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Whooping cough burping: A putative link between pertussis and new onset of gastroesophageal reflux an observational study

A putative link between pertussis and new onset of gastroesophageal reflux an observational study

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Whooping cough – NHS

Whooping cough (pertussis) is a bacterial infection of the lungs and breathing tubes. It spreads very easily and can sometimes cause serious problems. It’s important for babies and children to get vaccinated against it.

Check if you or your child has whooping cough

The first signs of whooping cough are similar to a cold, such as a runny nose and sore throat (a high temperature is uncommon).

After about a week, you or your child:

  • will get coughing bouts that last for a few minutes and are worse at night
  • may make a “whoop” sound – a gasp for breath between coughs (young babies and some adults may not “whoop”)
  • may have difficulty breathing after a coughing bout and may turn blue or grey (young infants)
  • may bring up a thick mucus, which can make you vomit
  • may become very red in the face (more common in adults)

The cough may last for several weeks or months.

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if:

  • your baby is under 6 months old and has symptoms of whooping cough
  • you or your child have a very bad cough that is getting worse
  • you’ve been in contact with someone with whooping cough and you’re pregnant
  • you or your child has been in contact with someone with whooping cough and have a weakened immune system

Whooping cough can spread very easily. It’s best to call the GP before you go in. They might suggest talking over the phone.

Check symptoms on 111 online (for children aged 5 and over) or call 111 (for children under 5).

Whooping cough can be dangerous

Babies under 6 months old with whooping cough have an increased chance of having problems such as:

  • dehydration
  • breathing difficulties
  • pneumonia
  • seizures (fits)

Whooping cough is less severe in older children and adults but coughing may cause problems including:

  • sore ribs
  • hernia
  • middle ear infections
  • pee leaking out when you cough (urinary incontinence)

Immediate action required: Call 999 or go to A&E if:

  • your or your child’s lips, tongue, face or skin suddenly turn blue or grey (on black or brown skin this may be easier to see on the palms of the hands or the soles of the feet)
  • you or your child are finding it hard to breathe properly (shallow breathing)
  • you or your child have chest pain that’s worse when breathing or coughing – this could be a sign of pneumonia
  • your child is having seizures (fits)

Treatment for whooping cough

Treatment for whooping cough depends on your age and how long you’ve had the infection.

Hospital treatment is usually needed if you have severe whooping cough, or your baby is under 6 months old and has whooping cough.

If whooping cough is diagnosed within 3 weeks of the infection, you’ll be given antibiotics to help stop it spreading to others. Antibiotics may not reduce symptoms.

If you’ve had whooping cough for more than 3 weeks, you’re no longer contagious and do not need antibiotics.


Keep taking the antibiotics until you’ve completed the course, even if you feel better. Stopping treatment too soon could lead to the infection coming back.

How to ease the symptoms of whooping cough

There are some things you can do to help ease the symptoms of whooping cough.


  • do not give a child under 16 paracetamol and ibuprofen at the same time – always check first with a GP or pharmacist

  • do not give aspirin to children under 16

  • do not take cough medicines – they’re not suitable for young children and do not help with this type of cough

How long whooping cough is contagious

If you have whooping cough, you’re contagious from about 6 days after the start of cold-like symptoms to 3 weeks after the coughing starts.

If you start antibiotics within 3 weeks of starting to cough, it will reduce the time you’re contagious for.


Stay off school, work or nursery until 48 hours after starting antibiotics, or 3 weeks after your symptoms started if you’ve not had antibiotics.

The whooping cough vaccine

The whooping cough vaccine protects babies and children from getting whooping cough. That’s why it’s important to have all the routine NHS vaccinations.

The whooping cough vaccine is routinely given as part of the:

  • 6-in-1 vaccine – for babies at 8, 12 and 16 weeks
  • 4-in-1 pre-school booster – for children aged 3 years 4 months

If you’re pregnant you should also have the whooping cough vaccine – ideally between 16 and 32 weeks.

Find out more about the whooping cough vaccination in pregnancy

Page last reviewed: 21 March 2023
Next review due: 21 March 2026

What is chronic cough? | Chikina S.Yu.

For citation. Chikina S.Yu. What is chronic cough? // RMJ. 2015. No. 18. S. 1101–1105.

