as pneumonia.

A person can also develop chronic bronchitis, which may cause long-term or recurring inflammation in the bronchial tubes.

Treatment options

Treatment focuses on removing the source of inflammation, such as avoiding smoking or second-hand smoke, and using medications to reduce swelling and inflammation.

The throat and mouth can become dry at night, especially if people:

• do not drink enough fluids
• sleep in a dry room
• sleep with their mouth open

This can cause the tissue at the back of the throat to feel irritated and scratchy, leading to a morning cough. People may also experience:

• trouble swallowing
• hoarse voice
• a burning feeling

Individuals may find the problem resolves by drinking more water, especially in the morning.

In some cases, chronic dry mouth may appear due to underlying health conditions, such as Sjögren’s syndrome, or medications such as diuretics.

Treatment options

If people find no relief by drinking more water or using a humidifier, they can consult with their doctor, who can check for underlying causes.

With GERD, stomach acid travels back up the esophagus, causing a burning, painful sensation and frequent heartburn.

People may experience symptoms at night if they eat shortly before lying down, which may lead to morning hoarseness or coughing.

Severe GERD may also irritate the throat or lungs, causing a chronic cough or difficulty swallowing.

Treatment options

Routine changes, such as consuming fewer acidic foods and eating at least 3 hours before lying down, may help. Some people may also find relief from sleeping with their head slightly elevated or by using over-the-counter antacids.

If these treatments are not effective, a doctor may prescribe medication or recommend surgery.

COPD is a chronic and progressive disease that makes it harder to breathe.

Over time, the condition damages the tiny air sacs in the lungs, making it harder for the lungs to exchange gas and take in oxygen.

Symptoms can include:

• coughing
• wheezing
• shortness of breath
• low energy

People may experience mild symptoms initially, which may become more severe over time.

Treatment options

Although there is no cure for COPD, a number of routine changes may help to ease symptoms, such as:

• getting more exercise
• quitting smoking
• medication to help open the airways
• oxygen therapy
• breathing treatments

Hypothyroidism is a condition where the thyroid produces too little thyroid hormone. It may cause a person’s voice to sound hoarse. Some people also have a sensation of something stuck in the throat, which can cause a cough.

While some notice a cough throughout the day, it may be worse in the morning when the throat is dry.

Treatment options

Medication can treat hypothyroidism, but it may take several months of treatments to notice an improvement in the voice.

Certain types of cancer, including lung cancer, may cause a chronic cough. In some people, this cough may be worse in the morning.

It can be difficult to tell the difference between a cough from cancer and other types of coughs, so it is important to speak with a doctor about any persistent coughing.

Treatment options

Treatment depends on the type of cancer a person has, but strategies may include radiation or chemotherapy.

An occasional morning cough might mean a person has a dry throat or mild allergies. Chronic coughing, either in the morning or at other times, may indicate a chronic medical condition that needs treatment.

People should speak with a doctor if:

• symptoms continue even after treatment for an infection
• coughing persists for more than a few weeks
• they cough up blood
• they have other symptoms, such as a fever or trouble breathing
• a newborn has a cough

Visit the emergency room if a person is experiencing a cough with chest pain, shortness of breath, or confusion, or they are coughing up large quantities of blood.

Most coughs are treatable. Even in the cases of a serious underlying medical condition, such as cancer, early intervention may greatly improve outcomes.

If people have an unexplained, persistent cough, they can consult with a doctor. Healthcare professionals can help assess symptoms and carry out tests to determine the underlying cause of the cough and recommend treatment options.

What could be the cause of chronic cough at night and in early morning? How can I stop the cough?

Thank you for your question. I’m sorry to hear that your mother is suffering from a prolonged and problematic cough which can be a complex condition.

Coughing is a reflex that protects your upper airway and lungs from irritants such as excessive mucous and foreign bodies. When persistent, it is often a symptom of a condition, ranging from conditions arising from the nose & sinuses (e.g sensitive nose, sinus infections), lungs (e.g asthma and bronchitis), throat and stomach (e.g. acid reflux from the stomach) to side effects from medications or smoking.

If the source of the cough is not found, it is difficult to treat. It would be beyond the scope of this Q&A to address all possible causes of prolonged cough.

The majority of prolonged coughs are due to:

1. Postnasal drip
2. Acid reflux
3. Asthma
4. Bronchitis
5. Smoking
6. Side effects from medications.

Since it seems that your mother has been cleared by a Respiratory Physician, we will discuss cough from irritation of the voicebox.

This is usually due to postnasal drip (back drip of mucous from nose allergy or sinus infection) or acid reflux from the stomach.

As the voicebox is a very sensitve organ, once inflamed, it can take months for the inflammation to resolve. It is important to remove the sources of irritation while waiting for inflammation of of the voicebox to resolve.

Since your mum has seen an ENT Specialist and was given an acid suppressant medication (Nexium) and nasal steroid sprays (to treat sensitive nose or nose allergies),  it is important to ensure good compliance with these medications.

The importance of compliance with nasal steroid sprays is often overlooked by many patients. It can take days to weeks for nasal steroid sprays to reduce the mucous in the nose and postnasal drip (which may be a possible source of irritant of your mother’s cough).

Apart from taking Nexium, it is also just as important to ensure that your mother adheres to antireflux measures (e.g no food/drinks 3-4 hours before sleeping, taking small meals and avoiding reflux causing or “heaty” food).

If your mother has done all that I’ve mentioned above, it may also be worthwhile to get her doctor to examine the medications that she is taking (one of the common blood pressure medication can cause cough as a side effect).

Exposure to cigarette smoke can also persistently irritate the voicebox and prevent a full recovery. As your mother’s cough started after a chest infection, she may also have “Postinfectious Cough”, of which the reason is unfortunately unknown.

Some studies attribute this to excessive inflammation of the upper and lower airway after an infection, resulting in a persistent overproduction of mucous. This is difficult to treat and often needs mucous thinners/expectorants and cough medications to keep the symptoms under control or bearable.

If your mother’s cough is accompanied by a whooping inspiratory sound or leads to vomiting, she may need to revisit the Respiratory Physician to rule out  infection that is due to B pertusis bacterial infection.

Hope this helps and all the best.

What is that morning cough all about?

Waking up coughing? Here’s why.

A cough, no matter what time of day it occurs, is vital for clearing the airways of irritants.

However, if you’re not a regular smoker and keep on waking up with a cough, you might start wondering why. There are several conditions that can cause an early morning cough:

1. Postnasal drip

Postnasal drip is one of the most common causes of a persistent cough. Your nose serves as a gateway to your respiratory tract – and to protect it from irritants, the nose produces mucus that serves as a filter. But sometimes the body produces too much, which has to go somewhere – usually all the way down the respiratory tract, which will cause irritation and a cough. As mucus pools at the back of the throat while you are lying down, a cough associated with nasal drip can be especially bad at night and first thing in the morning.

What to do: Postnasal drip has various causes: it could be an allergy, sinusitis, a cold or flu. If the postnasal drip is persistent and causing a cough, especially first thing in the morning, you might want to address the underlying cause of the nasal drip by means of a decongestant or antihistamines.

2. Hay fever

There are various things inside the home that may cause an allergic reaction that triggers hay fever symptoms. It could be dust, pollen or pet dander. These allergens are present in many homes and can irritate your airways.

What to do: Make sure your house, especially your bedroom, is always free of dust. If pet dander is the issue, try to make your bedroom a pet-free zone. Make sure your bedroom is well-ventilated.

3. Bronchitis

If you cough up phlegm, especially in the morning, it might be a sign of bronchitis. Acute bronchitis is the most common form and occurs when the bronchi (the airways of the lungs) become inflamed. The cough tends to be worse in the morning as phlegm and fluids settle in the lungs during the night while you are sleeping.

What to do: Acute bronchitis is a common condition and is often mild enough not to require medical intervention. If, however, you experience a high fever, green or yellow sputum and are struggling to breathe, you should see your doctor as soon as possible. The cough will most likely last for up to three weeks and will resolve itself. Repeat courses of antibiotics might not have any effect and be pointless.

In conclusion, most coughs which are more persistent at night and first thing when you wake up tend to be caused by phlegm or mucus pooling in the throat or respiratory system. If you are treating the underlying condition, but your cough persists, you can take the following steps.

• Keep the air in your bedroom moist by investing in a humidifier. Dry air can irritate the nasal passages, causing your body to produce even more mucus.
• Drink plenty of fluids to keep the mucus thin.
• Sleep with your head slightly elevated to keep mucus from pooling inside the throat.
• Take half a teaspoon of honey before you go to bed – this can provide soothing relief from coughs.
• Suck on a lozenge or take small sips of water to suppress your cough.
• Take a mucolytic as this may help reduce your cough.

^{Image credit: iStock}

That nagging cough – Harvard Health

Persistent cough, common causes and cures

What’s that nagging cough, and what can you do to cure it? Cough for a minute or two, and you may think something has “gone down the wrong pipe.” Cough for a day or two, and you may think you’ve picked up a cold or the flu. After a week, bronchitis or allergies may come to mind. But after three or four weeks, your mind starts to race, and the worry begins to mount.

For many people, chronic coughing raises the specter of cancer. But is cancer really a common cause of a cough that lingers? And if it’s not, what is — and what can you do to quiet a nagging cough?

What is a cough?

Although folk wisdom views coughing as a grave portent of illness — What did one casket say to the other? “I hear you coffin” — the cough is actually a vital player in the body’s defense against disease. Coughing expels mucus, microbes, and foreign particles from the respiratory tract, protecting the lungs from infection and inflammation.

The cough begins with an initial gasp that draws air deep into the lungs. Next, the glottis snaps shut, putting a lid over the trachea, or windpipe. The third step is the forceful contraction of the muscles of the chest cage, abdomen, and diaphragm (see figure). In normal breathing, these muscles push air gently from the lungs up through the nose and mouth. But when the glottis is closed, the air can’t move out, so tremendous pressure builds up in the air passages. Finally, the glottis swings open and the air rushes out. And it is quite a rush; in a vigorous cough, the air travels out at nearly the speed of sound, creating the barking or whooping noise that we call a cough.

A cough can be a conscious, voluntary act or an uncontrollable, involuntary reflex. In the latter case, stimulation of nerves in the larynx (“voice box”) and respiratory tract initiates the entire process. These nerves can be irritated by infections, allergies, cold air, tumors, chemical agents such as smoke, mechanical factors such as dust particles, or by normal body fluids such as nasal mucus or stomach acid. It’s no wonder, then, that so many different things can trigger a cough.

The chronic cough

Everyone coughs, and nobody worries about an occasional cough. Many acute illnesses — ranging from hay fever and the common cold to bronchitis and pneumonia — produce recurrent coughs. But the cough that accompanies acute illnesses resolves in a matter of a few days to a few weeks. In contrast, a chronic cough is variously defined as one that lingers for more than three to eight weeks, sometimes lasting for months or even years.

Chronic coughing is common, so frequent that it rates as one of the most common reasons for seeing a doctor. In addition to worry about the cause of the cough, patients experience frustration and anxiety, especially if diagnosis and treatment stretches out over weeks, which is often the case. Coughing interrupts sleep, producing fatigue and impairing concentration and work performance. In this age of scary new viruses, social interactions may suffer. And coughing can also have important physical consequences, ranging from urinary incontinence to fainting and broken ribs. Between medical tests, lost productivity at work, remedies that don’t help, and treatments that do, coughing can become expensive.

What causes chronic coughing?

Smoking is a leading cause. Sooner or later, most cigarette smokers develop a chronic “smoker’s cough.” Chemical irritation is responsible — but the same noxious chemicals that cause the simple smoker’s cough can lead to far more serious conditions, such as bronchitis, emphysema, pneumonia, and lung cancer. The chronic cough is always a cause of concern for smokers.

A lingering cough is also a worry for nonsmokers. Fortunately, benign problems are responsible for most chronic coughs in nonsmokers. Benign or not, persistent coughing can cause worry, embarrassment, exhaustion, and more. That’s why chronic coughs should be diagnosed and treated before they linger too long.

Dozens of conditions can cause a recurrent, lingering cough, but the lion’s share are caused by just five: postnasal drip, asthma, gastroesophageal reflux disease (GERD), chronic bronchitis, and treatment with ACE inhibitors, used for high blood pressure. Many people have several of these conditions, but in nonsmokers, the first three, singly or in combination, account for nearly all chronic coughs. The major causes of long-term coughing are listed below.

If you’re like most people with a lingering cough, consider these major causes:

1. Postnasal drip (also called the upper airway cough syndrome). The human nose is more than the organ of smell. It is also the gateway to the lower respiratory tract. As such, its job is to condition the air passing through en route to the lungs. The nose warms air that is cool, adds moisture to air that is dry, and removes particles from air that is dirty. The nasal membranes accomplish all three tasks by producing mucus that is warm, moist, and sticky.

Although the nose is a guardian of the more delicate lungs, it is subject to problems of its own. Viruses, allergies, sinusitis, dust particles, and airborne chemicals can all irritate the nasal membranes. The membranes respond to injury by producing more mucus — and unlike normal mucus, it’s thin, watery, and runny.

All that mucus has to go somewhere. When it drips out the nose, it’s a nuisance. But when it drips down the throat, it tickles the nerves of the nasopharynx, triggering a cough. In some cases, the nose itself is to blame (rhinitis), but in others, a prolonged postnasal drip lingers after a viral upper respiratory infection; some call this variety a post-infectious cough.

In typical cases, patients with postnasal drip cough more at night, and they are often aware of a tickling feeling at the back of their throats. But they can cough during the day, and their throats may be irritated and sore or perfectly fine.

