What are the most effective remedies for dry cough? When should you see a doctor for persistent coughing? Get the answers to these questions and more in this comprehensive article.

Understanding Dry Cough: Causes and Symptoms

A dry cough, also known as an unproductive cough, is a common condition that can be caused by a variety of factors, including the flu, common cold, asthma, or exposure to irritants like cigarette smoke. Unlike a productive, wet cough that helps remove mucus or phlegm from the lungs, a dry cough is unable to clear these substances from the respiratory system.

Dry coughs can linger for weeks after an illness and may also be a symptom of underlying health conditions such as postnasal drip, acid reflux, or GERD. While they can be uncomfortable for both children and adults, there are several at-home remedies and clinical treatments that can help alleviate the symptoms.

13 Effective Remedies for Dry Cough

1. Honey

Honey is a popular and effective remedy for dry cough, particularly in adults and children aged 1 and older. Honey has natural antibacterial properties and can help coat and soothe the irritated throat. In fact, a 2007 study found that honey was more successful than a cough suppressant in reducing nighttime coughing in children. You can take honey by the teaspoon or add it to warm tea or water.

2. Turmeric

Turmeric, a spice commonly used in Ayurvedic medicine, contains the compound curcumin, which has anti-inflammatory, antiviral, and antibacterial properties. To maximize the benefits, mix 1 teaspoon of turmeric with 1/8 teaspoon of black pepper and add it to a beverage or make it into a warm tea.

3. Ginger

Ginger is another versatile remedy for dry cough due to its antibacterial and anti-inflammatory properties. You can make ginger tea by steeping peeled or cut ginger root in warm water, and adding honey for additional benefits. You can also take ginger in capsule form or chew on fresh ginger root.

4. Marshmallow Root

Marshmallow root is a herb that has been used in cough syrups and lozenges to soothe dry, irritated throats. A survey-based study found that it is an effective treatment for reducing the irritation caused by dry cough, and it may also have antibacterial properties.

5. Peppermint

Peppermint contains menthol, which can help numb the nerve endings in the throat that become irritated by coughing. This can provide pain relief and reduce the urge to cough. Peppermint also has antibacterial and antiviral qualities and can help reduce congestion. Try drinking peppermint tea or using peppermint essential oil as an aromatherapy treatment.

6. Masala Chai Tea

In India, masala chai tea is a traditional remedy for sore throat and dry cough. This spiced tea contains antioxidant-rich ingredients like cloves and cardamom, which may help soothe the throat and reduce coughing.

Additional Remedies for Dry Cough

7. Stay Hydrated

Drinking plenty of fluids, such as water, herbal tea, or warm broth, can help thin out mucus and keep the throat moist, which may alleviate dry coughing.

8. Use a Humidifier

Running a humidifier can add moisture to the air, which can help soothe the irritated airways and reduce dry coughing, especially at night.

9. Suck on Lozenges

Sucking on cough lozenges or hard candies can help coat and soothe the throat, providing temporary relief from dry cough.

10. Try Steam Inhalation

Inhaling the steam from a hot shower or a bowl of hot water can help loosen mucus and provide temporary relief from dry cough.

11. Limit Irritants

Avoiding exposure to cigarette smoke, harsh chemicals, or other airborne irritants can help prevent and alleviate dry cough.

12. Use OTC Medications

Over-the-counter cough suppressants or expectorants may provide temporary relief for dry cough, but it’s best to consult a healthcare provider before use.

13. Consider Prescription Medications

In some cases, prescription medications like bronchodilators or corticosteroids may be necessary to treat the underlying cause of a persistent dry cough.

When to See a Doctor for Dry Cough

While most dry coughs can be managed with home remedies, it’s important to seek medical attention if the cough persists for more than a week, is accompanied by fever, shortness of breath, or other concerning symptoms, or if it interferes with your ability to sleep or perform daily activities.

A healthcare provider can help identify the underlying cause of the dry cough and recommend appropriate treatment, whether that’s medical intervention or a combination of home remedies and lifestyle changes.

Conclusion

Dry cough can be a frustrating and uncomfortable condition, but there are many effective remedies available to help alleviate the symptoms. By trying a combination of natural remedies, such as honey, turmeric, ginger, and peppermint, and making lifestyle adjustments, you can often find relief without the need for medical intervention.