Cough is one of the most common respiratory symptoms and at the same time one of the most intractable problems of modern clinical medicine. Cough is divided into acute (lasting less than 3 weeks) and chronic (lasting more than 8 weeks). Cough lasting 3 to 8 weeks. called subacute, it can be the result of an acute respiratory viral infection with a longer course (hence it is often called post-infectious cough) or the onset of a chronic cough [1]. Acute and subacute cough can stop spontaneously even without special treatment, such patients do not always go to the doctor. In contrast, chronic cough is a more severe condition; it accompanies many chronic respiratory diseases and at the same time can cause serious complications: gastroesophageal reflux (GER), urinary incontinence, insomnia, cause psychological, social and family problems and, finally, significantly reduce the quality of life of patients [2].

Cough triad
Over the past few decades, the view of the causes and pathogenesis of chronic cough has changed many times. Initially, cough was called chronic in any chronic respiratory diseases: chronic obstructive pulmonary disease (COPD), lung cancer, idiopathic pulmonary fibrosis. In the 1990s The theory of the “cough triad” has been formed, according to which the causes of chronic cough are most often bronchial asthma (BA), GER, or chronic rhinitis [3].

Bronchial asthma
Cough is one of the common symptoms of asthma and often accompanies other manifestations of it (suffocation attacks, episodes of shortness of breath, wheezing). Asthma is the cause of chronic cough in 24-29% of cases in adult non-smokers [4]. However, in a small percentage of patients, cough may be the predominant or only symptom of asthma. In such cases, one speaks of a cough variant of BA [4]. Thus, asthma should always be considered as a potential cause of chronic cough. If a patient with chronic cough tests positive for a bronchodilator on spirometry with a bronchodilation test, the diagnosis is usually straightforward. But often, when examining a patient, there are no wheezing in the lungs, and the study of pulmonary function does not reveal signs of reversible bronchial obstruction. In this case, bronchoprovocation tests are indicated, which help to identify bronchial hyperreactivity, typical of asthma. In addition, in many cases AD is accompanied by blood and/or sputum eosinophilia. Confirmation of the diagnosis of cough asthma is the disappearance of cough on the background of anti-asthma therapy. If it is not possible to perform a bronchoprovocation test, a trial of anti-asthma therapy with inhaled corticosteroids is recommended (recommendation grade A) [44]. In general, the approach to the treatment of cough asthma does not differ from the treatment of the classical form of this disease. As a rule, against the background of therapy with inhaled bronchodilators and corticosteroids, improvement occurs by the end of the first week of treatment, although the complete disappearance of cough may require continued therapy for up to 8 weeks. [44].

Gastroesophageal reflux
GER is the second most common cause of chronic cough. Although the classic manifestation of GER is heartburn, chronic cough is more associated with regurgitation (belching). Heartburn is a symptom of acid reflux, while more than half of patients with GER are non-acid in nature, therefore, such patients do not experience heartburn [3]. In this situation, the lack of classic GER symptoms and the widely available diagnostic tests to confirm this diagnosis puts the clinician in a difficult position. Signs of non-acid reflux are symptoms of an irritable colon, belching with air or food eaten, and postprandial cough (occurring approximately 10 minutes after eating when the lower esophageal sphincter opens) [3]. Belching with air (gaseous reflux) is considered a physiological phenomenon, since it prevents intestinal swelling. However, in individuals with chronic cough, even gaseous reflux can provoke coughing due to irritation of oropharyngeal receptors by air flow [5].

Chronic rhinitis
In the recent past, the fact that chronic cough can be associated with chronic rhinitis of any etiology was considered undeniable. Chronic rhinitis or chronic diseases of the paranasal sinuses are often accompanied by the so-called postnasal drip, i.e., the flow of nasal mucus along the back of the pharynx, which, mechanically irritating the cough receptors of the nasopharynx and oropharynx, can cause coughing. However, experts have now come to the conclusion that postnasal drip is a physiological process and by itself cannot be an adequate explanation for chronic cough [5]. On the other hand, chronic rhinitis may have an allergic origin, in which case the chronic cough is more likely to be associated with asthma.

Cough hypersensitivity syndrome
Not all patients with chronic cough show signs of asthma, chronic rhinitis, and GER, and trial therapy for these diseases also does not always lead to a reduction in cough. Previously, in such cases, they spoke of an “idiopathic” cough. However, studies in recent years have led to the conclusion that chronic cough should not be regarded as a symptom of any disease, but as an independent disease, since in different diseases cough has the same characteristics and similar conditions of occurrence. As a result, in recent years, the theory of cough hypersensitivity syndrome has been formed [6].
According to this theory, under certain circumstances, the sensitivity of cough receptors located in the mucous membrane of the upper and lower respiratory tract increases, which leads to their reaction to provoking factors that do not cause a cough in a healthy person: chemical (tobacco smoke, pungent odors, acute, peppered or salty food), mechanical (speech or physical activity, dry food, change in body position), temperature (change in temperature of inhaled air).