The best way to find out if a chronic cough is the result of postnasal drip is to try treatment. Nonprescription decongestant or antihistamine tablets are the first step. Most contain a decongestant, an antihistamine, or a combination of the two. In one form or another, these medications are generally effective and safe, but some people complain of a racing heart and souped-up feeling (due to the decongestant), while others feel sleepy (due to the antihistamine). Men with benign prostatic hyperplasia (BPH) may have difficulty passing urine while they’re taking decongestants, and antihistamines can occasionally trigger acute glaucoma. As with all medications, read the directions carefully.

Home remedies can help as well. Inhaling steam from a hot shower or kettle is the simplest. Nasal irrigations may also help by cleaning out irritating secretions. You can purchase saline nose sprays at your drugstore or you can do it yourself. First, soak a clean washcloth in a basin containing ⅛ teaspoon of table salt for each cup of water. Next, hold the dripping wet cloth up to your nostrils and sniff in the saline solution. If saline irrigations seem to help, repeat them one to three times per day.

Postnasal drip is the leading cause of the lingering cough. But it’s far from the only cause.

2. Asthma. Wheezing and breathlessness are the usual symptoms of asthma. But not all patients with asthma wheeze. Indeed, some just cough.

Asthma results from bronchospasm, the temporary, reversible narrowing of the medium-sized tubes that carry air into the lungs. In most cases, that air makes a whistling or wheezing sound as it moves through narrowed passages. Excessive mucus production, shortness of breath, and cough are the other classic symptoms of asthma. But in cough-variant asthma, coughing is the only symptom.

In most cases, cough-variant asthma produces a persistent, dry cough that occurs around the clock but may begin at night. Exposure to allergens, dust, or cold air often triggers coughing, as does exercise.

If doctors suspect that asthma is responsible for a chronic cough, they can order pulmonary function tests to confirm the diagnosis; if these tests are inconclusive, patients may be asked to inhale small doses of methacholine, a drug that often triggers wheezing in asthmatics.

Another approach to the diagnosis of cough-variant asthma is to see if the cough responds to anti-asthmatic treatment. Doctors often suggest a bronchodilator spray such as albuterol (Proventil, Ventolin). It’s short acting. So, in addition your doctor might prescribe an inhaled cortico steroid, such as fluticasone (Flovent), triamcinolone (Azmacort) or budesonide (Pulmicort).

If you have a chronic cough that may be due to asthma, ask your doctor to consider testing or treating. But if asthma is not the answer, ask him to think about the third leading cause of the cough that lingers.

3. Gastroesophageal reflux disease. Just as people are surprised to learn that asthma can cause coughing without wheezing; many people are shocked to learn that gastroesophageal reflux disease (GERD) can cause coughing without heartburn.

GERD occurs when stomach contents travel upstream, making their way up into the esophagus instead of down into the intestines. Heartburn is the usual symptom; belching, a sour taste in the mouth, and bad breath are common too. But acid also irritates nerves in the lower esophagus, and these nerves can trigger the cough reflex even without the distress signal of pain. In fact, up to one-third of patients with GERD are pain-free, complaining instead of cough, recurrent laryngitis, or unexplained sore throats.

GERD can be tricky to diagnose when there’s no pain. Barium swallow x-rays and esophagoscopy can help, but the gold standard is esophageal pH monitoring, in which the patient swallows a probe that remains in the lower esophagus for 24 hours to detect the presence of acid. It’s not as uncomfortable as it sounds, but it is expensive and inconvenient.

As with the other causes of chronic cough, a simpler approach to diagnosis is to try treatment. You can begin on your own. Avoid alcohol and foods that often trigger GERD, including those that contain chocolate, peppermint, caffeine, garlic, onions, citrus fruits, tomato sauce, or lots of fat. Eat small meals, and never lie down until two hours after you’ve eaten. Take liquid antacids, particularly at bedtime, and consider elevating the head of your bed or sleeping on a wedge-shaped pillow to keep your stomach’s contents flowing down at night.

If you’re constantly coughing after a week or so, you can add an over-the-counter acid suppressor. Today there are many to choose from, including ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), omeprazole (Prilosec) and lansoprazole (Prevacid). Stronger versions are available by prescription.

It may take three or four weeks of gradually escalating therapy to control GERD. But if your program doesn’t work, you are probably coughing for some other reason.

4. Chronic bronchitis and bronchiectasis. Chronic bronchitis is persistent inflammation of the bronchial tubes causing airway narrowing and production of excess mucus. It usually happens from tobacco use or long-term exposure to high levels of industrial air pollutants. Bronchiectasis is also a result of chronic inflammation that damages the walls of the bronchial tubes. In either variant, the inflammation leads to a chronic cough. The most effective treatment is to quit smoking and avoid air pollutants. In addition, your doctor can prescribe a corticosteroid inhaler, usually with a long-acting bronchodilator. People with chronic bronchitis are prone to flare-ups. Doctors call them COPD exacerbations. The main symptoms are increased coughing, thick dark mucus production, shortness of breath, and fatigue. The treatment includes antibiotics and an oral corticosteroid, usually prednisone.

5. Therapy with angiotensin-converting–enzyme (ACE) inhibitors. ACE inhibitors such as enalapril (Vasotec, generic), lisinopril (Prinivil, Zestril, generic), as well as many others, have assumed a prominent role in the treatment of high blood pressure and heart failure.

ACE inhibitors are favored by many doctors because they produce good results and have few side effects, with one exception — a persistent cough. It occurs in up to 20% of people taking an ACE inhibitor. The first symptom is often just a throat tickle, followed by a dry cough that can begin as soon as three weeks or as late as one year after the medication is started. Once the cough starts, it lingers and lingers.

If the cough is mild, patients may choose to continue their medication, or they may cough less if they change to a different ACE inhibitor. But the only way to eliminate a severe cough induced by an ACE inhibitor is to switch to another type of antihypertensive medication. Fortunately, many are available, including angiotensin-receptor blockers (ARBs) like losartan (Cozaar) and valsartan (Diovan) — drugs that act like ACE inhibitors without causing a cough.

Less common coughing causes

In nonsmokers, the Big Five account for more than nine of every 10 chronic coughs. But other problems can — and do — cause lingering coughs.

Lung infections make people cough. Most cases of pneumonia are acute infections requiring rapid diagnosis and treatment. However, some lung infections can be more indolent and can cause a persistent cough. Fever is an important clue to infectious causes of persistent coughing.

Pertussis (whooping cough) is a respiratory tract infection that can cause serious problems in children who have not been immunized properly with diphtheria-pertussis-tetanus (DPT) vaccine. Pertussis began to resurface in adolescents and adults because the original tetanus-diphtheria booster shots did not cover pertussis and the vaccine’s effectiveness wears off over time.

Heart disease can masquerade as lung disease if coughing and breathlessness are its main symptoms. It’s a common occurrence in patients with heart failure (HF). Their cough is most pronounced when they’re lying flat, so they often resort to sleeping propped up on pillows. The cough of HF may be dry, or it may produce thin, frothy white sputum. Leg swelling, fatigue, and exercise intolerance are other common symptoms of HF.

Abnormal swallowing can lead to persistent coughing if food triggers the cough reflex by heading down the “windpipe” instead of the “food pipe.” Called aspiration, the problem occurs mainly in people with strokes or other neurologic disorders that hamper normal swallowing.

Environmental irritants can trigger the cough reflex, not just once but with nearly every breath of air laden with chemicals or particles ranging from sulfur dioxide to nitric oxide to dust and molds. Even clean air can trigger coughing if it is too dry or too cold.

Lung cancer certainly belongs on the list of disorders that cause persistent coughing. Fortunately, though, it’s not high on the list, at least in nonsmokers.

Stress. Mental factors can produce many physical symptoms, including cough. Psychogenic coughing increases at times of stress and disappears during sleep.

Finding chronic cough causes and cures

Don’t ignore a chronic cough — but don’t panic just because your cough lingers for more than three or four weeks. Most often, the puzzle can be solved without elaborate tests, and the problem can be corrected with simple treatments. In fact, you may be able to diagnose and treat yourself, especially if postnasal drip or gastroesophageal reflux is the culprit. Even so, your doctor can also help. In most cases, it won’t take much more than a stethoscope and a treatment trial or two. But if your cough is accompanied by sputum production, bloody sputum, fever, weight loss, night sweats, breathlessness, undue fatigue, or chest pain, you should consult your doctor without delay.

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Why Your Cough Gets Worse at Night

The Science Behind a Cough That’s Worse at Night

Why do coughs get worse at night? There are a number of reasons why they do — or at least why they seem to.

Gravity The number one factor that makes your cough worse at night is simple: gravity. Mitchell Blass, MD, a physician with Georgia Infectious Diseases, says, “When we lie down, mucus automatically begins to pool.” The best way to counteract this gravitational pull is elevation. “Sleep with a pillow propping you up a little,” Dr. Blass suggests. “It will help keep the mucus from collecting in the back of the throat.”

A dry, indoor environment Dry air can aggravate an already irritated nose and throat, making your nighttime cough worse. To relieve a dry air cough, you can try a humidifier to put moisture back into the air and make it easier to breathe, but be sure to take proper care of the unit.

“Humidifiers are not always safe,” warns Blass. “If the water you put in it isn’t sterile, you run the risk of cycling the germs back into the air or breeding other diseases.” The last thing people with a cold or flu want is to experience complications, says Blass. “Bacterial infections can set in. Many flu-related deaths are caused by pneumonia that hits after people think they’re over the flu.” To ensure you use a humidifier safely, be sure to carefully follow all the directions that come with it.

How to Manage a Nighttime Cough

Most coughs associated with colds and flu are beneficial for clearing congestion from your lungs and airways, according to the Mayo Clinic. But sleep is also important for getting well — and it’s no fun tossing and turning all night.

How to Help a Cough at Night: Try These Tips

When it seems like you just can’t get any sleep, here’s how to stop coughing at night:

• Suck on a cough drop. Before you go to sleep, suck on a cough drop or hard candy to ease a dry cough (one that doesn’t produce mucus) and soothe your throat, advises the Mayo Clinic.
• Drink fluids. Be sure to drink plenty of fluids throughout the evening before bed — liquids help thin the mucus in your throat, and warm liquids are soothing, says the Mayo Clinic.
• Have some honey. Adding honey to warm liquids like water or tea or just taking a spoonful or two has been shown to have modest benefits in reducing cough, says Stephen Russell, MD, a physician at the University of Alabama at Birmingham Department of Medicine and an expert in upper respiratory infections. A study published in JAMA Pediatrics found that honey had modest benefits in reducing nocturnal cough in children ages 2–18. Never give honey to children under age 1 though, says Dr. Russell, because in rare cases it can cause infant botulism.
• Try cough medicine. Nighttime cough medicines typically contain an antihistamine that makes you feel sleepy, explains Russell. “Benadryl does a great job stopping allergies and postnasal drip with the side effect that it makes you sleepy,” says Russell, adding that it dries up the nose and helps stop the cough. But Benadryl may have some side effects for people over age 65, such as reducing stability in the middle of the night, he notes. Because of the risks of Benadryl and other over-the-counter cough medicines — some of which have not been proven to be more effective than placebos — Russell advises exploring natural remedies first, then using cough medicines with caution.

RELATED: Home Remedies to Stop a Bad Cough

When to See a Doctor About Your Cough

Acute or short-lived coughs — which often follow an upper respiratory tract infection such as the common cold — usually go away on their own without treatment, according to an article published in Thorax. But if your cough persists for more than a week, you should call your doctor, says Russell. If your cough is caused by an infection, your doctor may prescribe an antibiotic or antiviral medication, says the Cleveland Clinic.

A longer-lasting (chronic) cough could be the result of another health condition, such as allergies, gastroesophageal reflux disease (GERD), asthma, COPD (chronic obstructive pulmonary disease), or chronic sinusitis, according to the Mayo Clinic. Chronic bronchitis could also be the cause, according to the Cleveland Clinic, so make an appointment to see your doctor if your cough doesn’t get better.

Additional reporting by Jennifer D’Angelo Friedman.

What Is a Cough? Symptoms, Causes, Diagnosis, Treatment, and Prevention

How to Stop Coughing

A cough can be treated in a variety of ways, depending on the cause. For healthy adults, most cough remedies will involve self-care.

A cough that results from a virus can’t be treated with antibiotics. You can, however, soothe it with the following home remedies: (1)

• Keep hydrated by drinking plenty of fluids. Liquid helps thin the mucus in your throat, and warm liquids, such as broth, tea, or lemon juice, are soothing.
• Suck on cough drops or hard candies, which may ease a dry cough (one that doesn’t produce phlegm/mucus) and soothe an irritated throat.
• Have a spoonful of honey. One teaspoon of honey may help loosen a cough (never give honey to children younger than 1 year old because honey can contain bacteria harmful to infants).
• Use a cool mist humidifier or take a steamy shower to moisturize the air.

Other natural remedies include:

• Elevating your head with extra pillows when you’re sleeping
• Gargling warm salt water to remove mucus and soothe your throat

Medication Options

Cough medicines are typically used only for acute coughs that cause a lot of discomfort, interfere with sleep, and are not associated with any potentially more serious symptoms. (1)

Over-the-counter cough and cold medicines, like cough syrups and cough suppressants, may help you treat the symptoms of a cough. But research suggests that these medicines don’t work any better than placebos (inactive medicines). (1)

If your cough is caused by an infection, your doctor might prescribe an antibiotic or antiviral medication. (3)

If you have GERD, you may be prescribed a proton pump inhibitor, which is a kind of medicine that reduces the amount of stomach acid produced by glands in the lining of your stomach.