However, if the dry cough persists or worsens, it’s important to consult a healthcare provider to rule out any underlying health conditions and receive appropriate treatment. With the right approach, you can effectively manage your dry cough and get back to feeling your best.

13 Remedies and When to See a Doctor

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A dry cough may be caused by the flu, common cold, asthma, exposure to cigarette smoke, and more. Home remedies such as honey, peppermint, or air purifiers may help, but it’s best to talk to a doctor about persistent coughing.

A dry cough is also called an unproductive cough. Unlike productive, wet coughs, dry coughs are unable to remove mucus, phlegm, or irritants from your lungs or nasal passages.

Dry coughs can linger for weeks after you’ve had a cold or the flu. They may also be caused by a number of conditions, such as:

• postnasal drip
• asthma
• acid reflux or GERD

They may also be a long-lasting side effect from exposure to environmental toxins, such as cigarette smoke.

Dry coughs can be very uncomfortable and may occur in both children and adults. There are a number of clinical treatments you can use to alleviate them, but there are also at-home remedies which can be just as effective in many cases.

At-home remedies for dry cough aren’t one-size-fits-all. You may have to experiment with several before you find the ones that work for you.

In addition, not all of these remedies have been fully researched and proven to be effective. Some treatments are also inappropriate for babies or children.

1. Honey

For adults and children ages 1 and up, honey can be used to treat day and nighttime dry coughing.

Honey has antibacterial properties and can also help to coat the throat, alleviating irritation.

One study in 2007 found that honey was more successful than dextromethorphan, a cough suppressant ingredient, for reducing nagging bouts of nighttime coughing in children.

You can try taking honey by the teaspoon several times daily, or add it to tea or warm water to drink.

To avoid infant botulism, a rare complication which can occur in infants, never give honey to a child under 1 year old.

2. Turmeric

Turmeric contains curcumin, a compound which may have anti-inflammatory, antiviral, and antibacterial properties. It may also be beneficial for several conditions, including a dry cough.

Curcumin is best absorbed into the blood stream when taken with black pepper. You can add 1 teaspoon of turmeric and 1/8 teaspoon of black pepper into a beverage, such as cold orange juice, to drink. You can also make it into a warm tea.

Turmeric has been used to treat upper respiratory conditions, bronchitis, and asthma in Ayurvedic medicine for centuries.

You can get turmeric in its spice-form, as well as a capsule.

3. Ginger

Ginger has antibacterial and anti-inflammatory properties. It has also been shown to boost the immune system and relieve pain and discomfort.

Ginger can be found in many teas as an ingredient. You can also make ginger tea from ginger root by steeping the peeled or cut root in warm water. Adding honey may make it even more beneficial for dry cough.

You can also take ginger in capsule form, or chew on ginger root to alleviate dry cough.

4. Marshmallow root

Marshmallow root is a type of herb. It’s used in cough syrup and in lozenges to soothe dry cough.

A survey-based study found that it’s an effective treatment for soothing the throat and reducing the irritation caused by dry cough.

Marshmallow root may also have antibacterial properties.

5. Peppermint

Peppermint contains menthol, which helps to numb nerve endings in the throat that become irritated by coughing. This may provide pain relief and reduce the urge to cough.

Peppermint also helps reduce congestion, plus, it’s been found to have antibacterial and antiviral qualities.

There are a number of ways to take peppermint. These include drinking peppermint tea or sucking on peppermint lozenges. Try drinking peppermint tea right before bed to help alleviate nighttime coughs.

You can also use peppermint essential oil as an aromatherapy treatment.

6. Masala chai tea

The taste of chai tea has become very popular in the United States in recent years. In India, chai is used to treat conditions such as sore throat and dry cough.

Masala chai contains several antioxidant ingredients, including cloves and cardamom. Cloves may also be effective as an expectorant.

Chai tea also contains cinnamon, which has anti-inflammatory properties.

7. Capsaicin

Capsaicin, a compound found in chili peppers, has been shown to reduce chronic coughing.

While capsaicin can be taken as a capsule, you can also make tea from cayenne pepper hot sauce and warm water.

