Coughing is a protective reflex action of the human body. By coughing, secretions or inhaled foreign bodies can be discharged from the trachea and throat to keep the respiratory tract clean and unobstructed. It is mostly seen in winter and spring. Healthy people may occasionally develop a cough, but frequent, violent coughs can interfere with work and sleep and must be treated promptly. Common causes include upper respiratory tract infections, acute tracheobronchitis, chronic obstructive pulmonary disease, bronchial asthma, and adverse drug reactions.
The clinical manifestations of cough vary from one cause to another, and the causes of cough can be generally understood according to the characteristics of the cough.
1. A cough that appears suddenly and has a relatively short course may be caused by a cold, acute bronchitis, pneumonia, pneumothorax, pleurisy, or other diseases. Or it may appear in the early stages of the disease, where the patient’s righteousness is not deficient and the evil is more obvious, and treatment is based on attacking and removing the evil. Most coughs that appear slowly and have a long duration are caused by diseases such as chronic pharyngitis, chronic bronchitis, tuberculosis, lung cancer, bronchiectasis, and interstitial lung disease. The patient’s vital energy is already deficient and treatment should be both offensive and remedial.
2. If the cough is obvious when waking up in the morning, it is mostly seen in chronic bronchitis and bronchial dilatation, with phlegm and dampness; nighttime cough is mostly likely to be due to left heart insufficiency and bronchial asthma, mostly manifesting as yang deficiency or yin deficiency and fire; most coughs are obvious when eating are caused by esophagotracheal fistula; patients with bronchial dilatation, bronchial fistula, mediastinal tumors, and large pleural effusions mostly cough when their positions change.
3. Most coughs caused by pharyngitis, early tuberculosis, pneumoconiosis, lung cancer and pleurisy are dry coughs without sputum; if only a small amount of thin sputum can be coughed up it can be seen in acute bronchitis with the early stage of pneumonia and tuberculosis; coughing a large amount of sticky sputum may be due to bronchiectasis, lung abscess, abscess chest and bronchopulmonary cancer.
4, bronchitis often cough white mucous sputum; lung abscess, bronchiectasis, respiratory purulent infection is mostly yellow pus sputum; pneumonia, chronic bronchitis, pneumoconiosis is mostly yellow-green or gray sputum; pulmonary Pseudomonas aeruginosa infection is mostly green sputum; red or brown-red sputum is commonly found in tuberculosis, pulmonary infarction, lung cancer, bronchiectasis and other diseases; patients with Streptococcus pneumoniae pneumonia cough rust-colored sputum; amoebic lung abscess and pulmonary schistosomiasis cause chocolate-like sputum and jam-like sputum, respectively; black sputum is common in coal miners and boiler workers.
If the cough is accompanied by high fever, it often indicates lung abscess; with low fever, night sweats, and wasting, it often indicates tuberculosis; pleurisy, pleural tumor, pneumonia, and lung cancer involving the pleura can cause chest pain; bronchiectasis, lung abscess, and pulmonary cavity tuberculosis mostly cause massive hemoptysis; a small amount of hemoptysis can be seen in endobronchial tuberculosis, bronchial calculi, and lung cancer; chronic bronchitis, emphysema, and diffuse interstitial lung fibrosis mostly Chronic bronchitis, emphysema, and diffuse interstitial lung fibrosis are associated with dyspnea; laryngitis and laryngeal nodules can cause hoarseness.
The mechanisms that cause coughing attacks are mainly the following.
1, bronchospasm.
2. The production and release of histamine and other inflammatory mediators directly cause coughing;
3. Abnormal cough reflexes, i.e. damage to the airway epithelium containing cough receptor nerve endings, making the receptors susceptible to direct contact with irritants, or sensitization to the action of irritants for some reason, causing the cough reflex to become abnormally hyper-reactive and cough. Viral upper respiratory infections cause bronchospasm due to imbalance of plant nerve function; they also stimulate the production and release of inflammatory mediators such as vasoactive substances and histamine; they damage the airway epithelium, causing exposure of submucosal sensory nerve endings and slowing down the clearance of various irritants from the airway mucosal surface. This leads to increased airway reactivity, which is usually referred to as allergy. Therefore, most patients with long-term, chronic cough have some degree of allergic reaction.
Allergic cough has the following characteristics.
1. It can occur at any age during the pediatric period.
The cough is recurrent or persistent for more than one month, with episodes of coughing at night, in the morning, and aggravated by movement or crying.
3. The coughing season is not limited to winter and spring, but can occur at any time.
4. There may be a family or personal history of allergies and a positive skin test for allergens.
5.Blood tests may reveal elevated IgG or IgE, with no significant abnormalities in routine blood tests.
6.General antibiotics and cough suppressants are ineffective, and the administration of asthma suppressants can stop the cough.
7. Exclude common causes of recurrent respiratory tract infections and cough caused by immune deficiency or tuberculosis. 8. No significant abnormalities on chest x-ray.
Acute upper respiratory tract infection (i.e. cold) is a common respiratory disease. Most of the sputum culture tests do not detect any meaningful pathogenic bacteria.
More than 90% of upper respiratory tract infections are due to viral infections, which cause damage to the airway epithelium and exposure of submucosal sensory nerve endings, stimulating the production and release of vasoactive substances, histamine and other inflammatory mediators, resulting in Bronchospasm leads to airway hyperresponsiveness, so that the vast majority of patients with upper sensitization present with cough symptoms. Numerous studies have shown that this type of cough does not improve significantly after oral administration of antimicrobial drugs, which suggests that cough after upper respiratory tract infection is not caused by bacteria and, therefore, there is no significant benefit of taking antimicrobial drugs for the treatment of this type of cough.
Antimicrobial agents should be used only in cases of concurrent bacterial infections (e.g., coughing with large amounts of yellow pus, acute tonsillitis with suppuration, etc.). However, many people in clinical practice still routinely use oral or even intravenous antimicrobial drugs in the treatment of respiratory tract infections and the coughs they cause, which not only wastes drugs and increases the incidence of adverse reactions, but also causes bacteria to develop drug resistance.
In general, coughs following upper respiratory tract infections and allergic coughs without evidence of bacterial infection do not require treatment with antibacterial drugs. In particular, cephalosporins, amoxicillin and other antimicrobials are not used because many cough patients have more or less combined increased airway sensitivity, and these drugs can easily cause allergies and may aggravate the condition. Chinese herbal medicine has a better effect on this type of cough, and as long as the evidence is accurate, it can be cured quickly. If a combination of Chinese and Western medicine is used, along with drugs that have the effect of relieving the spasm of tracheal and bronchial smooth muscles, such as salbutamol, procaterol, ketotifen, etc., the treatment effect will be better.