Podcast
Questions and Answers
What percentage of American adults are estimated to experience chronic cough?
What percentage of American adults are estimated to experience chronic cough?
In 2019, cough was the second most common reason for emergency department visits among which age group?
In 2019, cough was the second most common reason for emergency department visits among which age group?
Which statement best describes the pathways involved in initiating a cough?
Which statement best describes the pathways involved in initiating a cough?
How much do Americans spend annually on nonprescription cough and cold medications?
How much do Americans spend annually on nonprescription cough and cold medications?
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What type of receptors are more sensitive to mechanical stimulation during cough initiation?
What type of receptors are more sensitive to mechanical stimulation during cough initiation?
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Which of the following classifications describes a cough that lasts less than three weeks?
Which of the following classifications describes a cough that lasts less than three weeks?
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What is the primary function of antitussives in cough treatment?
What is the primary function of antitussives in cough treatment?
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Which FDA-approved medication is indicated for symptomatic relief of acute, ineffective productive cough?
Which FDA-approved medication is indicated for symptomatic relief of acute, ineffective productive cough?
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What type of therapy includes nonmedicated lozenges and hydration for cough treatment?
What type of therapy includes nonmedicated lozenges and hydration for cough treatment?
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Which of the following is a potential consequence of chronic cough?
Which of the following is a potential consequence of chronic cough?
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Which of the following acts centrally on the medulla to increase cough threshold?
Which of the following acts centrally on the medulla to increase cough threshold?
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What is a core consideration when selecting a cough product for treatment?
What is a core consideration when selecting a cough product for treatment?
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What type of cough refers to a cough that produces mucus?
What type of cough refers to a cough that produces mucus?
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Study Notes
Cough Overview
- Cough is a vital defensive respiratory reflex
- It has significant adverse physical and psychological consequences
- Has a substantial economic impact
- Initiated by stimulation of chemically and mechanically sensitive, vagally mediated bronchopulmonary and extrapulmonary sensory nerves
- Classified as acute, subacute, or chronic, and productive or nonproductive
- Self-treatment aims to reduce cough frequency and severity
- Exclusions to self-treatment include signs/symptoms of serious underlying conditions
Pathophysiology of Cough
- Cough begins with deep inhalation, followed by glottis closure and contraction of chest/abdominal/diaphragmatic muscles
- Pressure in the thoracic cavity reaches 300 mm Hg
- Coughing expels mucus, debris, and foreign material
- Cough strength/intensity influenced by activated afferent nerve number/intensity
- Voluntary cough controlled by the cerebral cortex
Clinical Presentation of Cough
- Productive (wet/chesty): Serves physiologic purpose for expelling secretions to prevent infection and lung damage
- Ineffective productive: Difficult to expel secretions
- Nonproductive (dry/hacking): Serves no useful physiologic purpose, associated with conditions like viral/bacterial infections, GERD, cardiac disease and medications
Treatment Goals
- Reduce number and severity of coughing episodes
- Prevent complications of cough
- Symptomatic treatment
- Requires identification of underlying condition/disease
Common Causes of Cough
- Acute: Viral URTIs (common cold), acute bacterial sinusitis, acute bronchitis, pertussis, allergic rhinitis, COPD exacerbation, pneumonia, environmental irritants
- Subacute: Postinfectious (e.g., Mycoplasma pneumoniae), congestive heart failure
- Chronic: UACS, asthma or asthma-like conditions, GERD, COPD, chronic bronchitis
Nonpharmacologic Therapy
- Nonmedicated lozenges/hard candies
- Humidification
- Nasal drainage interventions
- Hydration
Pharmacologic Therapy
- FDA-approved nonprescription oral antitussives (codeine, dextromethorphan, diphenhydramine, chlophedianol)
- FDA-approved expectorant (guaifenesin)
- FDA-approved topical antitussives (camphor and menthol)
Clinical Considerations
- Cough is a common reason for outpatient visits and emergency department visits
- Clinical impact of cough highly significant
- Nearly 11% of American adults have chronic cough
- Americans spend >$9.1 billion annually on cough, cold, and related medications
- Cough suppression should not be used for productive cough unless benefits outweigh risks
Special Considerations
- Codeine (schedule V narcotic): Possible addiction and respiratory depression risks
- Cough suppressants: Reduced doses may be needed for elderly patients and those with chronic diseases or pre-existing conditions.
- Codeine/dextromethorphan use in children under 18 is contraindicated
- Guaifenesin for coughs due to acute infections may not resolve until 3-4 weeks
Patient Factors
- Cough is a symptom of various acute/chronic diseases
- Exclusions for self-care based on potential underlying conditions
- Proper assessment crucial before self-treatment
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Description
This quiz covers the essential aspects of cough, including its defensive reflex nature, classification, and implications for self-treatment. It also delves into the pathophysiological mechanisms behind coughing and the clinical presentations of cough types. Test your understanding of this critical respiratory reflex.