Cayenne is a type of chili pepper. Add drops of cayenne hot sauce into the water, tasting as you go, so you don’t exceed your threshold for how much heat you can handle. You can also buy chili peppers whole and steep them in warm water.

Capsaicin-based treatments aren’t recommended for children.

8. Aromatherapy with eucalyptus

Aromatherapy is the practice of using essential oils to soothe and heal.

Eucalyptus essential oil may help ease dry cough by working as a decongestant. Try adding eucalyptus to a diffuser, spritzer, or inhaler. You can also add a few drops to hot water in a bowl and inhale the steam.

Scenting your room with eucalyptus may help you get a better night’s sleep if nighttime coughing has been keeping you awake.

9. Use a humidifier

Dry air can aggravate a dry cough. Humidifiers put moisture into the air, which can provide relief.

Humidifiers help open up the sinuses, making them beneficial for nagging postnasal drip.

If your home has dry air, run a humidifier in your bedroom to help reduce dry cough during sleep.

10. Use an air purifier

Air purifiers can help rid your home of airborne irritants, such as dust and smoke. They also reduce allergens, such as pet dander and pollen.

Whether your cough is caused by environmental toxins or an underlying condition, breathing in clean air can help reduce throat irritation and the desire to cough.

11. Gargle with salt water

Gargling with warm salt water will help ease the discomfort and irritation caused by a dry cough. Salt water also helps kill bacteria in the mouth and throat.

To do this, dissolve 1 teaspoon of table salt in a large glass of warm water. Then gargle several times a day.

This dry cough remedy isn’t recommended for young children, who might swallow the salt water.

If you wake up with an irritated throat from coughing during the night, gargle with salt water immediately after brushing your teeth to help numb and soothe the nerve endings in your throat.

12. Antitussive cough syrup

Antitussive cough medications work by diminishing the cough reflex. This alleviates the desire to cough, making them especially beneficial for dry coughs.

Some antitussives contain codeine and are available by prescription only. Others are available over the counter. These typically contain active ingredients, such as dextromethorphan, camphor, or menthol.

13. Cough drops

Cough drops are medicated lozenges designed to lubricate and soothe irritated throat tissues. Their ingredients vary and so do their actions.

Some cough drops contain menthol, which acts as a numbing agent to reduce the urge to cough. You can also find cough drops that contain ginger or eucalyptus.

Many of the home remedies above — like honey or salt for rinses — are already in your cupboard at home, but others you may still need to buy. We’ve got you covered with the links below.

Herbs and teas

• turmeric
• ginger
• marshmallow root
• peppermint tea
• masala chai

Supplements

• turmeric
• ginger
• capsaicin capsule

Essential oils

• peppermint oil
• eucalyptus oil

Home products

• humidifier
• air purifier

Other remedies

• peppermint lozenges
• cough drops
• antitussive cough syrup
• cayenne hot sauce

Dry coughs can last for months and may be exhausting as well as disruptive.

Dry coughs usually stop on their own. However, if your cough is accompanied by other symptoms, see your doctor. These include:

• trouble breathing or catching your breath
• wheezing
• chest pain
• back pain
• fever
• chills

Also see your doctor if your cough worsens or doesn’t dissipate completely in 2 months.

Dry cough can be both long-lasting with numerous causes. But there are several highly effective at-home treatments, which can alleviate your cough.

If your cough worsens over time or doesn’t go away within 2 months, see your doctor.

Read this article in Spanish.

9 of the Best HEPA Air Purifiers & How to Choose

A high efficiency particulate air (HEPA) filter is a pleated device that can remove particles from surrounding air. A number of devices use these filters, such as air purifiers, which are designed to remove a host of particles and pollutants from the air in your home.

There is no federal certification or regulation for HEPA filters in the United States, but the Environmental Protection Agency offers some advice on how to choose efficient filters. Keep reading to learn some tips for choosing HEPA filters and how to find the best air purifier for your home.

HEPA filters remove tiny particles from dust, mold, pollen, bacteria, viruses, and more from the air. Thin glass fibers are randomly arranged into a dense, paperlike material that is folded into pleats to create the filter.

As air particles pass through these filters, pollutants are trapped in the fibers. Then, as larger particles stick to the filter, they keep other smaller particles from passing through. A HEPA filter can trap particles as small as 0.3 microns. For reference, the smallest thing the human eye can see is 25 microns, and a strand of hair is between 17 and 180 microns in diameter.

