What is a chronic cough?
A cough that is the only or main symptom of the respiratory system and has been present for more than 8 weeks with no obvious lesions on X-ray chest radiographs is usually referred to as chronic cough of unknown origin, or chronic cough for short.
Chronic cough is not the same as chronic bronchitis:
Research into the etiology of chronic cough has only begun in recent years, and many patients and even primary care physicians often equate chronic cough with chronic bronchitis, which is completely wrong. Chronic cough is only one symptom of a disease that includes many different causes, and chronic bronchitis is only one of the causes of chronic cough, accounting for a very small percentage of the disease. A study by the Guangzhou Institute of Pulmonology showed that 30% of patients with chronic cough had been misdiagnosed, and 20% of them had been misdiagnosed as “chronic bronchitis” or “bronchiectasis”.
What is a cough?
Coughing is a protective respiratory reflex of the body. It occurs when foreign bodies, irritating gases, respiratory secretions, etc. stimulate receptors in the respiratory mucosa and impulses are transmitted to the medullary cough center through afferent nerve fibers, causing a cough.
The action of coughing is a short, deep inhalation, with the vocal cords tightly closed and the respiratory muscles, intercostal muscles and diaphragm contracting rapidly and violently, causing a high pressure jet of gas to be ejected from the lungs, which becomes a cough. With the rapid rush of air, foreign bodies or secretions are expelled from the respiratory tract.
In addition to the respiratory organs such as the nose, pharynx, larynx, trachea, bronchi, lungs and pleura, cough is also caused by stimulation of the vagus nerve in the ear, meninges, heart, esophagus, stomach and other internal organs, which can also be transmitted to the cough center.
Cough is the main symptom of respiratory diseases. For example, cough without sputum or with little sputum as a dry cough is commonly seen in the early stages of acute pharyngitis and bronchitis; acute and sudden onset of cough is mostly seen in endobronchial foreign bodies; long-term chronic cough is mostly seen in chronic bronchitis and tuberculosis.
The detrimental effect of coughing is that it can spread tracheal lesions to the adjacent small bronchi and aggravate the condition. In addition, a persistent and violent cough can interfere with rest and can also easily consume energy and cause damage to the elastic tissue of the alveolar wall, leading to emphysema.
What are the physical and psychological risks of chronic cough?
Many patients with chronic cough have been misdiagnosed as “chronic bronchitis or chronic pharyngitis” for a long time, and treatment with various antibiotics has not been effective. Many patients have the disease for several years, which seriously interferes with their daily life and work and causes great suffering to the patient and his family. According to a statistic from the Guangzhou Institute of Pulmonary Research, up to 25% of female chronic cough patients suffer from urinary incontinence due to severe coughing, and some patients even need to use “diapers” at work. Some patients suspect that they have an incurable disease or are worried about being thought of as having an “infectious disease” due to their untreated cough, causing severe anxiety and social disorders, and in severe cases they are afraid to go to work or school.
Why is chronic cough easily misdiagnosed?
Patients with chronic cough have few symptoms, no significant abnormalities on X-ray imaging or even lung function, and few diagnostic clues, which is an important reason why patients with chronic cough are not diagnosed in a timely manner. The distribution of chronic cough etiology shows that chronic cough is not only associated with respiratory diseases, but also with nasal and gastroesophageal diseases and cardiovascular diseases. About 30 to 50% of patients with chronic cough are caused by postnasal drip syndrome and gastroesophageal reflux. If a clinician encounters a cough and simply associates it with a respiratory disease as a matter of course, it is highly likely to be misdiagnosed and mistreated.
What tests are needed to diagnose chronic cough?
The diagnosis of the etiology of chronic cough involves a variety of tests, including induced sputum cytology, airway hyperresponsiveness and cough sensitivity measurements, 24-hour esophageal pH measurements, nasopharyngoscopy, etc. The tests should be performed selectively according to the patient’s condition, rather than aimlessly performing a wide range of tests. It is not the case that the more expensive tests are of diagnostic value, e.g. CT is not usually necessary, and it can be said that more than 95% of patients with chronic cough have no significant abnormalities on chest CT. Some tests, although simple, are of great diagnostic value, such as the diagnosis of eosinophilic bronchitis which relies crucially on induced sputum cytology. Unfortunately, this test has not yet been performed in most units in China. Of course chest X-ray is a basic examination by which some obvious lung pathologies such as bronchopulmonary tumors, tuberculosis, pulmonary fibrosis, etc. can be excluded. The 24-hour esophageal pH measurement is currently the most effective method for diagnosing gastroesophageal reflux cough. In order to better serve the majority of patients, the Guangzhou Institute of Pulmonary Research has introduced an esophageal pH monitor from abroad and established a 24-hour esophageal pH monitoring method to determine the presence or absence of gastric acid reflux and the correlation coefficient between cough and reflux. Many patients with chronic cough receive correct diagnosis and effective treatment.
