Cough – This is a necessary reflex that protects the airways from foreign bodies. It is designed to protect the airways from blockage when large pieces of food or random objects enter, and also to remove excess mucus, which can accumulate for various reasons in the trachea and bronchi.

Under normal conditions, the mucous membrane of the respiratory tract is able to clean, warm and moisturize the inhaled air, and neutralize microbes with the help of nasal mucus. It collects the smallest particles on its surface and performs the function of disinfection with the help of enzymes and immune cells, preventing the penetration of pathogenic microorganisms. The main structure of protection is the so-called “Pirogov ring” – an accumulation of immune tissue in the oropharynx and nasopharynx, forming the tonsils and adenoids, which are responsible for the local immune response. As a result, the air reaches the lungs in an almost sterile state.

If you enter the respiratory tract:

  • large objects that threaten to block them.
  • dust particles that cannot be broken down by mucosal structures.
  • a large number of particles that the respiratory tract does not have time to process.
  • if the mucosal epithelium is damaged by pathogenic viruses or microbes, which leads to the accumulation of mucus, then protection begins to kick in in the form of frequent, intense coughing, aimed at removing foreign bodies and excess mucus from the respiratory tract. This is one of the main answers to the question, why does cough occur.

Why does a person cough?

The cough reflex begins with irritation of the receptors in the larynx and bronchi as a result of mucus or foreign bodies. This area is innervated by the vagus nerve; the area of ​​the vocal cords, the epiglottis area, and the area where the trachea divides into large bronchi respond most quickly to such irritation.

The impulse travels along nerve pathways to the cough center, which is located in the brain. In response to the impulse, the brain sends a signal to the respiratory tract, and the “initiation of cough movement” begins – a short inhalation with a muscle spasm of the larynx and an increase in the tone of the bronchial muscles. Then the abdominal muscles and diaphragm contract sharply with a quick exhalation through the mouth. Along with the air, mucus, dust, and foreign bodies come out of the respiratory tract, after which the coughing act can be considered complete.

Types of cough

We encounter a cough every day, if we are talking about a physiological protective cough, and several times a year we experience a cough as a symptom of an illness – during a bacterial or viral infection or during an allergic reaction. Cough most often is not the main or only symptom of the disease; it should be assessed in conjunction with other signs, which allows a diagnosis to be made. To assess the pathology, it is necessary to characterize the type of cough. First, assess the presence or absence of cough secretions. Based on sputum production, the cough may be:

  • Dry cough (Unproductive) – without sputum production.

or

  • Wet (Productive) – with the release of varying amounts of sputum, which may have a different character. The doctor always analyzes the type of sputum for the following reasons:
  1. quantity;
  2. Colour;
  3. presence of mucus;
  4. presence of pus;
  5. viscosity;
  6. presence of blood (streaks, hemoptysis).

Based on duration, cough is divided into:

  • Acute cough — duration up to 3 weeks;
  • Subacute – from 4-8 weeks;
  • Chronic cough – from 8 weeks or more.

By tone:

  • Short;
  • Barking;
  • Sip;
  • Silent.

By time of appearance:

  • Morning cough;
  • Evening cough;
  • Night cough.
  • Associated with a specific time of year – Seasonal cough (Autumn, Spring).

According to the localization of the stimulus:

  • Central genesis – with organic brain lesions, as well as with psychoneurological disorders as a result of the use of psychoactive substances.
  • Reflexogenic – when irritating the receptors of those organs that do not belong to the respiratory system. For example, irritation of the external auditory canal, a blow to the solar plexus, acid reflux from the stomach into the esophagus, diseases of the pericardium and diaphragm.
  • Exogenous cough – as a result of a reaction to external factors, it can be:
  1. Entry of foreign bodies and liquids into the respiratory tract;
  2. Inhalation of substances that damage the mucous membranes (Dust, smoking, perfumes or other aromatic substances, pollen of flowering plants, these can also be various other allergens;
  3. As a side effect from the use of the following antihypertensive drugs: beta-blockers, ACE inhibitors.
  • Endogenous cough – occurs due to diseases of the internal organs.
  1. Damage to the respiratory system – in diseases such as tumor, bronchial asthma, rhinitis, pharyngitis, tracheitis, pneumonia and bronchitis, bronchiectasis, pulmonary hypertension, pleurisy, lung abscess, abnormal development of the upper respiratory tract, occupational diseases and many others.
  2. Damage to other systems affecting the respiratory system: heart failure, sarcoidosis, heart defects, tumor, hemosiderosis, bleeding disorders, cystic fibrosis, reflux esophagitis and so on.

There may also be another classification according to intrathoracic (intrathoracic) and extrathoracic (extrathoracic) etiology:

Intrathoracic causes:

  • respiratory infections;
  • sleep apnea;
  • bronchial asthma;
  • interstitial lung diseases;
  • carcinoma of the central bronchi;
  • heart failure;
  • cystic fibrosis.

