Cough

Question 1

what is cough

Answer 1

Cough is a reflex response to airway irritation that removes foreign material and secretions from the bronchi and bronchioles

Dry cough: usually felt in the throat as a tickle that sets off the coughing while Productive cough usually produces phlegm.

Question 2

Explain the cough reflex

Answer 2

1. Stimulation of mechano- and chemo- receptors
2. Afferent impulses to cough centre (medulla)
3. Second-order neurons relay message to a respiratory pattern generator
4. Activation of efferent motor neurons (output)
5. Increased respiratory muscle contraction leading to the respiratory movement

Question 3

Discuss the different THREE types of cough

Answer 3

ACUTE COUGH
Duration: less than 3 weeks
Causes:
Most common: upper respiratory tract infections, acute bronchitis, pneumonia, COPD

SUB- ACUTE COUGH
Duration: 3–8 weeks.
Causes: After an obvious respiratory infection such as;
- Persistent pneumonia
- Acute bronchitis
- Pertussis (whooping cough)

CHRONIC COUGH
Duration: more than 8 weeks
Causes:
- Smoking -related
- Disease-related : e.g COPD, asthma, cancer,TB, Gastro-oesophageal reflux
- Medicine-related : e.g Angiotensin-Converting Enzyme inhibitors

Question 4

Describe the treatment of the VARIOUS cough types

Answer 4

ACUTE COUGH
- acute cough that persist 3-4 weeks, seek medical advice
- manage symptoms with self care e.g paracetamol or ibuprofen (pain), honey, herbal or OTC medicines
- Do not offer mucolytic
- Do not offer antibiotic unless there’s higher risk of complication

SUB-ACUTE OR CHRONIC COUGH
- Conduct clinical assessment to confirm or refute common causes followed by
- Sequential trials of treatment depending on clinical features:
- Post infectious cough
offer bronchodilator, corticosteroid, centrally acting antuissives
- ACE induced cough , prescribe alternative
- Smoking related, advice to stop smoking
- Environmental or occupational , refer to specialist

Offer Emergency admission if ;
- theres clinical features of suspected pulmonary embolism
- Sign or symptoms of serious illness
- clinical features of foreign body aspirations

Question 5

How is cough treated in children

Answer 5

• Warm drink of lemon and honey
• Cough syrup containing glycerol and honey

Children under the age of 6 should not be given over –the- counter cough and cold treatments containing cough medicines due to ;
- Side effects
- Allergies
- Sleep problem
- Hallucinations

Question 6

List the cough treatments available

Answer 6

Antitussives: inhibit the cough reflex by:
- Reducing sensory reception activation
- Depressing cough centre in brainstem

Sedative antihistamines
Mucolytics
Expectorants

Question 7

Describe the TWO types of antiussives and their role

Answer 7

1. Antitussives To Reduce Sensory Reception Activation

Menthol vapour (inhalation)
- Peripherally acting: reduce sensitivity of peripheral sensory cough receptors in pharynx and larynx to irritation

USE: inhaled, for treatment of productive and non-productive cough

Effect: Cough suppression is acute and short lasting

2. Antitussives To Reduce Sensitivity of Cough Centre
   - Dextromethorphan
   - Codeine
   - Pholcodine

Centrally acting: agonists of opioid and non-opioid receptors with a direct and depressing effect on the cough centre in the medulla

USE: oral administration, for treatment of dry cough ONLY and NOT in combiantion with mucolytics or expectorants!