Causes of ineffective cough: Weakness of the respiratory or abdominal muscles secondary to neurologic impairment (peripheral and central causes) or muscle weakness (Pompe disease), impaired chest mobility, increased mucus viscosity, ciliary dysfunction.Ĥ. H) Bloody sputum ( hemoptysis): Consider malignancy, tuberculosis, pulmonary embolus, vasculitis, rarely arteriovenous malformations in hereditary hemorrhagic telangiectasia (also known as Osler-Weber-Rendu syndrome).ģ. G) Sputum with food particles: Tracheoesophageal fistula, dysphagia with aspiration. Consider abscess and food aspiration.ĭ) Mucous, thick, viscous sputum occurring most frequently in the morning: Chronic bronchitis, chronic obstructive pulmonary disease, asthma.Į) Clear, viscous sputum: Asthma, rarely adenocarcinoma.į) Sputum with aggregates and plugs: Fungal infection, allergic bronchopulmonary aspergillosis, cystic fibrosis, rarely plastic bronchitis. A sudden-onset production of copious purulent sputum may indicate rupture of a lung abscess into a bronchus.Ĭ) Foul-smelling sputum: Usually present in anaerobic infection. Characteristics and possible causes of expectorated sputum:Ī) Purulent sputum (green or yellow): Bronchiectasis, primary ciliary dyskinesia, sinusitis, chronic bronchitis, pneumonia, tuberculosis.ī) Copious purulent sputum: Bronchiectasis. It may occur with use of angiotensin-converting enzyme inhibitors ( ACEIs) (cough affects up to 14% of patients treated with this class of drugs mechanism is currently unclear cough can often occur after a long latency and can continue for many months after drug discontinuation).Ģ) Productive cough leading to expectoration of sputum. Classification based on characteristics of cough:ġ) Nonproductive (so-called dry) cough may be caused by viral infections, asthma, interstitial lung disease, and smoking. Classification based on duration of cough:ġ) Acute cough: Persists for 8 weeks, peaks in patients in their 50s and 60s, and is twice as common in women compared with men. This clinical presentation has been recently termed “cough hypersensitivity syndrome” and reflects an underlying hypersensitivity of the peripheral airway nerves or central nervous system (or both).ġ. In such cases coughing can be triggered by trivial exposure to irritants such as perfumes, aerosols, or changes in temperature, but also by talking, laughing, or singing. In most cases coughing can occur appropriately as an automatic defensive reflex, but in ~12% of the general population chronic cough can become a persistent troublesome symptom lasting >8 weeks. The high pressure generated in the chest and lungs results in a forceful expulsion of air after the opening of the glottis, which drives particles out of the airway. Cough consists of a deep inspiration followed by expiration with an initial brief glottic closure. It is a protective reflex that clears the airways of excess secretions, foreign bodies, and noxious and harmful environmental irritants. PMID: 26426314 PMCID: PMC5831652.Ĭough is the most common symptom for which patients seek medical attention. Treatment of Unexplained Chronic Cough: CHEST Guideline and Expert Panel Report. Gibson P, Wang G, McGarvey L, Vertigan AE, Altman KW, Birring SS CHEST Expert Cough Panel. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Morice AH, Millqvist E, Bieksiene K, et al. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine. Chronic cough: Investigations, management, current and future treatments.
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