Learn More About Home Remedies for Coughs

Prevention of Coughs

Many coughs are caused by the common cold. To help reduce your risk of getting a cold, wash your hands often with soap and water for 20 seconds (use an alcohol-based hand sanitizer when soap and water are not available), avoid close contact with sick people, and try not to touch your face with unwashed hands, according to the Centers for Disease Control and Prevention (CDC). (7)

Home remedies like staying hydrated and moisturizing your bedroom with a humidifier can help you ease a cough if you already have one. Also avoid tobacco smoke, which can make your cough worse or may be the main cause of it.

RELATED: 10 Tips for Day and Night Cough Relief

Cough in Children – Children’s Health Issues

Cough. Symptoms for various diseases

Diagnosis and treatment of cough.Chinese National Leadership | partners

CSRD Asthma Research Working Group, China Association of Medical Workers

ICO: 10.3760 / cma.j.issn.0366-6999.2011.20.002

Correspondence: Dr. Lai Kefang, State Key Laboratory of Respiratory Diseases, First Clinical Hospital of Guangzhou Medical College, Guangzhou, Guangdong 510120, China (Email: klai @ 163.com)

Cough is a reflex defense reaction of the human body, aimed at removing secretions and harmful elements from the respiratory tract. However, frequent and severe coughing fits can interfere with the patient’s professional and daily activities. Cough is one of the most common symptoms in clinical practice and there are many reasons for it. Chronic cough can go unnoticed by the attending physician, especially if the chest x-ray does not reveal any pathological signs.In addition, in China, 70-80% of such patients are mistakenly diagnosed with bronchitis or chronic bronchitis, and then they are prescribed long, but ineffective, courses of antibiotics, or, due to the unclear diagnosis, they are sent for re-examination, which causes additional inconvenience and increases financial costs … ¹

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko. There are many different definitions of cough.So, the most popular is the definition developed by experts of the British Thoracic Society, who define cough as “a forced expiratory maneuver that usually occurs with closed vocal cords, which is accompanied by characteristic sounds.” Among the clinical definitions, it is worth highlighting the following: cough is a protective reflex act that plays an important role in the removal of sputum, foreign bodies (dust particles, smoke, etc.) from the respiratory tract [2-3]. In addition to the fact that cough is itself a common symptom that leads to seeking outpatient medical care [4], economic losses are also important, for example, according to estimates, in England the cost of treating acute cough is at least $ 979 million.pounds sterling annually, with 104 million spent by patients on the purchase of OTC drugs. In the United States, the annual cost of purchasing OTC drugs for the treatment of coughs and the elimination of cold symptoms reaches $ 3.6 billion [2-3, 5].

In recent years, there has been increasing concern about the primary symptom of cough, which has led to an interest in clinical studies examining the etiology, diagnosis and treatment of cough, with preliminary results obtained in China.To further standardize the diagnosis and treatment of acute and chronic cough, and to promote clinical and basic research in this area, the Chinese Society for the Treatment of Respiratory Diseases (CSRD) Asthma Working Group commissioned a panel of experts in 2005 to draft the first edition of the National Guidelines. China’s recommendations for the diagnosis and treatment of cough, which were based on evidence from international ^2.3 and local ^4.5 clinical studies on this topic.Since their first publication, these guidelines have become the most important guidelines for home clinical practice in this area, and since then many experts and other scientists have managed to supplement them with their valuable comments. To gather all these comments together and reflect the latest advances in cough research, the CSRD Asthma Research Working Group of the Chinese Society has released this version of the document. This revised edition is broadly structured as the 2005 recommendations, includes eight chapters, and continues to focus on chronic cough.Two new sections have been added to the program: subacute cough and empirical treatment of chronic cough. The diagnostic algorithm has also been revised to include the concept of an empirical approach to treatment, which will allow this guide to be adapted for use in community and rural hospitals.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: In our opinion, this is also important for the domestic practice of managing patients with cough, since subacute / post-infectious cough occupies a significant share in the structure of outpatient visits for medical care [2-3]….

CLASSIFICATION COUGH

Traditionally, cough has been classified according to its duration and excitation. Researchers distinguish three options: acute cough (lasting up to 3 weeks), subacute (lasting 3-8 weeks), and chronic, lasting more than 8 weeks. According to the excitation, the cough is divided into productive and unproductive (dry).

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: It is worth noting that productive cough is observed in diseases associated with inflammatory / infectious lesions of the respiratory tract, accompanied by hyperproduction of bronchial mucus [2-3].

Different types and forms of cough can indicate characteristic etiological factors. Chronic cough, for example, can be the result of a whole range of diseases and usually involves the development of two scenarios, depending on the indications of radiographic studies.In the first option, the presence of obvious pathological changes on the chest x-ray is often due to such underlying diseases as pneumonia, ⁶ tuberculosis ⁷ or lung cancer ⁸ . In the second version, radiographs with normal indicators, in which cough is the main or only symptom, represent the type of chronic cough on which attention will be focused in this version of the recommendations.

Comment d.MD, professor Zaitsev A.A.
Main Military Clinical Hospital named after N.N. Burdenko: In our opinion, it is worth classifying the cough also in terms of intensity, since this affects the need for antitussive therapy. In intensity, coughing, light and strong cough is distinguished. By the duration of the cough act: episodic short-term or paroxysmal and persistent cough [2-3].

ANAMNESIS, PATIENT EXAMINATION AND EXAMINATION

It is well known that a detailed history of the patient is of paramount importance in diagnosing the causes of cough. ⁹ Despite the only contrary statement in one study in 88 patients, ¹⁰ careful history and physical examination can reduce the range of differential diagnoses, which provides clues to the diagnosis of underlying diseases or even allows for an initial diagnosis and an empirical approach to treatment. An initial clinical assessment can also help guide the selection of further investigations and accelerate the identification of underlying diseases.

History

Particular attention should be paid to the duration of the cough, the time of onset, its frequency, nature, tone, character, predisposing or aggravating factors, the position of the patient’s body and other accompanying symptoms. An analysis of the volume, color, odor and consistency of the sputum being separated can be of great help in making the diagnosis.

The duration of the cough can help determine its category (acute, subacute, or chronic) and thereby narrow down the options for diagnosis.The timing of the onset of the cough is also an important indicator. For example, a post-exercise cough is most common in exercise asthma, a nocturnal cough is most commonly seen in cough asthma and heart disease, and a cough with profuse or purulent sputum can develop with respiratory tract infections. Exacerbation of chronic bronchitis (CB) usually occurs in winter and spring and is accompanied by the release of white mucous sputum. Bloody sputum or hemoptysis (hemoptysis) can be caused by tuberculosis, bronchiectasis, or lung cancer.

For patients with a clinical or family history of atopic or allergic disease, allergic rhinitis and asthma-induced cough are the most common suspicions. In addition, smoking and occupational exposure to dust or industrial chemicals are important contributors to chronic cough. Patients who previously suffered from gastric diseases are most susceptible to chronic cough associated with gastroesophageal reflux disease (GERD).Cough can also occur with chronic heart failure. Moreover, cough can develop during treatment of hypertension with angiotensin-converting enzyme (ACE) inhibitors.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: This section requires substantial additions. For example, paroxysmal “barking” cough (cough reprises – frequent, following one after another cough tremors) is characteristic of infection caused by Bordetella pertussis (whooping cough) [2-3].A rough, paroxysmal cough, aggravated during conversation, laughter, is characteristic of the syndrome of tracheobronchial dyskinesia (expiratory tracheal stenosis). A paroxysmal nocturnal cough is a common symptom of bronchial asthma, and an unproductive morning cough is characteristic of chronic bronchitis of a “smoker”. A cough that worsens while lying down may be a sign of a pathological process in the mediastinum (lymphadenopathy in sarcoidosis, lymphoproliferative or neoplastic process).On the contrary, disappearing in a horizontal position, the cough is possibly associated with pleural disease. No less important are the anamnestic indications of the relationship with the transferred / past infection, the beginning of taking medications (taking ACE inhibitors), staying in industrial areas (inhalation of air pollutants).

Medical examination

A thorough examination of all parts of the respiratory tract (nasal canal, pharynx, larynx, trachea and lungs) should be performed.Attention should be paid to the location of the trachea, the apparent enlargement of the jugular vein, the condition of the pharynx, larynx and nasal cavity, as well as breathing noises. When listening to the lungs, the nature and localization of the noises (wheezing, dry and / or wet wheezing) are determined. If wheezing is heard in the expiratory phase, then the diagnosis of bronchial asthma should be considered, while inspiratory wheezing may indicate central airway obstruction (lung cancer or bronchial tuberculosis). As for auscultation of the heart, it should be aimed at identifying signs of cardiomegaly and organic murmurs at the auscultation points of the valves.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: Auscultation of the lungs is an important element of the examination. The presence of dry wheezing rales indicates bronchial obstruction – damage to the lower respiratory tract (acute bronchitis, exacerbation of chronic bronchitis or bronchial asthma). Identification of a crepitus site is a typical sign of pneumonia [2-3]. Multiple foci of wet wheezing are observed in pulmonary edema or ARDS [6].Spilled inspiratory crepitus (“cellophane crackle”) is characteristic of interstitial lung diseases. Auscultation of the heart: it is possible to identify signs of cor pulmonale, such as the accent of the second tone over the pulmonary artery, characteristic murmurs in case of insufficiency of the pulmonary artery valve or tricuspid valve (it is worth noting that with damage to the tricuspid valve, pathological murmurs are often not heard, usually appear in terms with its significant destruction).

Surveys

Sputum induction, which is used primarily to obtain samples for cytological examination in the diagnosis of bronchogenic carcinoma, is now also used as the main method for assessing the presence of eosinophilia, which can lead to the development of eosinophilic bronchitis (EB) in patients without bronchial hyperreactivity.In China, the induced sputum test was first used to diagnose chronic cough at the beginning of this century and has now become one of the standard procedures performed at a number of medical centers throughout the country. Sputum induction is usually carried out by inhalation of a hypertonic solution through an ultrasonic nebulizer (the procedure is described in Appendix 1). ¹¹

Commentary of Doctor of Medical Sciences, Professor Zaitsev A.A.
Main Military Clinical Hospital named after N.N. Burdenko: Considering the poor tolerance of inhalations with hypertonic solution by patients, this method is practically not used in Russia today for the purpose of obtaining sputum for research. And in patients with suspicion of a specific process, sputum induction can serve as an additional factor in seeding the environment with Mycobacterium tuberculosis.
This section also requires substantial additions. For example, a general clinical examination of sputum is of great importance, which makes it possible to determine the presence of cellular elements (neutrophils, eosinophils, erythrocytes) and other specific indicators [2-3].The presence of eosinophils, Kurshman coils, Charcot-Leiden crystals in the sputum testifies in favor of bronchial asthma. A high content of neutrophils indicates an inflammatory process (for example, exacerbation of chronic bronchitis) and requires a decision on the appointment of antibiotic therapy, etc.

Visual diagnostics

It has been suggested that chest x-rays be included as part of the standard assessment procedure for every patient with chronic cough.If significant pathological changes are found, an additional thorough examination should be carried out in order to determine an accurate diagnosis. If there are no abnormalities on the radiograph, then the examination is continued according to the diagnostic algorithm, which is followed in the treatment of chronic cough (see Appendix IV: diagnostic algorithm for chronic cough). CT scan of the chest helps to identify lesions in the lungs and nodes in the anterior or posterior region of the mediastinum, as well as enlarged lymph nodes in the mediastinum.In addition, CT scans can be especially helpful in detecting lesions that are difficult to detect with x-rays and in identifying some of the least common causes of chronic cough, such as stones and foreign bodies in the bronchi. In addition, high-resolution CT (HRCT) can be used to diagnose interstitial pulmonary disease and atypical bronchiectasis at an early stage.

Pulmonary function tests

Pulmonary function tests and bronchodilation tests are effective methods for the differential diagnosis of obstructive airway diseases (ARDs) such as asthma, chronic obstructive pulmonary disease, and endobronchial tumors.The bronchoprovocation test (BPT) is the main method for detecting cough asthma (CFBA).

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: In Russia, the methacholine test (bronchoprovocation test) is not a routine technique and is performed only in large pulmonary centers.

Bronchoscopy

Bronchoscopy is used to assess endobronchial pathologies (eg, lung cancer, foreign bodies, and tuberculosis).

24-hour esophageal pH measurement

Daily monitoring of esophageal pH is most often used in the diagnosis of gastroesophageal reflux (GER), but in conditions of non-acid reflux, this method may not be as effective. The pH meter records the values ​​of six parameters, including the total number of refluxes with pH <4, the duration of the most prolonged reflux (in minutes), and the percentage of time during which the pH is <4. Then, based on these parameters, the GER severity index is calculated by DeMeester.Parallel recording of cough tremors in real time measures the likelihood of a symptomatic relationship (SAP) between reflux and cough, which provides insight into causality (see Appendix II). Non-acid reflux is diagnosed by measuring the intrinsic impedance or bilirubin content in the esophageal lumen.

Sensitivity of cough receptors

The assessment of the sensitivity of cough receptors is carried out in a provocative test, during which patients inhale aerosol particles of irritating agents that stimulate the receptors and thus cause a cough.The concentration of inhaled particles that can induce the cough reflex determines the cough threshold. The most commonly used cough-inducing agent is capsaicin (see Appendix III). Increased sensitivity is usually observed with allergic, post-infectious, or GERD-induced cough and cough of unknown etiology, and it is also noted in some patients with CVBA, EB, or SPND. ¹²

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: A test for assessing the sensitivity of cough receptors is extremely important in the management of patients with chronic cough! However, in the Russian Federation, this kind of research is carried out only in research centers (research work), and in routine practice, patients are not examined.

Other research

Determination of the content of eosinophils in the peripheral blood helps to identify background parasitic infections, atopic or allergic diseases.Also, when diagnosing allergic diseases and confirming reactions to possible allergens, an injection skin test and a test for specific immunoglobulin E (IgE) are performed.