What are the main causes of chronic cough?
The etiology of chronic cough is quite complex, except for a few chronic cough diseases associated with bacterial infections, where the use of cough suppressants or pan-antibiotics alone is ineffective and even further aggravates the condition. Therefore, only a clear diagnosis of the etiology of chronic cough and treatment targeting the cause can achieve a positive outcome. European and American studies have shown that postnasal drip syndrome, cough variant asthma, and gastroesophageal reflux disease are common causes of chronic cough, accounting for 80 to 95% of all chronic cough causes. A recently completed diagnostic study on the etiology of chronic cough at the Guangzhou Institute of Pulmonology showed that the top 5 causes of cough were found to be: eosinophilic bronchitis (22%), postnasal drip syndrome 17%, cough variant asthma (14%), allergic cough (12%), and gastroesophageal reflux (12%), which accounted for 77% of the causes of chronic cough, with eosinophilic bronchitis being the Eosinophilic bronchitis is the leading cause of chronic cough, and chronic bronchitis accounts for only 5%, with a different distribution of causes than abroad.
In addition to the five major causes of chronic cough mentioned above, there are also some rare causes that need to be noted, which are diverse, such as atypical bronchiectasis, early interstitial lung fibrosis, early bronchopulmonary carcinoma, endobronchial tuberculosis, bronchial microlithiasis, and left heart insufficiency.
What is cough syncope syndrome?
Cough syncope syndrome is a condition in which a patient with no previous history of seizures suffers a transient loss of consciousness due to a violent, continuous cough.
The cause of cough-induced transient loss of consciousness is unknown, and the main clinical feature is a few seconds of transient loss of consciousness following an episodic paroxysmal cough. Typically, coughing can cause a syncopal episode within a few seconds, sometimes with mild spasms. The duration of syncope is usually within 10 seconds, but in a few cases it can be as long as 30 to 60 seconds. It should be noted that the patient is prone to fainting when in a standing or sitting position, and that eating, laughing, and other situations can easily trigger violent coughing and coughing syncope. There are no sequelae after recovery of consciousness.
Patients are predominantly male, accounting for about 97% of the population, with a wide age distribution, but young adults are the most common, especially in males in their 40s, and pediatric patients can also be seen. The disease usually develops slowly, and for milder initial symptoms, it often goes unnoticed by the patient. The diagnosis is generally not difficult based on the characteristics of recurrent violent bouts of cough with transient loss of consciousness and the finding of primary illnesses such as chronic bronchitis and chronic cough. However, it needs to be differentiated from syncope and atypical seizures due to carotid sinus allergy, etc. EEG and evoked tests and treatment response can be used for differentiation, and a history of previous seizures and chronic lung disease can also be used as a reference for differential diagnosis.
Can parasitic worms cause cough?
It is commonly thought that parasites are found in the intestinal tract of the body, but they can also be found in the lungs or other parts of the body, causing coughing and other related symptoms. Pulmonary parasitosis is mostly a pulmonary manifestation of a systemic disease caused by parasites, or in some cases, it is confined to the lungs. Common parasitic diseases that can live in the lungs include.
1, pulmonary schistosomiasis, also known as pulmonary schistosomiasis, because pulmonary schistosomes are mainly parasitic in the lungs, so the pulmonary symptoms are more obvious. Patients often have a chronic cough, chest pain, sputum, hemoptysis, and some patients are accompanied by pleural effusion. Personal prevention is mainly not to eat raw or uncooked stream crabs and mayflies, and not to drink raw stream water.
2, pulmonary encysticercosis, a disease caused by the larvae of fine-grained echinococcus tapeworm parasitic in the lungs, common in pastoral areas. Dry cough, chest tightness, chest pain and other signs of irritation or pressure; when the cysts rupture can have choking cough, coughing out a lot of watery cyst fluid and can appear allergic reactions, such as skin flushing, wheezing, urticaria, etc.. Prevention should strengthen the management of dogs, strengthen the management of slaughterhouses, pay attention to personal protection, avoid close contact with dogs, etc.