Extrathoracic causes:

  • allergies;
  • reflux esophagitis;
  • by-effect antihypertensive therapy (ACE inhibitors).

Eliminating these problems is not only about pulmonologist, but also general practitioner, gastroenterologist, allergist, surgeon.

Which doctor to see for treatment of chronic cough (which doctor to go to), you can understand after visiting a therapist or family doctor.

Diagnostics


Physical examination at the doctor’s appointment

Physical examination is an examination directly at the appointment, when the doctor uses all the methods available to him to examine the patient to make a preliminary diagnosis. The patient is then given recommendations and directions on what tests he needs to undergo and which doctors to make an appointment with.

What a doctor can see on the body of a patient suffering from a cough:

  • Pinpoint hemorrhages under the conjunctiva of the eye (They talk about strong effort when coughing)
  • Thickened finger phalanges in the nail area are a symptom of drumsticks (May indicate chronic pulmonary disease)
  • Paleness and swelling of the nasal mucosa (May indicate a developed allergic reaction)
  • Hyperemia of the mucous membrane and excess nasal mucus (Speaks of infectious inflammation of the upper respiratory tract)
  • Bad breath combined with enlarged pharyngeal tonsils.
  • Assessment of cough timbre, since different diseases are accompanied by different types of cough according to their sonority)

Dry barking cough may indicate the beginning of development Acute respiratory infections, laryngeal edema, lobar pneumonia.

Whistling cough combined with noisy breathing (stridor) – sign of asthma.

Wet cough with fever indicates the presence of infection, this requires a more thorough diagnostic search for the cause and timely initiation of treatment.

When examining a patient with a stethoscope, the doctor may detect suspicious breathing sounds:

  • The patient’s loud, wheezing breathing indicates severe bronchial asthma or other narrowing (obstruction) of the airways.
  • Weakened or increased breathing may indicate compaction of the lung tissue, which occurs with pneumonia or pulmonary atelectasis, which can be caused by either a foreign body or massive inflammation of the lung tissue;
  • Large bubble or fine bubble moist rales can be heard in the lungs with bronchiolitis, bronchiectasis, pneumonia; heart failure and many other diseases.


Laboratory diagnosis

When treating cough in combination with serious pathological processes, it is necessary take a general blood test and a biochemical blood test, electrolyte metabolism, and other tests are prescribed depending on the specific symptoms that the doctor identifies in the patient.

  • A set of blood tests indicating an infectious process – C-reactive protein, ferritin, LDH, procalcitonin, proteinogram;
  • Sputum culture must be detected for purulent infections and tuberculosis.
  • Bronchodilation test – for bronchial asthma.
  • Skin tests – for allergic reactions.
  • Antibody test for mycoses (fungal diseases).
  • cultural, serological studies, PCR – if whooping cough or chlamydial infections are suspected.
  • Mantoux test for tuberculosis.


Instrumental examination

For accurate diagnosis of chronic cough the doctor needs to obtain the results of one or even several instrumental diagnostic studies. What research may need to be done:

  • X-ray of the lungs (fluorography);
  • CT lungs;
  • Ultrasound of the chest organs.
  • Electrocardiogram;
  • spirometry;
  • bronchodilator test;
  • fibrobronchoscopy;
  • Perfusion or ventilation lung scintigraphy with various radiopharmaceuticals (RP)

Chest x-ray

Can be prescribed by a doctor for chronic cough. It is performed in two projections and, if necessary, while inhaling.

Visualization of the lungs using this method can provide information about:

  • fluid in the pleura;
  • suspected fracture of the bones of the shoulder girdle or rib joints;
  • tumors;
  • compression of the lungs from internal organs;
  • emphysematous expansion of the chest; bloating of the lungs;
  • areas of compaction of lung tissue;
  • enlarged intrathoracic lymph nodes

But the resolving visualization of conventional radiography may not be enough, so in some cases it is necessary to do a more accurate radiation study – a computed tomogram (CT). It is often carried out with chronic cough and coronavirus.

Computed tomography of the chest

CT is a radiation X-ray method of research by layer-by-layer scanning of organs and tissues with the construction of a 3D image model. In a short time, the tomograph device is capable of taking many images, which can later be combined into one image.

CT scans can be performed with or without contrast.

During a chest examination, the following are well scanned:

  • trachea;
  • lungs;
  • bronchi;
  • mediastinal area;
  • thoracic region;
  • ribs

Indications for CT scanning:

  • tumors of the lungs and mediastinum;
  • rib injuries;
  • congenital pathologies;
  • inflammatory diseases (pneumonia, tuberculosis).