DIAGNOSTICS AND TREATMENT OF ACUTE COUGH

The causes of an acute cough can be fairly obvious, with respiratory infections and acute tracheobronchitis being the most common.

ORI

Among the clinical manifestations of ARI, there are catarrhal symptoms such as a runny nose and / or nasal congestion with clear discharge, postnasal flow, sneezing, sore throat, or swallowing discomfort, which may be accompanied by fever.Cough with ARI, as a rule, occurs due to postnasal leakage.

The need for antibacterial drugs is usually absent, and symptomatic therapy is prescribed as the primary treatment. (1) Anticongestants: pseudoephedrine hydrochloride (30-60 mg three times a day), etc. (2) Antihistamines: first generation antihistamines, for example, chlorpheniramine maleate (2-4 mg three times a day), etc. (3 ) Antipyretic drugs: antipyretic and pain relievers.(4) Antitussives: Patients with severe cough are usually given central or peripheral antitussives.

The use of the above drugs in complex treatment is widespread in clinical practice. So, the most preferred option for relieving catarrhal symptoms (sneezing, nasal congestion, etc.) are first-generation antihistamines in combination with pseudoephedrine.

Comment d.MD, professor Zaitsev A.A.
Main Military Clinical Hospital named after N.N. Burdenko: Indeed, the most frequent clinical situation is seeking medical help from a patient with an acute cough, usually associated with the course of ARVI (cold, acute pharyngitis) [2-3, 5, 7]. In this situation, it is advisable to prescribe emollients, moisturizers, drinking plenty of warm solutions, alkaline inhalations [7]. The appointment of mucoactive drugs is usually not required. The use of mucolytics can be reserved in a patient with ARVI with complaints of productive cough (this situation is often observed in smokers).Prescription of cough suppressants of central or peripheral action can be justified only in case of severe hacking cough, which disrupts the patient’s sleep and daytime activity! In a patient with suspected influenza infection, the use of antitussives is not recommended! The simultaneous administration of antitussive and mucoactive drugs is unacceptable.

Acute tracheal bronchitis

Description

Acute tracheal bronchitis is an inflammation of the mucous membrane of the trachea and bronchi, the occurrence of which can be triggered by both biological and non-biological factors.Most often, acute tracheal bronchitis is caused by viruses, which can subsequently lead to the development of secondary bacterial infections. Cold air, exposure to aerosol particles, irritating or toxic gases also contribute to the development of this disease.

Clinical picture

In the initial stage, patients usually have an upper respiratory tract infection. Soon, the cough may gradually intensify and be accompanied by sputum production.With the development of bacterial superinfection, the patient usually has purulent sputum. Acute tracheal bronchitis in most cases is a self-limited disease in which general symptoms usually disappear after a few days, but cough and sputum production may persist for another 2-3 weeks. On the roentgenogram, no obvious abnormalities are usually found, or there is only an increase in the pulmonary pattern. During auscultation, bronchial respiration and moist rales are noted.

Diagnostics

Diagnostics is carried out mainly on the basis of existing clinical manifestations, taking into account differential diagnoses, including influenza, pneumonia, tuberculosis, whooping cough (convulsive cough) and acute tonsillitis.

Treatment

Symptomatic therapy is central to the management of this disease. In patients with severe dry cough, the use of antitussive drugs is allowed. To improve the discharge of sputum in cases of violation of its secretion, expectorants can be used.For patients with bacterial infections, as evidenced by the presence of purulent sputum and an increase in the number of lymphocytes in the peripheral blood, it is preferable to treat with antibacterial drugs, which should be selected taking into account the pathogen (s) of infection detected during microbiological examination and its (their) sensitivity to medicines. Until the presence of pathogens is confirmed, it is possible to empirically prescribe oral antibacterial drugs (macrolides and beta-lactam antibiotics) based only on clinical signs.In addition, anti-asthma therapy is recommended in patients with bronchospasm.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: Acute bronchitis is a disease mainly of viral etiology and the use of antimicrobial drugs in the regimens of starting therapy for acute bronchitis is erroneous [8]. In order to differentiate viral and bacterial infections, it is advisable to widely introduce into routine practice the determination of the level of C-reactive protein in the blood, which allows the doctor to make the right decision about the need for antimicrobial or antiviral therapy [9].In the case of a viral infection, this figure is less than 20 mg / l. Taking into account the viral etiology of OB, according to indications, neurominidase inhibitors, interferons and their inducers are used [10]. Since the main clinical symptom of OB is productive cough, it is obvious that the main drugs indicated for the treatment of this disease are mucoactive agents [2-3, 8]. The use of bronchodilators (salbutamol, fenoterol) is justified in patients with OB with clinically expressed bronchial obstruction, persistent cough and signs of bronchial hyperreactivity [8].

DIAGNOSTICS AND TREATMENT OF SUBACUTE COUGH

Very often, a subacute cough develops from a post-infectious cough, accompanied by upper respiratory tract inflammation syndrome (URTI) and CVBA. ¹³ Therefore, the treatment of subacute cough must necessarily begin with the identification of previous respiratory infections and empirical therapy. If such primary therapy is ineffective, then other causes of its occurrence should be considered and treatment should be continued in accordance with the diagnostic algorithm to determine the etiology of chronic cough.

The cough may not stop and progress even after the acute symptoms of the respiratory infection have resolved. In addition to the most common respiratory viruses, other pathogenic microorganisms should be considered, such as mycoplasma, chlamydia and bacteria, ¹⁴ , since they can also provoke the development of post-infectious cough. The most common cause of this cough is an acute respiratory infection, which is why it is also called postinfluenza cough.It usually presents as a dry, irritating cough or with a small amount of mucous phlegm, lasts about 3-8 weeks and gives normal readings on a chest x-ray.

Post-infectious cough does not require special treatment, in most cases the symptoms go away on their own. In general, the use of antibiotics is not necessary, but for post-infectious cough caused by the pathogens of Mycoplasma pneumoniae, Chlamydia pneumoniae and Pertussis bacillus, treatment with macrolides ¹⁵ will be most effective.Symptomatic patients may be given short courses of antitussives, antihistamines, and anticongestants. For some patients, ipratropium bromide may also be effective.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: The cause of subacute (“post-infectious”) cough lasting from 3 to 8 weeks is bronchial hypereactivity [2-3]. According to a number of authors and underestimated in clinical practice, the cause of subacute cough in adults may also be the course of infection caused by Bordetella pertussis (whooping cough).During the examination, it is not possible to identify signs of lung damage, the FVD indicators are within the proper values. In this regard, treatment is prescribed on the basis of clinical and anamnestic data. Recommended treatments include inhalation of ipratropium bromide, antitussives (regalin, dextromethorphan, codeine-containing drugs), antitussive absorbable tablets, and corticosteroids. In case of indications of active infection with Bordetella pertussis or Bordetella parapertussis, as well as M.pneumoniae, C. pneumoniae, antibacterial therapy with macrolides (azithromycin, clarithromycin) is prescribed.

CAUSES, DIAGNOSTICS AND TREATMENT OF CHRONIC COUGH

The most common causes of chronic cough, accounting for 70 to 95% of all cases of respiratory disease in clinical practice, are CVBA, ARLD (formerly called postnasal drip syndrome (PBS)), EB, and cough associated with GERD. ^4.16-19 In addition, there are other, less common diseases, but including many pathologies localized both within and outside the respiratory system, for example, chronic bronchitis, bronchial tuberculosis, ²⁰ cervical spondylosis, ²¹ ectopic salivary gland ²² and arrhythmia. ²³ Since most chronic coughs are not associated with infection, antibiotic treatment is not required. In case of ambiguous etiology or inability to exclude the presence of infection, great caution should be exercised when prescribing oral and intravenous corticosteroids or avoiding their use altogether.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: Chronic (more than 8 weeks) productive cough can be observed with postnasal drip syndrome, BA, COPD, bronchiectasis, neoplasms of the respiratory tract and lungs, etc.[2-3, 11]. An unproductive chronic cough is often observed in patients with diseases of the gastrointestinal tract (gastroesophageal reflux disease – GERD, hiatal hernia), diseases of the cardiovascular system (congestive heart failure). Often, a cough is associated with taking medications (angiotensin-converting enzyme inhibitors, amiodarone, inhaled drugs). Chronic cough is an indication for an in-depth examination of the patient with the use of radiation, laboratory, instrumental diagnostic methods.And only after the diagnosis! the issue of prescribing appropriate pharmacotherapy is being considered. Cough treatment, first of all, should be etiotropic, i.e. aimed at eliminating the cause of the cough. For example, effective therapy for exacerbation of COPD / chronic bronchitis, compensation for heart failure, withdrawal of drugs that provoke cough, elimination of contact with an allergen.

Upper Airway Inflammation Syndrome (URTI) / Postnasal Flow Syndrome (Nasal Flow Syndrome)

Description

Postnasal leakage syndrome or postnasal syndrome is an inflammatory process, accompanied mainly by a cough, which leads to drainage of the mucous discharge along the back wall of the nasopharynx against the background of any disease of the nasal cavity, which directly or indirectly provokes stimulation of cough receptors.

With regard to coughing against the background of diseases of the upper respiratory tract, one question remains unresolved: do these diseases cause a cough reflex through the common final pathway, as postnasal syndrome (NNS), or in some cases they provoke irritation or inflammation of the upper respiratory tract, which directly stimulates cough receptors and activates the cough reflex, regardless of or in combination with concomitant SPNZ. In 2006, the American Committee for the Development of Recommendations for the Treatment of Coughs decided that the thromine SPNZ should be replaced by the ATPC in order to avoid future confusion in the diagnosis of this type of cough until more information on this issue is available.

ATS is one of the most common causes of chronic cough. In addition to rhinitis and sinusitis, this syndrome can provoke diseases that affect the larynx and pharynx, including allergic and non-allergic pharyngitis, laryngitis, neoplasms of the pharynx and larynx, chronic tonsillitis. ²⁴

Clinical picture

(1) Main symptoms. In addition to coughing and sputum production, patients also present with the following symptoms: nasal congestion, large amounts of mucus, perspiration, frequent coughing, accumulation of phlegm on the back of the throat, and postnasal drip.The main symptoms of allergic rhinitis are itchy nose, sneezing, heavy nasal discharge, and itchy eyes. Rhinosinusitis is characterized by mucopurulent and purulent nasal discharge, deterioration of smell, as well as facial, toothache and headache.

Allergic pharyngitis is mainly characterized by a sore throat and a paroxysmal cough. The main manifestations of non-allergic pharyngitis are sore throat and a burning sensation or foreign body sensation in the throat.Inflammation and growths in the larynx usually cause hoarseness, dysphonia, or loss of voice.

(2) Signs. In allergic rhinitis, the nasal mucosa is usually pale and edematous. Liquid serous discharge or thicker mucus may be present within the nasal canal or at the base of the nasal cavity. With non-allergic rhinitis, the nasal mucosa looks thickened and hyperemic, and in some patients, the surface of the oropharyngeal mucosa becomes uneven, like a “cobblestone”, there are viscous purulent discharge that accumulates on the back of the pharynx.

(3) Inspection. On imaging, features of chronic sinusitis include thickening of the mucous membrane and increased fluid levels in the paranasal sinuses. Patients with seasonal coughs or coughs caused by exposure to specific allergens (pollen or dust) should undergo allergy tests to confirm the diagnosis.

Diagnostics

VVDP / SPNZ can be the result of many major diseases affecting the nasal cavity, paranasal sinuses, pharynx and larynx.Because of this, the survey results include a huge range of different signs and symptoms, many of which are non-specific and uninformative. Therefore, there are significant difficulties in making an accurate diagnosis based only on anamnesis data and examination results. Once a differential diagnosis is advanced, appropriate treatment should be initiated to address the underlying disease, and if a positive response is achieved, this additional information may aid in establishing the correct diagnosis.In addition, the presence of lower respiratory tract disease or GER should not be ruled out.

Treatment

Treatment should be based on the elimination of the underlying disease provoking ATS / PTSD. In patients with non-allergic rhinitis and ARI, first-line therapy should necessarily include first-generation antihistamines and anti-congestants. In most patients, a clinical response is achieved within a few days to two weeks after starting treatment.

With allergic rhinitis, patients are first prescribed intranasal glucocorticosteroids and antihistamines for oral administration. Beclomethasone (50 g) or other inhaled glucocorticosteroids (GCS) in an equivalent dose (budesonide or mometasone) should be taken once or twice a day. For allergic rhinitis, various antihistamines are extremely effective. Consideration should be given to the use of 2nd generation (non-sedating) antihistamines, such as loratadine, as the first treatment.Eliminating or reducing the effects of specific allergens on the body can help alleviate the symptoms of allergic rhinitis. Leukotriene receptor antagonists, as well as short-term anticongestants for nasal and oral administration, can be included in the treatment regimen, if necessary. Patients with severe symptoms that do not respond to standard treatment may benefit from allergen immunotherapy, but it may take a long time for clinical improvement to occur.

For bacterial sinusitis, antimicrobials should be given. The choice of antibiotics should take into account their ability to target gram-positive, gram-negative and anaerobic bacteria. It is assumed that antimicrobial therapy for acute bacterial sinusitis should last 2 weeks, and even longer for chronic bacterial sinusitis, depending on the patient’s clinical condition. The most commonly used drugs are amoxicillin / clavulanic acid, cephalosporins, or quinolones.It has been proven that long-term use of macrolides in small doses provides a therapeutic effect in chronic sinusitis. In combination with inhaled corticosteroids for nasal use, the duration of the treatment period can be more than 3 months. Anticongestants help to reduce congestion and swelling of the nasal mucosa and remove secretions. The duration of use of intranasal sprays is usually <1 week. Combined therapy with 1st generation antihistamines and anticongestants is recommended for 2-3 weeks.If the patient does not have a response to these drugs, you should consult a specialist, as endoscopic sinus surgery may be required.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: Postnasal drip syndrome is not an independent nosological form. The most common causes leading to postnasal drip are given in table.1.