When placed into filtration systems like air cleaners and purifiers, HEPA filters can remove 99.97 percent of particles from the air. These filters were initially used in nuclear plants, but a host of new devices use this technology in products that can help clean the air in your home.

Types of filters

There are many kinds of air filters and air purification devices available for home use. HEPA filters can be used in cleaning devices, air filters, portable air cleaners, whole-home fan systems, heating and cooling units, and more. The goal is to filter tiny particles from the air as it passes through these devices.

HEPA filters aren’t the only way to do this, but they are recognized as highly effective, filtering some of the smallest particles from the air. Other examples of filters include:

• Ultra-HEPA filters or ULPA filters. These can trap up to 99.999 percent of particles 0.3 microns or smaller.
• Electrostatic filters. These trap particles using a small static charge, which help the particles stick to the filter.
• Electrostatic precipitators. These filters use metal plates or wires to attract particles with an opposite charge. They can often be washed and reused.
• Ionization. These filters rely on a small charge that emit a magnetic-like attraction to particles in the air. This type of filtration may release ozone gases and could cause irritation for people with respiratory diseases.

There are so many options when it comes to home air cleaning, and the choices can become overwhelming. While the EPA does not certify or recommend particular types of air filters, the agency does offer advice for selecting the right product for you. These recommendations were the basis of our selection process and include the following considerations.

• Size matters. Look for portable filters designed for the room size you are trying to use it in. Generally, the clean air delivery rate (CADR) score of your filter should be equal to about two-thirds of the area in the room.
• Avoid air cleaners that generate ozone. Ozone is a gas that is released during some air purification processes. While ozone gas is meant to clean and sanitize air, it’s also considered a pollutant that can cause irritation and damage to the lungs when inhaled. Air cleaners that use ozone are generally intended for rooms that are uninhabited at the time of use. They are not for use in confined spaces when you are present. No government agency in the United States has approved any ozone generators as air cleaners in homes.
• Look at industry ratings. While EPA doesn’t set rules for these filters, there are industry leaders that set standards for HEPA filtration. When purchasing a filter, it should meet one of the following criteria:
  • designated HEPA filter
  • CADR rated
  • manufacturer states the product filters most particles smaller than 1 micron

How is filtration measured?

Clean Air Delivery Rate (CADR) is a way of measuring home air purifiers. It measures what sizes of particles can be removed in a volume of air, or how many cubic feet per minute can be filtered. The rating is assigned after testing small, medium, and large particle filtration — usually using smoke, pollen, and dust. How much of these elements are filtered per minute is measured, and a CADR score is assigned based on the results.

To decide what CADR rating you need, look at the size of the room you want to filter. The higher the CADR rating, the more particles the device will remove from the area, and the larger room it can service.

While CADR is the residential rating tool, industrial HEPA filters are usually measured with minimum efficiency reporting values (MERV) ratings that range from 1 to 16. The American Society of Heating, Refrigerating, and Air Conditioning Engineers developed this system. Higher values indicate better filtration power.

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Pricing guide

The price of an air purifier depends on the size, features, and how well it filters the air. Prices can range from $100 to thousands. On most commerce sites, you will be able to customize your search by filtration and price range to find the model that works best for your needs and budget.

We combed reviews and ratings from a number of home HEPA air purifiers, compiling a list that combined those ratings and feedback with the recommendations from EPA and industry leaders. Air cleaners that used ozone or ionization technology were excluded. The results are:

Honeywell True HEPA Whole Room Air Purifier with Allergen Remover, HPA 300

• CADR rating: 300
• Price (MSRP): $249.99

This device can usually be found in many brick-and-mortar stores and on sale, making it an easy choice to buy in a hurry — when it’s in stock. This machine is made to be portable and easy to move between rooms. It’s quieter than some of its competitors but still delivers great filtration.

Models built for smaller rooms or for moving a smaller volume of air can also be found, bringing price tags down. Consumers love this product, according to ratings, listing it as an affordable and effective device.

Shop now at Lowe’s

Levoit Core 400s

• CADR rating: 260
• Price (MSRP): $219.99

Levoit is a favorite on consumer-driven sites like Amazon, and offers a variety of models to fit every price range. The Core 400s is priced just below the range of other high performers, so it’s affordable but also does the job.