3. Pulmonary toxoplasmosis is an acute or chronic respiratory infection caused by Toxoplasma gondii, which can be transmitted by congenital and acquired routes. Prevention should emphasize hygiene promotion and education, not playing with cats and dogs, and preventing water sources from being contaminated by cats. Forbid the consumption of undercooked meat, eggs and milk.
4. Pneumocystis carinii 5. Pulmonary mites 6. Pulmonary thoracic amebiasis 7. Chest filariasis 8. Pulmonary schistosomiasis 9. Malaria lung 10. Hookworm disease 11. Trichinosis 12. Cantonal tuberculosis, etc.
Why does heart disease cause cough?
Cough and dyspnea are often early symptoms of pulmonary stasis due to chronic cardiac insufficiency. In rheumatic heart disease, coronary heart disease, and hypertensive heart disease, the absolute or relative reduction in blood displacement of the heart, the inability of the heart to completely drain the blood returning to the heart, and the inability of blood from the lungs to return to the heart in a timely manner, lead to pulmonary vascular bed stasis and result in cardiac insufficiency. Clinical manifestations often appear as a persistent dry cough followed by plasma sputum and even bloody foamy sputum in severe cases.
What are the characteristics of chronic pharyngitis cough?
Chronic pharyngitis is a common throat disorder in the population. It is mainly due to incomplete treatment of acute pharyngitis and its recurrent attacks, which turn into chronic over time; some patients suffer from air pollution in the work environment; some are stimulated by tobacco, alcohol, spicy food, etc. Chronic pharyngolaryngitis cough is often triggered by itchy throat, with a shallow cough, a little white mucus sputum, recurrent symptoms, long duration, often accompanied by the habit of “throat clearing”, accompanied by dry mouth, redness and pain in the throat, foreign body sensation in the throat, aggravated after exertion, and hoarseness in severe cases.
Do medications cause coughing?
The answer is yes, and sometimes certain medications are the culprit of a cough. There are more than 100 medications known to cause coughing. It is important to emphasize that if you develop a cough after taking a certain medication, you should see your doctor to find the “culprit” of the cough and, if it is really caused by the medication, follow your doctor’s advice to replace it with another medication or stop taking it. The following is a brief description of the characteristics of coughs caused by angiotensin-converting enzyme inhibitors, amiodarone, hydrochlorothiazide, and bleomycin.
The main clinical manifestations of ACEI-induced cough are paroxysmal dry cough, or cough with a little white sputum, which can appear as early as 1 day after taking the drug, but mostly about 1 week after taking the drug, mostly aggravated at night or in the lying position, and in some patients ACEI can cause nonspecific airway hyperresponsiveness, dyspnea, bronchospasm, and asthma. The management of ACEI-induced cough is to discontinue the drug and replace it with another one.
Amiodarone (antiarrhythmic), hydrochlorothiazide (diuretic), and bleomycin (antineoplastic) can also cause cough.
Why does moving into a new home cause cough?
In recent years, with the rapid improvement in the living standards of urban residents, there has been a boom in the decoration of new homes with new building and decorative materials, and it is these new building and decorative materials that cause indoor air pollution and have an impact on human health. One of the most important disease-causing factors is formaldehyde, currently decorated with all man-made panels, various decorative materials, paints, coatings contain formaldehyde, benzene in varying degrees. Formaldehyde is a harmful substance that can stimulate the human respiratory tract, commonly causing symptoms such as watery eyes, sneezing, coughing, nausea, headache, and breathing difficulties.
When decorating your home. Try to use decorative materials with the “green mark”. Keep your room well ventilated.
What occupations are likely to cause coughing?
Traffic police officers spend their days with car exhaust, dust, dust and other suspended particles, so they are prone to coughing; teachers and others use their voices too much due to their occupations, which can easily cause coughing; interior decoration workers are often exposed to formaldehyde and benzene, which can easily cause coughing by stimulating the respiratory tract; workers with long-term exposure to dust inhale high concentrations of dust for a long time, which can cause damage to the mucous membranes of the upper respiratory tract and bronchi at all levels, easily causing coughing.
Why does coughing cause abdominal pain?
During a cough attack, the vocal cords close, the diaphragm contracts strongly, and the respiratory and abdominal muscles also contract violently, causing a rapid rise in intrapulmonary and intrathoracic pressure and a sharp increase in intra-abdominal pressure, which strains the abdominal muscles and abdominal organs and can easily strain the abdominal muscles.