Table 1. The most common causes of postnasal drip [2]

The assumption that the cough is due to postnasal flow syndrome is usually not difficult, since with active questioning, the patient describes a characteristic sensation of secretion on the back of the pharynx (symptoms intensify in the morning, patients wake up with discomfort in the throat).Cough in “postnasal flow syndrome” is characterized by patients as unproductive, but this statement is based on the release of several mucous clots to the patient, usually in the morning against the background of a prolonged, painful (sometimes up to vomiting) cough. After the release of lumps of mucus, the cough subsides. When examining the pharynx, you can see the mucous cords stretching from the nasopharynx behind the soft palate.
Treatment of the underlying disease is the key to stopping the manifestations of postnasal flow syndrome! In the case of rhinitis of a non-allergic nature, antihistamines of the 1st generation and anti-congestants are used in the therapy of “postnasal drip” – tab.2.
Table 2. Decongestants [2, 5, 7]

– belong to the group of potent drugs, excluded from the list of non-prescription drugs
The main methods of drug treatment for postnasal drip syndrome in patients with allergic rhinitis are the use of antihistamines and intranasal corticosteroids.It is preferable to use drugs of the second (cetirizine, loratadine) and third (desloratadine, fexofenadine, levocetirizine) generations – tab. 3.
Table 3. Classification of antihistamines [2]

A common mistake in the treatment of postnasal leakage syndrome is the prolonged use of vasoconstrictor drops to facilitate nasal breathing, which often leads to the development of rhinitis medicamentosa.

Cough form of bronchial asthma

CFBA is the most common cause of chronic cough in China, accounting for 14-28% of all cases.

Description

Cough asthma is a type of asthma in which cough is the only or main clinical symptom. ²⁵ In CFBA, there are usually no symptoms such as wheezing or shortness of breath, but airway hyperresponsiveness (AHR) is observed.

Clinical picture

CFBA is predominantly expressed in severe attacks of dry cough, beginning mainly at night, and occurs or worsens with respiratory tract infections, when inhaling cold air, dust or vapors.

Diagnostics

Basically, CFBA is diagnosed by the observed set of clinical manifestations, lack of response to standard therapy against an infectious disease and antimicrobial treatment, positive response to RPT or bronchodilation test, as well as a significant decrease in cough against the background of anti-asthma therapy.

Diagnostic criteria: (1) chronic cough, usually irritating cough at night, (2) positive BPT, or variability in daily peak expiratory flow values> 20%, or positive bronchodilatory response, (3) efficacy of anti-asthma therapy.

Treatment

For cough asthma, the same treatment principles should be applied as for “classic” asthma. Most patients will be effectively treated with low doses of inhaled corticosteroids (ICS) in combination with bronchodilators (β ₂ -adrenomimetics or aminophylline) or combined preparations of ICS and bronchodilators (for example, budesonide / formoterol or fluticasone / salmeterol), ²⁶ if necessary, short-term use of small doses of glucocorticosteroids for oral administration.The duration of treatment should be at least eight weeks. It was also reported that leukotriene receptor antagonists play an active role in the treatment of CFBA, ²⁷ , but their effect remains unconfirmed due to insufficient sample size.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: The cough variant of bronchial asthma is one of the most common causes of chronic cough.The basis for the diagnosis of this disease is bronchial hyperreactivity, detected in bronchoprovocation tests. Cough with this variant of bronchial asthma may be its only manifestation, and a decrease in cough against the background of anti-asthma therapy confirms the diagnosis. The basis of therapy is the use of ICS (ICS / LABA). In recent years, there is evidence that leukotriene receptor antagonists are showing good effect in the treatment of this disease!

Eosinophilic bronchitis (EB)

Several studies have shown that eosinophilic bronchitis is a common cause of chronic cough (15-22% of cases in China). ^18.19,28.29

Description

Eosinophilic bronchitis is a type of non-asthmatic EB in which there is eosinophilic infiltration of the airways, a negative response when testing AHR, a good response to glucocorticosteroid treatment, and the main symptom of which is cough.

Clinical picture

The main and often the only clinical symptom of EB is a chronic irritating cough, unproductive or unproductive (with separation of white mucous sputum), which occurs during the day or night.Some people may be extremely sensitive to cooking oil vapors, dust, odors, and cold air as they trigger a cough. At the same time, the indicators of lung function and the variability of the peak expiratory flow rate in patients are normal, and there is no GRDP.

Diagnostics

EB does not have any specific clinical signs and in some patients is characterized by the same symptoms as CFBA. Physical examination usually does not reveal any peculiarities.The diagnosis of EB is primarily based on differential cell counts in induced sputum (detailed in Appendix II). Diagnostic criteria: (1) chronic cough: dry, irritating cough or cough with a small amount of mucous phlegm; (2) normal readings on radiography; (3) normal indicators of lung function and variability of peak expiratory flow rate, absence of AHR; (4) eosinophil content in induced sputum ≥2.5%; (5) absence of other eosinophilic diseases; (6) response to oral and inhaled forms of glucocorticosteroids.

Treatment

In the treatment of EB, glucocorticosteroid therapy has a beneficial effect, contributing to a rapid decrease in the severity of cough and its elimination. ICS is also often used, for example, beclomethasone dipropionate 250-500 mcg or its equivalents, twice a day for at least 4 weeks. In addition to the initial treatment, in patients with severe cough and a high content of eosinophils in the sputum, prednisolone is prescribed orally at a dose of 10-20 mg per day for 3-5 days.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: This process – eosinophilic bronchitis is an infrequent disease that appears in outpatient or inpatient records of patients in the Russian Federation. It is obvious that its diagnosis is based on the detection of eosinophils in sputum in the absence of signs of DP hypereractivity [2-3]. The cough in this situation is well controlled by the appointment of ICS.

Cough associated with gastroesophageal reflux disease (GERD)

In China, cough associated with GERD accounts for only 12% –14% of all chronic coughs. ^4.19 Despite a lower incidence compared to Western countries, this type of cough is most often ignored by Chinese doctors. Among the mechanisms underlying the pathogenesis of cough in GERD, one can distinguish microaspiration, stimulation of the esophagotracheobronchial reflex, dysfunction of esophageal motility, autonomic dysfunction, and neurogenic inflammation of the airways. Currently, it is believed that neurogenic inflammation of the airways, caused by the esophagotracheobronchial reflex, is of leading importance in the development of cough against the background of GERD.In a small number of patients, a cough associated with GERD can also be caused by the flow of bile into the esophagus.

Description

Cough against the background of GERD is a type of GERD in which the main or only symptom is a cough that occurs when stomach acid or other gastric contents are thrown into the esophagus.

Clinical picture

Some patients with a cough associated with GERD may have typical reflux symptoms, including heartburn (a burning sensation in the chest region), acid reflux into the esophagus, and belching, but most patients only complain of a cough.Coughing attacks begin mainly in the daytime with an upright position of the patient’s body, are unproductive or unproductive (with a small amount of white mucous sputum) in nature and occur or intensify when eating acidic or fatty foods.

Diagnostic criteria

(1) Chronic cough that occurs mainly during the day, (2) generalized DeMeester indicator based on 24-hour monitoring of pH in the esophagus ≥12.70 and / or SAP ≥75%, (3) Reduction or disappearance of cough against the background of appropriate drug treatment.It should be noted that sometimes the results of pH monitoring can be within normal limits in the case of non-acid reflux, therefore it is recommended to perform resistance testing in the esophagus or monitor bile reflux to clarify the diagnosis.

A low baseline Demeester index (<12.70) with daily monitoring of pH in the esophagus is observed in healthy individuals. ³⁰ Anti-reflux therapy is effective in some patients with normal Demeester and high SAP.In cases where monitoring of pH in the esophagus is not available or costly, it is recommended to diagnose based on the results of empirical treatment in patients with the following symptoms: (1) cough that occurs during or after meals, (2) typical reflux symptoms (heartburn or belching) , (3) exclusion of diagnoses of CFBA, AHVDP and EB or poor response to treatment for these diseases. Standard treatment with proton pump blockers, such as omeprazole 20 mg twice daily, should be continued for at least eight weeks.The diagnosis of GERD is confirmed if the cough disappears or decreases significantly with anti-reflux therapy.

Treatment

(1) Lifestyle changes: overweight people are advised to normalize body weight, adhere to a proper diet, avoid late snacks, exclude sour and fatty foods, coffee, and quit smoking from the diet. (2) Antacid drug therapy: often prescribed proton pump blockers (omeprazole, lansoprazole, rabeprazole, and esomeprazole) or H ₂ blockers (ranitidine or other drugs of the same class).Proton pump blockers have been shown to be more effective. (3) Drugs that accelerate peristalsis: patients with delayed evacuation of gastric contents should be given domperidone. The use of drugs that accelerate peristalsis helps to improve the outcome among patients for whom antacid monotherapy has proved ineffective. Medical treatment should last at least three months, as the healing effects usually begin to appear only from 2-4 weeks. In the absence of a positive response to complex treatment with the above drugs, one should make sure that the choice of dose and duration of therapy is adequate and the possibility of the presence of other etiological factors should be considered.If necessary, appropriate specialists should be involved in the work to select the correct treatment regimen. In a small cohort, patients with severe reflux who have failed conservative treatment may benefit from anti-reflux surgery. Before carrying out it, it is necessary to perform a thorough assessment of all indications, since there is a risk of postoperative complications and relapses.

Commentary of Doctor of Medical Sciences, Professor Zaitsev A.A.
Main Military Clinical Hospital named after N.N. Burdenko: Gastroesophageal reflux is one of the leading causes of chronic cough. There are two forms of gastroesophageal reflux: physiological, which does not cause the development of esophagitis, and pathological, accompanied by damage to the esophageal mucosa with the development of reflux esophagitis and GERD [2-3].
The mechanism of coughing in this case is a vagus-mediated esophageal tracheobronchial reflex.
The diagnosis is confirmed by fibrogastroscopy, and the most sensitive and specific test is a 24-hour esophageal pH meter.In this case, it is important to assess the duration, frequency of reflux episodes, and to establish a relationship with cough episodes. If the pH metry confirms gastroesophageal reflux as the cause of chronic cough, proton pump blockers (omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole), prokinetics (itoprid, domperidone) are considered as therapy. GERD therapy can also include antacids and alginates. Duration of treatment is at least 2 months.
If a 24-hour pH meter is not available at a hospital, empiric antireflux therapy is prescribed.It should be noted that if the disappearance of cough against the background of antireflux therapy reliably testifies in favor of GERD, then the insufficient effect of treatment does not exclude this diagnosis. In such cases, a more thorough examination and selection of adequate therapy by a gastroenterologist are necessary. The possibility of the existence of several causes of cough in a particular patient with verified GERD and insufficient effect of antireflux therapy should also not be ruled out.
Along with drug treatment, a patient with symptoms of GERD should be given a number of simple lifestyle and dietary changes that may be accompanied by a decrease in the severity of cough.These recommendations include avoiding smoking and drinking alcohol, overeating, normalizing body weight, adhering to a diet (the last meal 3-4 hours before bedtime, eating and drinking in small portions), limiting the consumption of fats, carbonated drinks, coffee, chocolate , mint, limiting physical activity and bending of the trunk, especially after eating, sleeping with the head end of the bed raised (by 15-20 cm), not wearing clothes and underwear that tighten the stomach

DIAGNOSTICS AND TREATMENT OF CHRONIC COUGH IN THE BACKGROUND OF OTHER DISEASES

Allergic cough

Description

In a clinical setting, some patients with chronic cough may show signs of allergy, respond well to treatment with antihistamines and glucocorticosteroids, but show no signs of asthma, allergic rhinitis, or EB.This type of cough is called allergic. In Chinese practice, the definition of allergic cough differs from that in Japanese ³¹ in two aspects: (1) an increased content of eosinophils in induced sputum obtained with appropriate testing is not taken into account in the diagnosis of allergic cough, but serves as a sign of another disease (EB), ( 2) patients with allergic cough do not necessarily have signs of hypersensitivity of cough receptors. In Western countries, allergic cough is not considered an etiological diagnosis.Instead, a “quiet” postnasal syndrome is distinguished, characterized by a chronic cough without symptoms of rhinitis or sinusitis, but with sensitivity to antihistamine therapy. At the same time, according to one national study, allergy was found to be the most common cause of cough in China, although the pathogenesis of this condition and its relationship with allergic pharyngolaryngitis, UHRP and post-infectious cough have not yet been fully understood. ¹⁹

Clinical picture

An allergic cough manifests itself as a paroxysmal, dry, irritating cough that does not change during the day. It easily occurs when exposed to vapors of edible vegetable oil, dust, cold air, as well as when talking, and is accompanied by a sore throat. In this condition, spirometry and the study of induced sputum are usually indicated.

Diagnostic criteria

There are currently no clear diagnostic criteria for allergic cough.Therefore, when diagnosing, it is recommended to pay attention to the following signs: (1) An allergic cough is often characterized as dry and irritating. (2) Typical test results are normal lung function and no AHR. (3) In addition, the following features may also be present; (a) a history of allergies or occupational exposure to allergens, dust, or chemicals (b) a positive injection skin test, (c) an increased level of total or specific IgE in serum, (d) an increased sensitivity of cough receptors.(4) The cough subsides with treatment with antihistamines and / or glucocorticosteroids.

Treatment

In patients with allergic cough, antihistamines give a positive result, if necessary, used in combination with inhaled glucocorticosteroids or a short course (3-5 days) of oral glucocorticosteroids.