Named for the room size it’s designed to filter (400 square feet), the Core 400s features a large HEPA filter. Options for bells and whistles like voice control are also available, and the device is easily portable.

Shop now at Levoit

Winix 5500-2

• CADR rating: 246
• Price (MSRP): $249.99

The Winix line also offers several models, but the 5500-2 is a performer for the budget conscious. There are no smart sensors or fancy apps with this model, but you can use automatic settings.

AHAM Verifide, a manufacturers’ association and product testing program, certified this air purifier’s performance for rooms up to 360 square feet.

Shop now at Winix

Blueair Blue Pure 211+

• CADR rating: 350
• Price (MSRP): $299.99

Blueair actually makes it onto our list twice. Once for this air purifier that tops several “best HEPA air purifier” lists on consumer sites. Consumer Reports praises the model for having top-rated filtration at both high and low speeds (CADR scores are usually based on filtration at the highest speed only). The second time, below, is for its line of air purifiers overall, which gives an option for most room sizes and budgets.

This portable machine is designed for home use and has washable filter components to extend the life of your filter. This isn’t the quietest model, but it has other features, like a light to remind you when it’s time to change the filter.

One thing to keep in mind is that Blueair doesn’t use True HEPA filtration. They use a combination of physical filters and electrostatic charge, that they call HEPASilent.

The 16-pound machine has no handle or wheels.

There are other sizes available in the Blue line as well.

Shop now at Blueair

Medify Air MA-40

• CADR rating: 380
• Price (MSRP): $349. 99

Medify Air is another popular brand, especially among those who need air purifiers for medical reasons. While it promises to be “quiet,” the quietest setting is about half the volume of a vacuum cleaner, making its noise level a matter of opinion.

This large unit could be difficult to move due to its design and size, but it delivers high levels of filtration for the price. There are a variety of models from this manufacturer to choose from.

Shop now at Medify Air

BISSELL air320

• CADR rating: 241
• Price (MSRP): $329.99

BISSELL is a well-known name in filtration and the air320 purifier evokes the feeling of nostalgia with a retro furniture look. While the device can be portable, this might be difficult due to its size. The 20-pound device does come with a carrying handle, though. BISSELL offers a number of other models as well.

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Rabbit Air MinusA2

• CADR rating: 200
• Price range (MSRP): $549. 95–$639.95

For people looking for style and function, Rabbit Air offers a well-reviewed — albeit expensive — option. These devices come in black and white, or a few famous art prints like Monet’s “Water Lilies” and Van Gogh’s “Starry Night.”

Extremely quiet on the lowest settings, you may sacrifice some function for volume and appearance with this model. CADR ratings are lower than some cheaper models, but if you’re looking for function and appearance with high-tech options, this model could suit your needs.

This is the only device on our list that gives you the option to either set it on a tabletop or mount it on a wall.

Shop now at Rabbit Air

Blueair Classic Air Purifiers

• CADR rating range: 200–640
• Price range: $350–$900

There are several models in the Blueair Classic line of air purifiers. These workhorses earn top ratings from a number of reviews, especially from people who need air filtration for allergies or asthma.

Some from this line are heavier models than Blueair’s Pure line, and a few have caster wheels to help make them portable. Reviews claim these are quieter than Pure at lower speeds, but can be loud at higher speeds. Still, these purifiers are quick and efficient at higher settings.

Shop now at Blueair

Coway Airmega Air Purifiers

• CADR rating range: 150–350
• Price range (MSRP): $189.99–$749.99

This line features a variety of styles and colors, but the real draw is its filtering power. While the filtration power is high, though, so is the price. One of the pricier options on our list, the Coway devices feature extras like Wi-Fi connectivity, a mobile app, and voice control.

Shop now at Coway

When choosing an air purifier, keep in mind that you should purchase your device based on room size and filtering ability. Also, the device can only filter as well as you maintain it. A dirty or expired HEPA filter will not do its job well. Check the manufacturer’s recommendation on filter replacement. Generally, these should be switched every 60 to 90 days.

You should also be sure to follow the manufacturer’s recommendations on placement, operation, and maintenance for best results.

