Pulmonary Medicine
James M. Rippe in Manual of Lifestyle Medicine, 2021
Acute cough is one that has been present for less than three weeks (2). The most common cause of acute cough is respiratory infection, which is typically characterized by spittle production and may be accompanied by a raw substernal sensation. Subclinical bronchial spasm may also cause acute cough. Mild asthma may also present with acute cough. Some exposures to allergens, cold air, or exercising may result in a transient cough. Pulmonary function tests, including spirometry, are often needed to make a specific diagnosis. Hyper-reactive airways without wheezing can present as a chronic cough, which has been termed cough-variant asthma. GERD also is a common cause of chronic cough. Chronic bronchitis which is defined as a productive cough present for more than three months a year for more than two years is another cause of chronic cough. A chest X-ray is often helpful in determining abnormalities that may result in a chronic cough.
SBA Answers and Explanations
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury in SBAs for the MRCS Part A, 2018
Pharyngeal pouches occur most commonly in patients aged over 70 years. Typical symptoms include dysphagia, regurgitation, chronic cough, aspiration, and weight loss. The aetiology remains unknown, but many theories centre upon a structural or physiological abnormality of the oesophageal muscles. The pharyngeal pouch is thought to be due to a mucosal out-pouching between the two parts of the inferior constrictor: thyropharyngeus above and cricopharyngeus below. The potential gap is called Killian’s dehiscence. Food is propelled from the pharynx to the oesophagus by a series of sequential contractions of the superior, middle, and thyropharyngeus constrictors. Then the cricopharyngeus, which acts as a sphincter, relaxes to allow food to enter the oesophagus. If it fails to relax, the pressure above will produce a posterior out-pouching through the weak Killian’s dehiscence. It cannot expand posteriorly because of the adjacent vertebrae, so it descends down the back of the oesophagus to present as a lump in the posterior triangle of the neck. This is usually on the left as the oesophagus lies on the left side of the vertebral bodies. The diagnosis is confirmed on barium studies.
Cough In Children
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan in Diagnosing and Treating Common Problems in Paediatrics, 2017
The differential diagnosis of children with chronic cough (>8 weeks) is extensive, but less than 5% of children who present with cough will have symptoms beyond 8 weeks. As a consequence, aetiologies are determined from cohort studies and the results may not be generalisable to all populations. In a prospective cohort study of children referred with cough for greater than 3 weeks (mean, 6 months) under 18 years who were extensively investigated the following diagnoses were made: persistent bacterial bronchitis, 40%; natural resolution, 22%; bronchiectasis, 6%; asthma, 4%; upper airway cough syndrome, 3%; gastro-oesophageal reflux, 3%; habit cough, 1%; idiopathic, 5%; multiple causes, 55%. Forty-three per cent of households had smokers, 62% had cough under 1 year and 89% of coughs were described as wet. In children who present with chronic cough two aetiologies will be found in 50% of patients.
Impact of capsaicin concentration evoking coughs on clinical variables in patients with asthma
Published in Experimental Lung Research, 2021
Kyung-Hun Park, Byeong-Gon Kim, Preun-Haneul Lee, Jisu Hong, Junehyuck Lee, Sung-Woo Park, Do-Jin Kim, An-Soo Jang
Chronic cough is defined as a cough of more than 8 weeks duration.11 Diagnosis of bronchial asthma was based on the Global Initiative for Asthma guidelines.12 All subjects had a clinical diagnosis of asthma that was supported by one or more of the following criteria: (1) variability in the maximum diurnal peak expiratory flow of more than 20% over the course of 14 days, (2) an increase in the forced expiratory volume in 1 s (FEV1) of more than 15% following inhalation of 200–400 μg albuterol, or (3) a 20% reduction in the FEV1 in response to a provocative concentration of inhaled methacholine (PC20 methacholine) of less than 10 mg mL−1. All subjects underwent standardized assessments, which included a complete blood cell count with differential counts, measurement of the immunoglobulin E (IgE) level, chest posteroanterior radiography, allergy skin prick test, and spirometry. All data were collected at the time of diagnosis, before administration of asthma medication. The pack-year is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked. Exclusion criteria included respiratory infection during inclusion, vocal cord dysfunction, obstructive sleep apnea, Churg–Strauss syndrome, cardiac dysfunction, and allergic bronchopulmonary aspergillosis. This study was approved by the Institutional Review Board of Soonchunhyang University.
Diagnostic value of FeNO and MMEF for predicting cough variant asthma in chronic cough patients with or without allergic rhinitis
Published in Journal of Asthma, 2021
Li-Chang Chen, Guan-Sheng Zeng, Ling-Ling Wu, Mei Zi, Ze-Kui Fang, Hui-Zhen Fan, Hua-Peng Yu
Cough is an important defense mechanism of the human body that can help discharge respiratory secretions. However, long-term cough may cause hoarseness, anxiety, insomnia and other discomforts, greatly affecting the daily lives of patients. Chronic cough (>8 weeks) is one of the most widespread and troublesome nonspecific symptoms in patients visiting respiratory clinics (19). Asthma is one of the main causes of chronic cough. The results of our study indicated that CVA accounted for approximately 40% of patients with chronic cough. Lai et al (20) showed that CVA accounted for 32.6% of chronic cough. The possible reasons for this inconsistency might be differences in the selection criteria and retrospective bias. The diagnosis of CVA is based on laboratory evidence of BHR and therapeutic efficacy (1). However, the BHR test is expensive, time-consuming and has highly technical requirements for operators, which limits its popularization. In contrast, with the advantages of safety, rapidity and simplicity, spirometry and FeNO tests are available in most primary hospitals. In this study, we investigated the value of MMEF and FeNO in differentiating CVA patients among those chronic cough. Because FeNO is affected by allergic diseases such as allergic rhinitis, additional analysis was performed to evaluate the effects of allergic rhinitis.
Usefulness of simultaneous impulse oscillometry and spirometry with airway response to bronchodilator in the diagnosis of asthmatic cough
Published in Journal of Asthma, 2023
Namiko Taniuchi, Mitsunori Hino, Akiko Yoshikawa, Akihiko Miyanaga, Yosuke Tanaka, Masahiro Seike, Akihiko Gemma
CVA is diagnosed by coughing without wheezing for more than 8 weeks, the absence of wheezing on auscultation, and response to bronchodilators (6). In clinical practice, bronchodilators are rarely used as single agents to diagnose CVA, and some clinicians do not consider the bronchodilator an effective part of the diagnostic criteria. Bronchodilators are also effective in COPD-derived cough and cough-dominant BA, and making a differential diagnosis using traditional domestic diagnostic criteria can be challenging. The US and European guidelines list four causes of chronic cough, namely, upper airway cough syndrome, asthma, non-asthmatic eosinophilic bronchitis, and GERD (10,36). These are causes for chronic cough in patients who are nonsmokers not on ACE inhibitors. However, several problems have been raised. First, it is quite difficult to assign the diagnosis of patients complaining of cough to one of these four diseases. Furthermore, the mechanisms by which these underlying diseases cause cough are not well understood. This study’s purpose and benefit of distinguishing between BA and CVA in patients with chronic cough are that they have different prognoses and treatment strategies (e.g. the risk of fatal severe attacks and the need to continue ICS prophylactic inhalation).
Related Knowledge Centers
- Asthma
- Cough
- Pneumonia
- Influenza
- Infection
- Respiratory System
- Chronic Condition
- Post-Nasal Drip
- Gastroesophageal Reflux Disease
- Nasal Congestion