Chronic bronchitis

The main symptom of chronic bronchitis is a productive cough that lasts a total of at least three months per year for two consecutive years, while other possible causes of chronic cough must be excluded.Coughs and mucus (frothy or thick) are usually more intense in the morning, but can also occur at night during an exacerbation.

Although chronic bronchitis has been found to be a common disease in out-of-hospital epidemiological studies, only a small proportion of patients with cough are diagnosed with this disorder in respiratory clinics. ^16.19 Unfortunately, the lack of objective criteria for the diagnosis of chronic bronchitis leads to a different diagnosis in a number of patients with chronic cough.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: Among the population of Russia, the incidence of chronic bronchitis, calculated on the number of patients seeking medical care, is 10-20%. However, it is obvious that the true prevalence of the disease is much higher. With regard to chronic obstructive pulmonary disease (COPD), it is known that at present it is a global problem, since the number of patients reaches 15% of the adult population of developed countries, and the annual death toll is more than 3 million people [12-13].Within the framework of the cited recommendations, no data on the prevalence of cough in COPD are provided and, in our opinion, this fact is a significant omission. Moreover, a productive cough is the most important risk factor for exacerbations of the disease [14]. In the case of chronic bronchitis, mucoactive drugs, rational antibiotic therapy during an exacerbation of the disease are of primary importance [13]. In COPD, the standard of treatment is the prescription of long-acting bronchodilators and their combinations [12].ICS are prescribed if indicated (frequent exacerbations observed against the background of double bronchodilatory therapy, the number of eosinophils is more than 300 in 1 μl), as well as mucoactive drugs in patients with frequent exacerbations and productive cough.

Bronchiectasis

Bronchiectasis is an irreversible local expansion of parts of the bronchial tree with deformation of the lumen of the airways and disruption of the structure of their walls under the influence of chronic inflammation.Most often, bronchiectasis occurs at the level of the second-order bronchi. Among its clinical manifestations, a cough with purulent sputum and hemoptysis are distinguished. In patients with a history of characteristic signs, it is usually easy to diagnose this disorder, but it can just as easily be overlooked in the case of mild bronchiectasis or the presence of atypical manifestations.

When in doubt, the cellular structure of the pulmonary pattern on chest x-ray helps in the diagnosis of this disease.However, in patients with suspected bronchiectasis, chest HRCT remains the preferred diagnostic method.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: In recent years, significant attention has been paid to bronchiectasis. Treatment of bronchiectasis is not an easy task, as the efficacy of many drugs, including mucolytics, has not been convincingly proven in randomized controlled trials.It is important to use various methods of treatment to improve sputum discharge, antibacterial therapy aimed at eradication of P. aeruginosa, rational antibiotic therapy during exacerbations of the disease [15].

Bronchial tuberculosis

In China, bronchial tuberculosis is a common cause of chronic cough, although its prevalence remains unknown. While pulmonary tuberculosis is found in many patients, some patients only have simple bronchial tuberculosis, characterized by a chronic cough that is either the only symptom or is accompanied by a slight fever, night sweats, and weight loss.Sometimes inspiratory wheezing can be detected with auscultation, but in very rare cases. There are often no visible changes on chest radiographs, which leads to an erroneous diagnosis or omission of this diagnosis in clinical practice. ²⁰

Patients at high risk of bronchial tuberculosis should be referred for sputum examination, which may indicate the presence of acid-fasting mycobacteria or Mycobacterium tuberculosis.Too few specific changes are found on chest x-rays. Among the nonspecific pathological changes, one can distinguish a thickening of the walls of the bronchi, as well as a narrowing or blockage of the lumen. High-resolution CT scans are more sensitive than x-rays for detecting signs of lesions. For example, the detection of third-order bronchial damage during CT scanning allows indirect confirmation of the presence of bronchial tuberculosis.Bronchoscopy is also a useful method for diagnosing bronchial tuberculosis, as it involves biopsy and scraping of the bronchi to obtain samples that may be positive on microscopic examination.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: In our country with a high incidence of tuberculosis, when changes in the lungs are detected by X-ray / CT, this process requires an obligatory exclusion [16].The basis for the diagnosis of tuberculosis is the detection of acid-fast mycobacteria by light / luminescence microscopy in sputum smears (material obtained by fiberoptic bronchoscopy) stained according to Ziehl-Neelson. In this case, at least 3 sputum samples should be examined within 3 consecutive days and at least 100 visual fields should be viewed. The polymerase chain reaction allows you to identify the specific DNA of mycobacteria. Tuberculin diagnostics is of some importance – the absence of a reaction testifies in favor of non-tuberculous lung lesions.On the contrary, a hyperergic reaction (papule size 21 mm or more) suggests infection with mycobacteria.

Cough while taking ACE inhibitors

Cough is the most common side effect, occurring in about 10-30% of people taking ACE inhibitors (a class of drugs used primarily to treat high blood pressure). Cough while taking an ACE inhibitor is 1-3% of all cases of chronic cough. The diagnosis is confirmed if, after the withdrawal of the ACE inhibitor, the cough stops, but in some cases it can last up to four weeks.As a replacement, it is possible to prescribe angiotensin II receptor antagonists if the cough was triggered by taking an ACE inhibitor.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: Chronic cough is a well-known side effect of angiotensin-converting enzyme inhibitors. According to known data, the incidence of cough against the background of the use of ACE inhibitors reaches 5-35%. Interestingly, cough develops more often in patients receiving ACE inhibitors for acute heart failure than in patients taking the same drugs for hypertension [2-3].A cough can appear at any time, both a few hours after taking the first dose of the drug, and after a few weeks or months. The only successful treatment for cough associated with taking an ACE inhibitor is to stop taking the drug. As a rule, the cough stops within a week after the cessation of therapy, less often it takes a longer time to stop it. The tactics of managing a patient with a prolonged cough of unknown etiology, but taking an ACE inhibitor, should include the cancellation of the latter.After completing the diagnostic search and establishing an alternative cause of the cough, it is possible to return to taking the drug.

Bronchogenic carcinoma

At an early stage, brochogenic carcinoma gives only mild and atypical symptoms that do not always allow one to immediately identify the disease. Cough is an early symptom of lung cancer with central localization, but at this stage, chest X-ray may not detect changes, which leads to a misdiagnosis or a false negative result.Consequently, lung cancer as a differential diagnosis should be considered primarily in patients who are heavy smokers who have a dry cough with bloody sputum, chest pain, unexplained weight loss or changes in the nature of the previous cough. In these cases, X-ray examinations and bronchoscopy are indicated.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: In the case of chronic cough, it is mandatory to perform an X-ray examination and, if there are changes, a CT scan! In smokers over the age of 40, the CT-based algorithm is of fundamental importance. In the presence of changes on CT, indicating a neoplastic process, it is recommended to plan a fibrobronchoscopy.

Psychogenic cough

A psychogenic cough, also called habitual cough, indicates a serious mental disorder or deliberate coughing.Psychogenic cough is quite common among children and accounts for 3-10% of coughs lasting more than one month. Usually, coughing occurs during the daytime, is often accompanied by anxiety, and disappears when attention is switched or during sleep.

This diagnosis is considered last, only when all other possible causes of cough have been ruled out. For children, suggestion therapy is the main method. ³² A short course of antitussive drugs is prescribed as adjunctive therapy.In older children, psychological counseling, psychotherapy and adequate prescription of anxiolytic drugs will be effective. Tourette’s syndrome may be a potential differential diagnosis in children with psychogenic cough.

Commentary of Doctor of Medical Sciences, Professor A.A. Zaitsev
Main Military Clinical Hospital named after N.N. Burdenko: Psychogenic cough is mainly typical for children and adolescents. Complaints of a patient with psychogenic cough are extremely diverse: persistent cough, dryness, burning, tickling, sore mouth, numbness, tightness in the throat [2-3].A neurotic cough is often dry, hoarse, monotonous, sometimes loud, barking. It can be provoked by pungent odors, a quick change in the weather, affective tension, a cough sometimes arises under the influence of anxious thoughts, stress. If other reasons are excluded and a psychogenic genesis of cough is suspected, a psychiatrist’s consultation is necessary, and the treatment consists of the recommendations of this specialist (sedatives, etc.) and, if necessary, the appointment of short courses of antitussive drugs.

Other rare diseases

Other rare conditions that provoke chronic cough may include interstitial lung disease, foreign bodies, pulmonary or bronchial microlithiasis, osteochondroplastic tracheobronchopathy, mediastinal tumors, left ventricular dysfunction, cervical spondylosis, ²¹ ectopic salivary gland ²³

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Causes of cough in children – Clinic “Seven Doctors”

Autumn has come. Perhaps the most common reason parents go to a pediatrician at this time of year is a child’s cough. Let’s take a look at what a cough is and what to do if your child is coughing. The cough is a reflex.

How a cough appears

Information from the “cough” receptors goes to the vagus nerve, from it to the medulla oblongata, then to the efferent fibers and muscles, and the person coughs.
“Cough” receptors are located in the oropharynx, in the large bronchi, in the lower third of the esophagus and even in the external auditory canal. Hence, by the way, there may be a cough with a sulfur plug in the ear.
Important! There are no receptors in the small bronchi, therefore, if the small bronchi or alveoli are affected, there will be no coughing, but there will be, for example, shortness of breath. The strength of the cough depends on the strength of muscle contraction! Therefore, in children with a pronounced long-term lack of vitamin D (with rickets) or in healthy children of the first year of life, the cough will be mild.

There are many types of cough:

• due to the occurrence of
• in rhythm
• in timbre, for example, a short, careful cough, with a painful grimace on the face is characteristic of pneumonia (pneumonia)
• by the time of occurrence, for example , morning cough is characteristic of inflammation of the upper respiratory tract, evening cough is more common with bronchitis, pneumonia, night cough can be when the contents of the stomach are thrown into the esophagus (remember about the “cough” receptors in the lower third of the esophagus) (the so-called reflux esophagitis), with obstructive bronchitis (this is bronchitis with viscous difficult-to-pass sputum).
• by nature (wet, that is, with phlegm or dry, without phlegm). But children of the first years of life do not know how to spit phlegm like adults, and their phlegm is viscous. Therefore, it may seem that the cough is without phlegm, that is, dry, but in fact there is phlegm. Therefore, drugs that suppress cough in children in the first years of life should be used with great care and only as directed by a competent doctor.
• by the duration of cough (acute cough lasts up to 4 weeks, more than 4 weeks – chronic cough in children).

Causes of cough

The most common cause of cough in children is the so-called postnasal drip, that is, drainage of discharge from the nose along the back of the throat. Usually children cough when they lie down and when they wake up and get up, they can cough when laughing hard or while eating.

In such a situation, an examination by a pediatrician, an otorhinolaryngologist and, possibly, an X-ray of the sinuses is necessary.

In case of prolonged coughing it is necessary to think about bronchial asthma.For bronchial asthma, obstructive bronchitis, coughing is characteristic, not only during ARVI, but also when the child is healthy. For example, after exercise. These children usually show signs of allergies, such as skin allergies (atopic dermatitis) and / or allergic rhinitis. Cough in the morning is characteristic.

In such a situation, an examination by a pediatrician and an allergist is necessary.

Still need to recall whooping cough. Unfortunately, there is whooping cough in our city and there is a lot of it. Vaccinated children also get sick, but not as badly and seriously as unvaccinated children, especially toddlers.Adults can also get whooping cough. A dry, prolonged cough is characteristic, which begins as an ordinary ARVI (with a not strong cough), and over time the cough intensifies, there are strong frequent coughing attacks, difficulty breathing (the so-called reprises). This is a long period, it is also sometimes called “100 days of cough.”

Complications may develop: bronchitis, pneumonia, atelectasis, convulsions, encephalopathy. All children who have had whooping cough have changes in the nervous system within 6 months of the illness.

But vaccinated children are characterized by the so-called atypical course of whooping cough, when the cough is not strong, without serious complications.

It must be said that vaccinated children get sick, usually at school age, since immunity after pertussis vaccinations, given in the first and second years of life, usually decreases by school age.

There is also a so-called psychogenic cough – it occurs only during the day, it can interfere with the child’s sleep, but as soon as the child falls asleep, the cough goes away.Such a diagnosis can be made only after excluding diseases of the bronchopulmonary system.

Consultation of a pediatrician and a psychotherapist is needed here. Such children are taught psycho-relaxation techniques.

These are just some of the types of cough. As you can see, there are a lot of reasons for coughing in children. Therefore, it is so important not to self-medicate, but to find a permanent competent pediatrician and consult him if your child has symptoms of ill health.
Don’t get sick!

Nocturnal cough prevents sleep.How do I stop an attack?

Cough is an important helper in the fight against illness. It is a protective reflex that helps clear phlegm and germs from the airways. But nocturnal attacks of coughing interfere with rest and exhaust the already weakened organism.

Why does the cough get worse at night?

When a person is in a horizontal position, mucus accumulates in the nasopharynx, the airways are not cleared.With a runny nose, discharge from the nose and paranasal sinuses flows down the throat and causes a cough reflex, so coughing torments in sleep, especially when we roll over from side to side, and in the morning when we get out of bed.

Dust and dry air can aggravate coughing. This is especially true in apartments with central heating. Dry and hot air irritates the mucous membranes and provokes coughing fits. To alleviate your condition, regularly ventilate the bedroom and do wet cleaning.It will not be superfluous to buy a humidifier. But if you don’t have one, and you need to fight a cough right now, you can hang a damp towel on the battery or put a container of water next to the bed.

Dry and wet cough – is there a difference?

Yes. A moist cough associated with colds and flu is beneficial for clearing the nasopharynx and airways. The phlegm protects the mucous membranes and prevents bacteria from entering the body.