Overall, consider why you want an air purifier, how well the device you are considering filters air, and your budget. Some units may have an attractive price, but it all comes down to how well a unit will filter the air in the size of the room you will be using it in.

Dry mouth at night during sleep: causes

We all love to sleep soundly at night – and we do it right, because, as neurologist Alexei Danilov, professor of the Department of Nervous Diseases of the First Moscow State Medical University, explains in his interview, lack of sleep leads to poor mood, depression and reduced concentration, increases the risk of obesity and the development of a number of chronic diseases. To be in shape, a person needs to sleep a certain number of hours. But sometimes we wake up in the middle of the night, and one of the main reasons for this is dry mouth. If you have ever experienced this problem, it will be helpful for you to know what causes it, how to deal with it, and when to see a doctor.

What is dry mouth?

Dry mouth, or xerostomia, occurs when there is a deficiency of saliva. Saliva performs several functions at once: it helps to digest food, protects against caries, facilitates chewing and swallowing. Everyone experiences dry mouth, especially during times of stress, but chronic xerostomia is a more serious problem.

Symptoms of dry mouth

Common symptoms include dryness of the tongue and throat, cracked lips, sticky and sticky sensation in the mouth. Some people with dry mouth experience difficulty in tasting, chewing, and swallowing food, as well as speech problems, sores, and a burning sensation in the mouth. If you have several symptoms of dry mouth, consult your dentist or physician – such symptoms may be a sign of an underlying medical condition.

What causes dry mouth?

It is important to know not only the symptoms, but also the causes of dry mouth at night. It can occur because you snore or sleep with your mouth open, smoke, drink alcohol, or experience stress and emotional overload. In addition, dry mouth at night can be a sign of Sjögren’s syndrome or a side effect of medications for treating sinusitis, anxiety, and depression, for example.

Best Strategies for Combating Dry Mouth

The first thing you need to do is talk to a dentist who can determine the cause of dry mouth and, if it is a symptom of a disease, suggest treatment options. While waiting for a visit to the clinic, try to relieve yourself:

• Keep a glass or bottle of water on your bedside table to quench your thirst at night
• Dentists also advise using sugar-free gum or sugar-free lozenges throughout the day
• Turn on a humidifier in the bedroom at night
• Cut down on caffeine and soda
• Give up tobacco and alcohol
• Drink plenty of fluids throughout the day to stay hydrated

In addition, taking good care of your teeth and gums is a great help in combating dry mouth. Be sure to use an alcohol-free mouthwash, brush your teeth twice a day, and use dental floss to help remove food particles stuck between your teeth in hard-to-reach areas.

Don’t let dry mouth get in the way of your night’s sleep. Take the necessary measures and wake up in the morning in a good mood, fully prepared for a new day.

Medznat – A case of neurogenic cough associated with irritation of the vagus nerve receptors as a result of unilateral vascular compression of its root

CASE PRESENTATION

Patient (age
60 years old), came to the hospital with complaints of non-productive cough, which
cannot be controlled with drug therapy and which is ongoing
last 15 years. The development of cough was not preceded by a viral rash or trauma,
no respiratory tract infection, no exposure to aggressive fumes. The patient
no history of allergy, bronchial asthma, or gastroesophageal reflux
disease. At first, the cough was mild, but over time, attacks
coughs became more frequent, became stronger and more prolonged. Sometimes the attacks were
so strong that the patient could faint or wake up at night from
cough. Coughing fits began spontaneously, but many activities
for example, exercise, singing, or laughing may have triggered it. According to
of the patient, there were no voice disturbances between episodes of coughing.
The patient did not experience sore throat, sensation of constriction or spasm of the vocal
ligaments. The patient reported that coughing had a significant effect on his
working capacity: in 2016, he was unable to work due to a cough. IN
In 2018, the intensity of the cough decreased for several months, but then
aggravated again. The patient had a history of angina pectoris.
The patient was placed three cardiac stents with clopidogrel. At 1962 and
1965 The patient underwent tonsillectomy and myringotomy. In 1977
year he quit smoking. All allergy tests and provocative test with
methacholine were negative. The patient’s pH measurement was not possible
due to a strong reflex from the pharynx. Therapy with pantoprazole at a dose
40 mg and long-term antacid therapy also did not give positive results.
results. 10 years after the onset of coughing attacks, therapy was started
an angiotensin-converting enzyme (ACE) inhibitor and ramipril for
arterial hypertension. After 3 months, therapy was discontinued due to lack of
positive results. The results of CT examination of the chest organs
cells without features. Deviations were not identified by the results
studies carried out after numerous consultations with specialists
(allergist, cardiologist, pulmonologist, otolaryngologist).