Cough hypersensitivity syndrome includes a cough that is not explained by any disease, accompanied by a sensation of tickling or irritation in the throat or behind the sternum, dysphonia / hoarseness [6]. Cough hypersensitivity is not an allergic reaction, since it is based on a different pathophysiological mechanism.
The universal trigger for chronic cough is upper respiratory tract infection. After the elimination of the pathogen, the cough reflex usually returns to a normal level, but sometimes the patient retains an increased sensitivity of cough receptors even to weak stimuli for a long time after an acute respiratory infection [5]. Cough hypersensitivity syndrome can be genetically determined [7] or can be formed against the background of a chronic inflammatory process in the airways. The exact mechanism for the transition from acute/subacute cough to chronic is currently not fully understood; it may include a different combination of biological, neurological, genetic, immunological mechanisms and environmental factors (air temperature, infection, irritants, pollutants). Unfortunately, at present there are no methods for assessing the sensitivity of cough receptors that could be used in everyday clinical practice, so the diagnosis of cough hypersensitivity remains exclusively clinical. It has been established that chronic cough is twice as common in women of middle, especially perimenopausal age (40–50 years) as compared with men of the same age. It is assumed that the reason for gender differences in the prevalence of chronic cough lies in the need for increased protection of the respiratory tract of women from aspiration during pregnancy [6].

Treatment of chronic cough
According to the experts of the European Respiratory Society, the treatment of chronic cough should begin with an attempt to establish its cause (history taking, lung x-ray, clinical blood test, spirometry with a bronchodilation test, ENT consultation). If asthma, chronic diseases of the nose and paranasal sinuses or GER are detected, patients are shown specific treatment according to the established diagnosis. In the absence of clear signs of a specific disease after the initial examination, a trial therapy for 8 weeks is recommended. sequentially with asthma (inhaled corticosteroids), antireflux (proton pump inhibitors) drugs and intranasal steroids. A decrease in cough with one of these treatment options is regarded as indirect confirmation of the corresponding cause of the cough. In the absence of the effect of trial therapy, further examination of the patient is recommended using more complex diagnostic methods: computed tomography (CT) of the lungs, bronchoscopy, bronchoprovocation tests, gastroscopy, etc. (Fig. 1) [8].

Non-specific therapy for chronic cough consists of the use of cough suppressants and other symptomatic treatment to reduce the severity of cough during the period of examination of the patient and before the start of specific therapy or when it is ineffective. Today, there are no drugs that can effectively reduce chronic idiopathic cough. According to the theory of cough hypersensitivity, in order to eliminate cough in such patients, it is necessary to reduce the sensitivity of cough receptors in the respiratory tract. Such drugs are currently being developed.
Table 1 lists drugs that can reduce chronic idiopathic cough with varying degrees of effectiveness [9].
Morphine and central antipsychotics (amitriptyline, gabapentin, pregabalin), in addition to the ability to suppress cough, have a powerful psychotropic effect, which significantly limits their use. Codeine may have an antitussive effect in some categories of patients, which, however, has not been confirmed in all studies, but the optimal duration of its use has not been studied, therefore, long-term use of codeine in patients with chronic cough is not recommended [10]. A modern practitioner can use dextromethorphan, which is part of the combined over-the-counter cough medicines, or ambroxol, but the antitussive activity of these drugs is low [10, 11]. With GER-induced cough and the absence of the effect of antireflux therapy, baclofen can be prescribed, but its effectiveness is also insufficient [10]. Lidocaine can reduce the intensity of cough due to the local anesthetic effect on the receptors of the oropharyngeal zone, however, the same effect increases the risk of aspiration of saliva, bronchial secretions and food, therefore, in routine medical practice, it should not be used as an antitussive agent [12]. Macrolides are effective in the treatment of whooping cough and Mycoplasma pneumoniae and Chlamydia pneumoniae infections that are accompanied by cough, in addition, they can reduce inflammation in the airways in patients with COPD and bronchiectasis and, possibly, thereby reduce the severity of cough [13, 14], and can also reduce the intensity of GER-induced cough. However, due to the insufficient amount of evidence-based information, this aspect of their use, as well as phosphodiesterase inhibitors [15], has not yet entered routine medical practice.