A dry, throat-chilling cough, on the contrary, is quite dangerous for the body.With such a cough, phlegm does not stand out, the bronchi are not cleared, and the nasopharynx dries up. A constant inflammatory process is maintained on the walls of the respiratory tract. A dry cough, unlike a wet cough, does not help to recover, but only exhausts and interferes with rest. To speed up the healing process, you need to try to convert a dry cough into a wet one. But this should be done under the supervision of a doctor.

Is a child’s nighttime cough dangerous?

Not unless the cough is a symptom of a serious illness (such as asthma or pneumonia).The most common cause of cough in children is a viral infection. Viruses infect the respiratory tract at different levels – from the nose to the bronchi, bronchioles and lungs. Sometimes the cough continues for several weeks, because the child does not have time to recover from one infection and picks up another. About 10% of children continue to cough even after treated with ARVI.

Some doctors even propose to introduce a new term – “post-viral cough”. Such long attacks frighten parents, but more often than not they do not talk about serious pathologies.

But even if the disease is not dangerous or has completely passed, it is difficult for a child to endure sleepless nights, especially with a dry cough. And parents have a hard time if they don’t know how to help.

Important: If your child coughs frequently at night, it could be a sign of respiratory problems, allergies or whooping cough. Be sure to consult a doctor and do not treat the child yourself, so as not to worsen his condition.

What if my child coughs and cannot sleep?

To quickly stop an attack of a nocturnal cough and help a child, you can:

• Place a high pillow under the back, turn the child from back to side to prevent a strong outflow of mucus that has been swallowed and accumulated during the day.
• If the child does not have allergies, a spoonful of honey will help – it envelops and soothes the mucous membranes of the throat.
• Give your child a drink of warm tea or water to soothe a cough and calm the respiratory tract. It is better not to drink carbonated drinks or citrus juices – they can further irritate the already inflamed mucous membranes.

How to stop a nocturnal cough attack in an adult?

Try to find a comfortable position.Place a high pillow under your back. Drink warm tea or water to soften your throat. This is especially important for dry coughs – the liquid will help soothe the irritation.

If you find it difficult to breathe, ventilate the bedroom and try to humidify the air. If you don’t have a humidifier, hang a couple of wet towels over the radiator. You can have a small steam therapy session: go to the bathroom, close the door, turn on the hot water and wait a few minutes.

What drugs will help get rid of cough?

Treating a cough only with folk remedies is ineffective and dangerous.If it does not go away for several days or nights, be sure to see your doctor. It is important to remember that a cough is a symptom of a disease, and not an independent disease, therefore, complex treatment is required.

Mucolytic and expectorant drugs are used to combat wet coughs. They improve the excretion of phlegm and mucus. But with a dry cough, such medicines do not help, but only intensify the attacks, because the body will try to remove phlegm, which is not there. Antitussive drugs that inhibit or suppress the cough reflex help get rid of dry coughs.

Mucolytic drugs, which include, for example, ambroxol, will help to cope with a wet cough with bronchitis or pneumonia. SANTO manufactures Ambro® solution that can be taken by mouth or inhaled. Ambro® has anti-inflammatory and antioxidant properties, stimulates local immunity, increases the concentration of antibiotics in sputum and bronchial secretions.

Types of cough | articles, Neotravisil

There are several classifications of cough according to different parameters:

By its nature:

• unproductive, or dry;
• productive, or wet – with sputum discharge.

Downstream:

• acute – up to 3 weeks;
• protracted – 3-6 weeks,
  but less than 3 months;
• chronic – over 3 months.

By spawn time during the day:

• morning,
• daytime,
• evening,
• night.

By timbre:

• short,
• barking,
• husky,
• is silent.

By intensity:

• cough;
• severe paroxysmal cough;
• series of cough shocks.

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By duration:

• episodic short-term;
• paroxysmal;
• permanent.

All these indicators are important for diagnosis, treatment prescription and, possibly, further examinations.The first questions that doctors usually ask patients with a cough usually concern its nature – “is the cough dry or wet?”, “Does the phlegm go away?” Since the answers to them, especially in acute respiratory diseases, can help the doctor understand further treatment tactics.

With a dry cough, sputum discharge does not occur

With a dry cough, sputum does not pass (therefore it is also called unproductive), because it has a thicker and more viscous consistency than a wet cough.A dry cough is obsessive and tiring, and there is no relief when coughing up. With laryngitis (inflammation of the mucous membranes of the larynx) and tracheitis (inflammation of the mucous membrane of the trachea), dry cough often has a barking character, and is combined with a sore throat. At the very beginning of the development of bronchitis (inflammation of the mucous membranes of the bronchi) and pneumonia (inflammation of the lungs), the cough can also be dry, but in these diseases it is more a cough with scanty sputum than absolutely unproductive.

A moist cough leads to copious secretion of phlegm from the lungs and bronchi.This cough is also called a productive cough.
By itself, a cough with sputum production is not dangerous, it is part of the physiological mechanism for cleansing the respiratory tract from any dangerous irritating agents – dirt, dust, allergens, bacteria. These substances accumulate in the mucus covering the inner walls of the respiratory tract, its production and excretion, if necessary, increase, which leads to an increase in the amount of sputum secreted. A wet cough usually occurs as mucus accumulates in the bronchi, and in case of serious pathologies also pus, blood, fluid, and stops after coughing up.
The nature of the sputum discharge is of great diagnostic value. So, for example, at the initial stages of tracheitis and acute bronchitis, sputum can be mucous, viscous and vitreous, later it becomes mucopurulent. In different types of acute pneumonia, sputum has a different character: for example, mucopurulent sputum is separated in focal pneumonia, and in lobar pneumonia – rusty sputum ⁴ .
In acute respiratory infections, the cough usually has a certain “development cycle”: at first it is dry, and then it turns into a wet one, which becomes more superficial and disappears as it coughs up and over time.

A moist or productive cough leads to copious secretion of mucus from the lungs and bronchi

Acute dry cough is characteristic of acute respiratory viral infections and inflammatory processes in the larynx (laryngitis), trachea (tracheitis), bronchi (bronchitis) and lungs (pneumonia). When diagnosing such an acute cough, it is important to make sure that it is really associated with an infection – in this case, it will most likely be accompanied by an increase in temperature, as well as a runny nose, sore throat and poor health.The most important task in this case is to exclude the possibility of pneumonia (pneumonia).

Acute wet cough is observed with bronchitis, the cough ends with sputum discharge and reappears when it accumulates. If there is a strong accumulation of phlegm in the lungs, wheezing can be heard. With pneumonia, the cough is usually moist from the first hours of the illness, it is often described as deep.

Prolonged cough (more than 2-3 weeks) is often observed after acute bronchitis. It is associated with increased production of sputum after infection and, often, with increased sensitivity of cough receptors.

A prolonged dry cough is possible with tracheitis or tracheobronchitis as a result of infection with certain respiratory viral infections (RS, rhinos, parainfluenza viruses). Such a cough is often painful, paroxysmal, the attack ends with the discharge of a lump of dense mucus.

Spasmodic cough is a debilitating dry cough in the form of attacks, which is characteristic of bronchial asthma.

A prolonged, persistent dry cough is observed in chronic respiratory diseases and diseases of other organs, often of a non-infectious nature (tumor diseases of the respiratory system, gastroesophageal reflux (backward reflux of food from the stomach into the esophagus), heart failure, etc.).

A persistent wet cough is observed in most suppurative diseases of the lungs, accompanied by the accumulation of sputum. In smokers, such a cough is caused by chronic inflammation of the upper respiratory tract and is usually observed in the morning, it is caused by the accumulation of phlegm during the night and difficult expectoration, it is also called – “smoker’s cough”.

Specific nocturnal cough is a feature of bronchial asthma, it usually occurs closer to the morning due to increased bronchospasm; he often indicates an allergy to the feather in the pillow.Nocturnal cough is also seen with gastroesophageal reflux.

But it should be said that one cannot draw conclusions and make a diagnosis only on the basis of the color of the sputum or the nature of the cough. It is dangerous to procrastinate in any case, so timely consultation with a doctor is essential. Lack of proper treatment may mean that complications may appear in the near future.

References:
1. Radzig E. Yu. Cough is a protective mechanism and symptom of respiratory tract infections.Pediatrics, 88, No. 5, pp. 112-116, 2009.
2. Volkov A. V. Cough. Antitussive drugs. Russian Medical Journal, No. 5, p. 368, 2009.
3. Chikina S. Yu .. Cough: basic principles of diagnosis and treatment. General Medicine, No. 3, pp. 30-34, 2010.
4. Butov MA Propedeutics of internal diseases: a tutorial. – 2nd ed. – M .: Neopolit, 2017.
5. Borodulin V.I., Topolyansky A.I. Handbook of a practitioner in 2 volumes. M .: Onyx: Peace and Education, 2007.

How to relieve a coughing attack in a child

Photo source: shutterstock.com

What is cough

Cough is a defensive reaction of the body, refers to congenital unconditioned reflexes. It works with any irritants in the respiratory tract, pushes them out through intensified exhalation through the mouth – cough shocks. Sputum, blood, pus, dust, objects and any substances can act as an irritant. They provoke receptors in the respiratory tract (in the nose and paranasal sinuses, larynx, trachea, pleura, bronchi).

The mechanism of coughing is a short deep breath, simultaneous contraction of the muscles of the larynx and tension of the abdominal wall, then forced exhalation through the glottis.

Basically, cough is a symptom of the disease and requires compulsory treatment. Most often accompanies acute respiratory infections and diseases of the upper respiratory tract. Less commonly, it can signal diseases of the heart, ENT organs and the nervous system.

How to recognize a coughing fit

If the cough is paroxysmal, occurs at night and in the morning, and is repeated during the waking hours, you should consult a doctor. Such a cough clearly signals illness.Especially if it is accompanied by fever, fatigue, snot, red throat, general weakness.

But it must be remembered that cough is not always a companion of the disease, sometimes it is needed to clear the airways and eliminate obstacles to breathing. It goes away quickly and does not recur, unlike a cough that causes illness.

Types and causes of infant cough

Cough is different, and the appointment of treatment depends on its duration, frequency and time.

Causes of cough

The causes of cough are divided into several groups, and you need to understand the cause of the cough in order to prescribe the correct treatment.

1. Catarrhal diseases of ENT organs and respiratory organs – are often accompanied by copious secretion of mucus, which flows down the back wall of the larynx. A cough arises as an attempt to clear the airways of copious secretions. Colds are most often caused by hypothermia.

2. Infectious diseases of the upper respiratory tract and nasopharynx – the reason is the same: an abundant secret secreted as a response to the work of viruses.

3. Asthma – coughing attacks can occur in the cold, with intense movement, in contact with allergens. Usually a cough occurs at night, it is accompanied by shortness of breath, whistling in the chest on inhalation-exhalation.

4. Chronic bronchitis – the cough occurs in the morning, after sputum discharge, it calms down.

5. Inflammation of the lungs, tuberculosis – the type of cough depends on the stage of development of the disease.

6. Diseases of the esophagus and stomach – the contents of the stomach enter the respiratory tract. The cough is long and dry, the breathing is wheezing. It is accompanied by stomach pains, heartburn and vomiting.

7. Allergy – A cough occurs in response to profuse mucus production and as an attempt to get rid of allergens in the airways.

8. Heart disease – nocturnal, dry, hoarse cough. It is accompanied by symptoms characteristic of diseases of the organs of the cardiovascular system.

9. Nervous cough is difficult to diagnose, and the reasons for its appearance are individual for each case.

10. Foreign body in the respiratory system – a cough appears when small objects, such as crumbs, get in contact.

11. Violation of the humidity regime in the room – dry or very humid air can cause a coughing fit, especially in young children.

12. Air pollution – smoke, strong odors such as paint or poor quality plastic can also trigger a cough.

Photo source: shutterstock.com

What is a cough

The classification of cough is based on its main manifestations.

Time of day, or daily dynamics

• Morning – occurs after waking up, with a change in body position, is a symptom of inflammation in the upper respiratory tract.

• Day – this time is typical for acute respiratory infections, pneumonia and bronchitis, increases in the evening.

• Evening – A strong evening cough occurs with bronchitis and pneumonia.

• Night – as a rule, it is a paroxysmal cough, it accompanies bronchial asthma, laryngitis and whooping cough.

Duration of cough

Frequency of coughing

• Intermittent cough – mild or paroxysmal, at the same time during the day.

• Persistent cough – lasts long enough, periodically weakening and intensifying.

Dry or unproductive cough

Accompanies colds and infectious diseases of the upper respiratory tract.

Signs:

• lack of phlegm;

• worsens in the evening and at night;

• paroxysmal;

• during the day, attacks occur from 5 times;

• sometimes he is accompanied by a temperature;

• shortness of breath occurs;

• can be barking and hysterical;

• accompanied (but not always) by pain.

It is a mandatory symptom for:

• flu;

• laryngitis;

• whooping cough;

• tracheitis;

• pleurisy;

• pharyngitis;

• allergies;

• false croup;

• measles.

Wet or productive cough

Appears after dry cough.

Signs:

• sputum leaves;

• a loud coughing sound, becomes quieter after the phlegm has passed;

• sputum is colorless;

• if a yellow or green discoloration appears, blotches of pus and blood are signs of inflammation.

It is a mandatory symptom for:

Cough treatment

Important! Cough treatment is prescribed only by a doctor! It is very dangerous to self-diagnose and self-medicate!

Treatment is primarily aimed at alleviating a dry, unproductive cough, and after that – already at relieving wet and completely getting rid of it.

Dry cough

An unproductive cough is very exhausting for the patient, a person can sleep poorly, be lethargic, and can lead to loss of voice.By itself, such a cough does not go away, it must be treated.