What is the most likely diagnosis based on the description of the clinical case?

• Pulmonary tuberculosis
• Cough syndrome
  upper respiratory tract hypersensitivity
• Neurogenic
  cough associated with irritation of the vagus nerve receptors
• Chronic
  hypersensitivity pneumonitis

Introduction

According to
definition provided by Altman et al. in the latest review, neurogenic
cough is a chronic cough that lasts more than 8 weeks, and the mechanism
development of cough is not associated with external stimuli. This diagnosis is
diagnosis of exclusion, which is made only after a complete
testing to reduce the likelihood of other causes. According to the American
board of physicians-specialists in diseases of the chest (ACCP),
among the possible causes of cough, it is necessary to consider bronchial asthma,
non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and
diseases of the sinonasal region.

Modern
theories of the etiology of neurogenic cough note a certain similarity of such a cough
with trigeminal neuralgia, so one of the possible causes of neurogenic
cough may be vascular compression of the vagus nerve root. The most frequent
trigeminal neuralgia is caused by compression of the trigeminal nerve
vessel. Drug therapy is usually carried out with drugs to treat
neuralgia, it is also possible to perform neurosurgical intervention by the method
microvascular decompression. Performing a surgical intervention
recommended for patients who are unable to take medication
drugs due to poor tolerance or the risk of side effects.
Drug therapy for neurogenic cough can be done with amitriptyline,
tramadol and gabapentin. You can also use this unconventional
approach like speech therapy. Some patients with neurogenic cough may
develop VANCOUVER syndrome (neurogenic cough associated with irritation
vagus nerve receptors as a result of unilateral vascular
compression of its spine). If there is no response to drug therapy
a positive result can be obtained by applying the method
microvascular decompression.

Currently
analysis presents a rare case of unilateral vascular root compression
vagus nerve in the brainstem, which led to the development
neurogenic cough. Previous studies have not mentioned this etiology.
neurogenic cough. The analysis of a clinical case describes the features of a patient’s cough
and his response to numerous treatments, imaging findings
research and surgery. A treatment model is also presented
this rare disease.

CASE HISTORY

The patient had a history of angina pectoris, which was
stenting of the coronary arteries was performed with the installation of three cardiostents with
clopidogrel.

EXAMINATION AND LABORATORY STUDIES

According to the results of physical examination, cranial nerves are normal, lymphatic
nodes are not enlarged. According to the results of the examination of the nasal cavity signs
diseases of the sinonasal region were not detected. Was held
laryngoscopy, the results were normal:
i.e. normal mucous wave, no neoplasms, normal
closing of the glottis with a slight discrepancy in the back,
normal mobility on both sides, no swelling or redness of the cricoid
area or area of ​​the arytenoid cartilage, without hyperfunction of the supraglottic muscles.
The cough severity index (CSI) score of 1 was 20 out of 40, and the quality of life score
on the Leicester Cough Questionnaire (LCQ) 2 was 93 points out of 133. Index of symptoms
reflux (RSI) and voice impairment impact index (VHI) were normal and
were 11/45 and 0/40.4, respectively.

MANAGEMENT

Trial therapy with carbamazepine 200 mg was initiated
1 time / day, a week later the dose was increased to 200 mg
2 times/day During the second week of therapy, there was a significant decrease
frequency and intensity of coughing fits (80%). However, in connection with
serious side effects of carbamazepine (emotional instability,
suicidal ideation, etc.), the drug had to be discontinued, which
led to an exacerbation of coughing fits. According to the results of psychiatric
consultation, no signs of depression after discontinuation of carbamazepine were detected. Except
In addition, there were no signs of past psychopathy, feigning illness, or
conversion disorder. From trial therapy with gabapentin and amitriptyline
were rejected based on the results of the first trial therapy. Recent experience
researchers who managed to find a relationship between cough caused by hemi-laryngopharyngeal
spasm, and vascular compression of the vagus nerve root, prompted them
Perform an MRI of the patient’s brain. On a pulse train
spin echo revealed unilateral vascular compression of the vagus root
nerve in the brainstem on the left. Cessation of coughing fits for almost
8 hours were achieved with the help of inhalations of humidified air with nebulized
lidocaine concentration of 1% at a dose of 5 cm3. Unilateral
blockade of the superior laryngeal nerve (first on the left, and after 1 week on the right)
gave a positive result. The results of a neurological study of the lower
parts of the brain stem on the left confirmed the presence of severe compression
left vagus nerve root with a loop of the posterior inferior cerebellar artery (PICA).