Thus, today we cannot effectively treat chronic idiopathic cough, but we can try to prevent its development. It was mentioned above that chronic cough in most cases begins as an acute cough with an acute infection of the upper respiratory tract, and its chronicity, as a rule, contributes to chronic inflammation in the mucous membrane of the respiratory tract [5]. Therefore, timely and active treatment of acute respiratory infection and acute inflammation can theoretically reduce the risk of acute cough becoming chronic. It is known that, on the one hand, not any inflammation requires antibiotics, on the other hand, not only antibiotics have an anti-inflammatory effect on the respiratory tract.

Thiol derivatives: erdosteine ​​
One of the common and well-known drugs are thiol derivatives, which include acetylcysteine, carbocysteine ​​and erdosteine ​​registered in the Russian Federation. In addition to the known mucoactive properties, these drugs have powerful antioxidant activity, which causes anti-inflammatory and anti-adhesive effects [16].
Like other representatives of thiols, erdosteine ​​has a triple effect on the respiratory tract. First, it is a powerful mucolytic and increases the activity of mucociliary clearance, promoting the elimination of bacteria from the respiratory tract [17]. Secondly, erdosteine ​​is an effective antioxidant that can suppress oxidative processes in the respiratory tract and lung tissue that develop during acute and chronic inflammation, and thus have an anti-inflammatory effect. The antioxidant activity of erdosteine ​​is higher than that of other representatives of thiols [18]. Thirdly, the drug has a direct anti-adhesive activity, destroying the pilin protein molecules on the surface of the bacterial cell, which serve to attach the bacterium to the epithelium of the respiratory tract [19].
For clinicians, it is important that erdosteine ​​increases the concentration of antibiotics, in particular amoxicillin [20] and clarithromycin [21], in bronchial secretion, without affecting their concentration in blood serum, and enhances the effectiveness of treatment compared with antibiotic therapy in combination with placebo .

Erdostein accelerates the resolution of exacerbations of chronic bronchitis (CB), eliminates clinical symptoms faster and promotes the elimination of bacterial pathogens (Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae) from the bronchi compared with placebo [20].
In 2010, a meta-analysis of 15 randomized controlled clinical trials involving a total of 1046 patients with CB or COPD showed that erdosteine ​​was faster than placebo and other mucolytics in reducing the clinical symptoms of an exacerbation; in particular, cough frequency decreased by 81%, cough intensity by 70% compared with placebo. The overall efficacy of erdosteine, as assessed by physicians, was also higher than that of placebo and other mucolytics [22].
With long-term use in patients with CB/COPD, erdosteine ​​may also have a preventive effect, reducing the frequency of future exacerbations of these diseases. At 1991 M. Fioretti et al. in a double-blind, placebo-controlled study, the effect of erdosteine ​​on the frequency of exacerbations of chronic bronchitis in 184 patients was evaluated. The number of patients who did not have exacerbations during the study period was significantly higher in the erdosteine ​​group (48.9%) than in the placebo group (12.6%) [23]. The larger, randomized, multicenter, double-blind, placebo-controlled EQUALIFE trial in 155 patients with moderate COPD who received oral erdosteine ​​600 mg/day or placebo for 8 months. in the cold season, showed that after 8 months. treatment, the number of COPD exacerbations and associated hospitalizations in the erdosteine ​​group was significantly less than in the placebo group: 0. 94±1.12 compared to 1.38±1.30 and 0.16±0.57 compared to 0.31±0.74 exacerbations/hospitalizations per patient, respectively. The total length of stay in the hospital was also shorter among patients treated with erdosteine ​​(70 days compared to 163 days in the placebo group). In general, erdosteine ​​reduced the frequency of COPD exacerbations by 36.9%, the duration of hospitalizations by 57%. In addition, a significant improvement in lung function, exercise tolerance and quality of life was shown during treatment with erdosteine ​​compared with placebo [24].
Erdostein is well tolerated: in terms of the frequency of side effects among 1046 patients, it did not differ from placebo and other mucolytics [22]. The maximum duration of its continuous use today is 8 months. [24]. The results of a large international RESTORE study are currently awaiting, in which the duration of continuous use of erdosteine ​​in patients with COPD was 1 year.

In recent years, a significant step has been made in understanding the nature of chronic cough. On the basis of the data obtained, a new pathogenetic concept of chronic cough as an independent disease was formulated, which makes it possible to explain its occurrence in almost any clinical situation. Currently, new drugs are being developed that affect the sensitivity of cough receptors in the respiratory tract, however, today, in the absence of effective drugs to eliminate chronic cough, based on the published results of clinical studies, it is logical to assume that the use of erdosteine ​​in acute respiratory infections can reduce the bacterial or viral load on the respiratory way, reduce the severity of inflammation in the bronchial wall and prevent the formation of cough hypersensitivity syndrome.

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