In addition to drug therapy, the following is recommended:

• control air humidity and temperature in the room where the patient is;

• drink a large amount of liquid, up to 1.5 liters per day – tea, fruit drink, herbal infusions, mineral water without gas;

• observe bed rest;

• moisturize the nasal passages with saline.

Wet cough

A productive cough is easier than a dry one, but if it is not treated or sputum is controlled, then serious complications of the disease can be obtained, since the mucus that accumulates in the bronchi is an excellent breeding ground for microbes and bacteria. You should definitely pay attention to the deterioration of health – to an increase in temperature, the appearance of blotches in sputum, shortness of breath, hoarse breathing. At this stage of treatment, inhalations, physiotherapy, massage can be prescribed.Warming ointments, mustard plasters, foot baths are widely used.

It is important to observe bed rest, temperature and humidity regimes in the room, give plenty of drink, and ventilate the room.

First aid during an attack

How to relieve a dry cough in a child

Algorithm of actions during an attack:

1. Calm down.

2. Give the patient a warm drink.

3. Moisten the nasal passages with saline.

4. Humidify indoor air.

5. While the air in the room is humidified, move with the patient to the bathroom, open the tap and sit next to open water (in a small bathroom, the air will humidify faster, therefore, relief will come much faster).

6. Inhale with a nebulizer with saline or mineral water.

Important! The use of any drugs must be previously agreed with the doctor!

How to relieve a wet cough attack in a child

Algorithm of actions during an attack:

1. Calm down.

2. Putting the patient on his stomach and massage, gently tapping on the back – this will help the sputum discharge.

3. After the massage, sit the patient down.

4. Clear mucus from the nose.

5. Give plenty of warm drink.

6. Humidify indoor air.

How to relieve an attack of allergic cough in a child

Algorithm of actions during an attack:

1. Calm down.

2. Remove the allergen if possible.

3. Ventilate the room.

4. Humidify the air.

5. If possible, carry out wet cleaning (at least wipe the floor and wipe off the dust).

6. Give an antihistamine as agreed with your doctor.

Important! If swelling of the mucous membranes begins with an allergic cough, call an ambulance immediately! Quincke’s edema may begin, which, in turn, can be fatal!

How to relieve a child’s coughing attack at night

Algorithm of actions during an attack:

1. Calm down.

2. To plant the patient.

3. Humidify indoor air.

4. Give warm drink.

5. Moisten the nasal passages.

6. For a wet cough, apply a tapping massage.

7. With a dry cough, moisten the air as much as possible and, if possible, inhale.

Photo source: shutterstock.com

When to call an ambulance

For any of these signs, you must immediately call an ambulance:

• suffocation;

• a sharp jump in temperature;

• laryngeal edema;

• vomiting and nausea;

• Strong headache.

Medicines

For unproductive cough

After examination, the doctor may prescribe drugs to soften cough and thin phlegm:

• mucolytic drugs – thin the phlegm and help its discharge from the bronchi. As a rule, these are “Bronholitin”, “Ambroxol”, “Lazolvan”. Inhalation can be prescribed using a nebulizer based on “Ambroxol” and saline;

• antitussives – should suppress coughing attacks by acting on the cough center.They can be given only until the sputum has begun to flow, otherwise the mucus will stagnate in the respiratory tract, and this is dangerous with complications. It is good to take before bedtime to relieve and remove nocturnal coughing fits – “Stoptussin”, “Gedelix”, “Tusuprex”, “Gerbion”, “Libeksin”;

• antihistamines – relieve swelling in the nasopharynx and throat, help to remove inflammation: “Tavegil”, “Suprastinex”, “Zodak”;

• anesthetics – to relieve painful manifestations caused by paroxysmal coughing.In pharmacies there is a large selection of pastilles and lozenges with anesthetic and antiseptic properties: “Septolete”, “Faringosept”, “Strepsils”, “Hexaliz”, “Falimint”;

• antibiotics – strictly according to the doctor’s prescription! They can be prescribed when the patient’s condition worsens.

For productive cough

Important! When taking expectorants, in no case should you take antitussive drugs!

Treatment is aimed at clearing mucus from the airways and relieving inflammation and its consequences:

• mucolytic drugs – they should dilute phlegm well in order to facilitate its discharge: “Bromhexin”, “Lazolvan”, “Fluimucil”, “Bronchobos”;

• expectorant drugs – stimulate secretion release: “Mukaltin”, “Bronchikum”, “Bronhofit”, “Codelak Broncho”, “Prospan”;

• antispasmodic – relieve spasm in the bronchi, increase the lumen in the airways and facilitate the release of mucus.They are prescribed by a doctor depending on the course and nature of the disease.

Folk remedies

In addition to medicines, there is a large arsenal of traditional medicine for coughing.

Folk remedies for dry cough:

1. Drinking – herbal infusions and teas, fruit drinks, vitamin drinks, freshly squeezed juices from fruits, vegetables and berries, compotes, it is possible from dried fruits and frozen berries, berry jelly (especially with an exhausting and painful cough).

2. With a dry cough, all of the following remedies are aimed at thinning mucus and relieving coughing fits:

• herbal infusions and decoctions – can be bought in pharmacies ready for brewing and conveniently packaged leaves of plantain, yarrow, coltsfoot, violet, caraway seeds, thyme, pine buds, fennel fruits, licorice root, elecampane, marshmallow;

• warm and hot milk – goat’s milk with the addition of a small amount of butter, a spoonful of honey and a pinch of baking soda works best for coughing;

• rubbing and compresses with the use of essential oils – a few drops are rubbed into the skin on the chest, after which a dry warming wrap is done.Eucalyptus, fir, almond oil is suitable;

• black radish with honey – an excellent recipe for getting rid of a dry cough: take out the middle of the radish and put a little honey in this depression, give the resulting juice a teaspoon 3-4 times a day;

• iodine mesh – done on the chest, has a warming effect.

Folk remedies for wet cough:

• anise broth: a pinch of anise seeds is mixed with a spoonful of honey, a pinch of salt and a glass of water, boiled and taken in 1 tablespoon every 2 hours;

• a decoction of plantain leaves is an excellent expectorant: for half a liter of boiling water 2-3 tablespoons of a dry leaf, leave for 2-3 hours, strain and take 1/3 cup 3 times a day;

• ginger: chop the ginger root and pour boiling water over it, take after meals 4 times a day;

• inhalations – with menthol, coltsfoot and thyme.

Attention! When treating with folk remedies, it is important to make sure that the ingredients do not cause an allergic reaction!

What is forbidden to do with coughing attacks

1. Do not treat cough. By itself, it can only pass as a symptom of a viral upper respiratory tract infection. And if such a cough does not go away for more than 2-3 weeks, this is a reason to consult a doctor and start treatment.

2. The use of antibiotics.Such treatment should only be prescribed and under the supervision of a physician!

3. Stay in a hot and dry place. Dry and warm air only provokes coughing fits, it is imperative to monitor the humidity in the room.

4. If you have a wet cough, take cough suppressants. The phlegm and mucus should go away, and such remedies prevent the cough from pushing the secret out.

5. Treat only with folk remedies.The therapy should be comprehensive.

6. Treat with antibiotics only. See item 5.

7. To carry out many warming procedures. Warming up with mustard plasters or an iodine net can alleviate the patient’s condition, but will not cure a cough.

Smoker’s bronchitis

Date of publication: 05 December 2019 . Category: News and Announcements.

What is chronic bronchitis of a smoker is known to almost every person who suffers from such an addiction as smoking. Anyone who smokes is familiar with the morning cough that occurs after the first cigarette smoked after a night’s sleep. Such a cough is designed to remove mucus from the lungs – figuratively speaking, “cleanse” them. And every day, every week, every year this cough in the morning becomes more and more intense.

Very often, at the initial stages of the disease, a smoker simply does not notice this morning cough – he does not pay any attention to it. And if he does, he simply shrugs it off, considering the cough to be some kind of mild and completely harmless side effect of smoking. However, if you do not pay attention to this problem, very soon it will take on a global scale, endangering your health.

Chronic bronchitis of a smoking person is the disease that the overwhelming majority of people who smoke systematically and for quite a long time face.The main reason that causes a cough is that with each puff, the smoker inhales smoke, which contains the combustion products of paper and tar contained in tobacco.

This disease can manifest itself in each smoker individually. It depends on many factors – primarily on the individual characteristics of the body of each individual person, on the smoking experience, on the number of cigarettes smoked. In addition, the individual sensitivity of the smoker to all those constituents of tobacco smoke that enter the human lungs plays an important role.By the way, the likelihood of a smoker’s bronchitis and the severity of its course depends on this very factor.

Symptoms of the disease

The symptoms of smoker’s bronchitis are very different. They also depend on the individual characteristics of the smoker’s body, on the state of his immune system, on the form of the disease and the severity of its course. As a rule, in those people whose bronchial sensitivity is higher than the rest, bronchitis of this type takes on a very severe form of the course – bronchial obstruction.With it, a sick person develops a progressive narrowing of the bronchi. So:

Intense cough

The most important symptom of this disease is a wet cough, which occurs immediately after waking up and until the time when a person smokes his first cigarette in the morning. Cough can be of very different degrees of intensity – it can vary absolutely arbitrarily, even in one person.

By the way – for sure, many smokers have noticed the following feature – it is worth smoking a cigarette of a different brand than usual, as a strong cough begins with the release of phlegm.This symptom also very eloquently indicates that, most likely, the smoker has already developed chronic bronchitis. And he should think about his health.

Waste dyspnea

In addition to coughing, a person suffering from bronchitis of a smoker, in the absence of timely treatment started, is very likely to develop bronchial obstruction. A sick person begins to develop shortness of breath. At first, it is very insignificant and often remains invisible, but over time it intensifies.At first, it makes itself felt only with strong physical exertion, then it appears with very moderate ones. If in this case, too, a person does not catch his eye and does not seek medical help from a doctor, he is at great risk not only to his health, but also to his life.

Shortness of breath continues to increase, arising even in a state of complete rest of the sick person. This phenomenon is called chronic obstructive pulmonary disease. Its direct consequence is a complex of very unpleasant painful symptoms, in the absence of the necessary treatment – disability and even premature death.

Moreover, be sure to remember that not only the smoker himself, but also his family members and all the people around him are at risk of falling ill with such a dangerous disease. After all, they, most often, are the so-called passive smokers, who are forced to inhale the smoke from the smoker’s cigarettes, thereby endangering their health. Therefore, if you smoke yourself, you should not endanger your loved ones. After all, nicotine is your choice, not theirs.

Treatment of chronic bronchitis of a smoker

In the event that you or your loved one have noticed symptoms of a similar smoker’s bronchitis, you cannot hesitate a day – try to seek medical help as soon as possible.And do not pull until you have shortness of breath – consult a doctor – pulmonologist or therapist at the first sign – a wet morning cough.

Your doctor will carefully examine you to rule out the possibility of any other lung disease. After that, the doctor will prescribe a study of lung function – this is done in order to identify the possible presence of chronic obstructive pulmonary disease. If you already suffer from shortness of breath at the time of going to the doctor, be sure to tell him about it.In this case, it is necessary to examine lung function as soon as possible in order to begin treatment of this complex disease as early as possible.

The first and most important thing to do in order to get rid of a smoker’s bronchitis is to quit smoking. Of course, this is very, very difficult, especially if a person has a long smoking experience. To our great regret, a smoker often mistakenly believes that it makes no sense for him to quit smoking, since he has been smoking for a very long time.And giving up cigarettes won’t do any good.

However, this is not at all the case – it is very important to quit smoking at any stage of the disease or its treatment, regardless of the person’s smoking history. Of course, in especially severe cases, it will hardly be possible to get rid of the disease by giving up cigarettes, however, preventing further progression of the disease and alleviating its course by giving up cigarettes.

However, when quitting smoking, it is necessary to remember about some of the peculiarities of the body’s reaction to the cessation of the intake of nicotine into it.Unfortunately, they are found in almost all smokers, sometimes delivering a certain amount of unpleasant minutes.

As a rule, from the very first days of cessation of cigarettes in a person, morning cough increases to a large extent, sputum leaves very badly, breathing becomes difficult, the general condition of a person and his well-being worsens.

Such symptoms of exacerbation of a smoker’s bronchitis reach their maximum approximately on the seventh day after quitting cigarettes.A similar phenomenon in medicine is called nicotine withdrawal syndrome. As a rule, it is this reason that becomes the main excuse for those who break down and start smoking again. However, do not rush to do this – the discomfort will soon subside, gradually disappearing altogether.

Very often it is extremely and extremely difficult for a person to quit smoking on their own – and this is not accidental. Once in the body, nicotine very actively stimulates those parts of the brain that are responsible for breathing and the cough reflex.This is why smokers feel much better after smoking at least one cigarette. For such people, the help of both doctors and close people and relatives will be very useful.

The doctor will probably prescribe certain drugs containing nicotine and facilitating the withdrawal from cigarettes, facilitating the process of cleansing the lungs of phlegm, vasodilating drugs that will make it easier for a person the first month after quitting smoking. In no case do not take any pharmacological preparations on your own without consulting your doctor.The risk is too great not only not to alleviate your condition, but also to aggravate it even more.

In the event that the bronchitis of a smoking person is extremely acute and the person’s well-being suffers very much, you should immediately go to bed and call a doctor. You should not joke with this disease – after all, as it was already clear from all of the above, it is very, very dangerous. Before the arrival of the doctor, the following measures can be taken:

Bed rest must be strictly observed for any sick person.

Drink plenty of fluids. It allows you to prevent dehydration and sputum stagnation.

In any case, the key to the success of such a responsible and very important event as smoking cessation is only the desire of the smoker himself, striving to quit the addiction.