An intervention was performed using the microvascular technique
decompression. During the intervention, the posterior inferior cerebellar artery
moved away from the vagus nerve and fixed in the anteromedial position using
teflon and Tisseel bioglue. In the postoperative ward, the patient had
coughing fits, but after a few hours the cough disappeared. The patient could loudly
speak and even sing without coughing. Within a year after the intervention in the patient
there are no coughing fits that bothered him before. Patient
there is a significant improvement in quality of life assessments (which corresponds to
maximum LCQ scores) and cough severity (corresponding to
minimum estimates of the CSI index). Signs of postoperative dysphonia,
limb dysmetria, dysphonia or dysarthria were absent. results
laryngoscopy performed 6 weeks after the intervention,
testified to the normal functioning of the vocal cords.

DISCUSSION

This case report presents a rare condition in which
in which vascular compression of the vagus nerve root caused the development
chronic non-productive neurogenic cough. In the treatment of cough was obtained
good response to neuralgia drugs, but no response to
antireflux drugs, speech therapy, antibiotics, and psychotherapy. Degree
cough severity gradually progressed, with periods of improvement noted
and worsening, as in trigeminal neuralgia. Diagnosis confirmation
with this rare disease, MRI results will serve as evidence of
vascular compression of the vagus nerve, a positive response to unilateral
vagus nerve block. The disease is treatable, but
neurosurgical interventions near the brain stem is associated with significant
risk.

Presented case gives a preview of symptoms and pathophysiology
this rare disease. However, to confirm the results
further study of the case series is needed. A disease that is not
treatable with numerous drugs, and the lack of
a history of mental disorders reduces the likelihood of receiving observable
results due to the placebo effect. There is a need for special
test to differentiate patients with chronic cough
other etiology from patients with cough caused by accidental vessel contact with
vagus nerve root. Serial unilateral proximal
vagus nerve block may be a valid diagnostic test. Temporary
cessation of cough after unilateral vagus nerve block with the same
side (but not the opposite), where the results of MRI revealed vascular
compression may serve as the test of choice in the diagnosis of VANCOUVER syndrome. IN
In this case, unilateral therapy was used to reduce the severity of symptoms.
bronchial ventilation with lidocaine and unilateral blockade of the upper laryngeal
nerve. The diagnosis could be confirmed by a positive response to a unilateral
blockade, but a negative response does not exclude the possibility of a diagnosis.

Prior to the intervention, the patient had a clear understanding that
after decompression of the vessel pressing on his left vagus nerve,
the cough may not go away. Postvascular compression of the trigeminal nerve,
focal demyelination at the site of compression could cause epaptic transmission
signal from nerve fibers that transmit touch (Aβ) to fibers,
transmitting a signal of acute or burning pain. Tracheobronchial sensory
and laryngeal afferents are transmitted to the brainstem via the vagus
nerve. Similarly, compression of the vagus nerve could cause epaptic
transmission from nerve fibers carrying information from non-cough receptors to
fibers that carry information from cough receptors. Except 80% touch
nerve fibers, the vagus nerve also has motor fibers. If at
ephaptic transmission of an electrical signal that travels along the vagus nerve,
enters the motor nerve fibers, the patient may develop a cough and
hemi-laryngopharyngeal spasm.

STUDYING

The results of the analysis of this clinical case indicate the need
consider the likelihood of unilateral vascular compression of the vagus nerve in patients
with drug-resistant non-productive cough.
This analysis also gives a preliminary idea of ​​the symptoms,
pathophysiology and treatment of this rare disease.

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