CT with contrast carried out to study blood vessels during tumor processes. Before the examination, the patient is given intravenous contrast, after which the pulmonary artery and thoracic aorta are clearly visualized.

CT clearly shows:

  • vascular malformations (congenital anomalies);
  • aneurysms;
  • stenosis and other damage to the vascular wall.

US chest organs

Ultrasound examination is one of the safest. It uses signals that are sent to the organ, then go from the organ to the sensor, and an image is obtained on the screen. Indications for ultrasound examination for chronic cough:

  • the presence of fluid in the pleural sinuses;
  • suspicion of breast tumor;
  • examination of the heart and large vessels.

Take an x-ray or fluorography of the lungs You can go to any clinic.

Spirometry (Spirography)

This is a method of assessing the function of external respiration using a device – a spirometer. This is a tube that is used in conjunction with a nose clip. The patient, on command, inhales and exhales into the tube as needed. Indicators and respiratory characteristics are recorded.

If carried out correctly and all preparation measures are followed, you can get an idea of ​​the vital volumes and capacities of the lungs; this includes many indicators, including the vital capacity of the lungs, reserve volumes of inhalation and exhalation, exhalation volume in the first second, exhalation speed.

Indicators of external respiration functions naturally decrease with cough caused by various pulmonary diseases. And also after recovery they return to normal.

Fibrobronchoscopy

This is a method for examining the trachea and bronchi with the introduction of a bronchoscope into the respiratory tract, it is used for chronic diseases of the larynx, trachea, bronchi and lungs, it allows you to examine the mucous membrane and take a biopsy if cancer is suspected or perform therapeutic lavage of the bronchi (Lavage, bronchopulmonary lavage, BLA ) during infectious and inflammatory processes;

Chronic cough. Treatment

There are the following types of medications used in the treatment of cough:

  • Antitussives are drugs that inhibit the cough reflex.
  • Mucolytics – medications that thin sputum and facilitate its secretion, are used when necessary treat barking cough.
  • Mucoregulatory – normalizing the viscosity of sputum.
  • Expectorants, facilitating the removal of sputum, increasing its amount during a dry cough.
  • Anti-inflammatory drugs used in the form of special inhalers for bronchial asthma or chronic nonspecific lung diseases (CNPD);
  • Bronchodilators are medicinal substances used to dilate constricted bronchi, used both in the form of tablets and syrups, and in the form of inhalers;
  • Antihistamines are used for allergic diseases of the respiratory tract;
  • Antibiotics of various classes, antiviral and antifungal drugs, which are prescribed for infectious lesions of the bronchi and lungs, depending on the determination of the antibiotic sensitivity of the microbial flora;

There are many dry cough syrups for children and adults. Answer to the question: “how to treat dry cough” It’s better to get it from a specialist. Only he can tell whether it should be done inhalation, accept pills, medicines, herbs.

There are many cough remedies in pharmacies, you need to choose the one that suits you at the moment, and not constantly change different ones cough medicinewithout considering its root cause.

Cough after coronavirus

After a coronavirus infection, it often persists prolonged dry cough, which can bother a person for several months.

Why doesn’t my cough go away after Covid? The fact is that interstitial pneumonia develops, and then fibrosis may begin to form (replacement of lung tissue with connective tissue – scars). The duration of recovery of lung tissue depends on the person’s age, health status, bad habits, lifestyle, genetic predisposition, as well as the fact how severe the Covid-19 infection was, how deep the lung damage was caused by the virus, whether the patient was connected to a ventilator or Was oxygen therapy enough, and for how long did it last?

Spirography may show disturbances in people suffering from lung diseases. People with severe shortness of breath in the post-Covid period, associated with tissue scarring, may experience a decrease in the diffusion capacity of the lungs. However, when pulmonary function is restored, functional respiratory parameters return to normal.

Rehabilitation after covid

Along with a chronic cough, there may be additional symptoms such as hoarseness, sore throat, sensation of a lump in the throat, general weakness, slowness of thinking, excessive sweating. What can you do to speed up the recovery of the bronchial mucosa yourself at home:

  • gargle with infusion of chamomile or calendula.
  • eat slowly, sitting upright while eating.
  • Do not lie down for half an hour after eating.
  • If you experience shortness of breath or cough while eating, you should stop eating for 2 minutes, then continue.
  • maintain optimal humidity in the room (up to 45-50%), since dry air is an irritant to the mucous membranes of the upper respiratory tract and increases coughing

In conclusion, it is worth noting that correct adherence to all necessary doctor’s recommendations will help speed up recovery after covid. If serious rehabilitation is necessary, it must begin as quickly as possible.

It is best to constantly adhere to preventive tactics: be physically active, eat right, spend enough time in the fresh air, do not succumb to psychological problems and stress, observe a work and rest schedule, eat well and eliminate bad habits.

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