Coughing fits are normal
Cough without a cold
If the patient does not see any improvement after weeks or months, the following three candidates are particularly common as triggers: post-nasal drip syndrome (PND), gastroesophageal reflux, or asthma. These three factors are also known as the "pathological triad of chronic cough" because, taken together, they account for 80 percent of persistent coughs.
PND often develops after a previous infection. Chronic secretion from the nasal cavity runs down the back of the pharynx into the windpipe and irritates the cough receptors there and in the upper bronchi. A stubborn dry cough is the result. Chronic sinusitis or allergic or non-allergic rhinitis is very common in these patients. The cough is probably the result of chemical irritation from the inflammatory mediators contained in the mucus; mechanical irritation may also occur.
The fact that the cough is triggered by the inflammation and not by the secretion flowing down led to PND also being referred to as "Upper Airway Cough Syndrome". This makes it clear that this type of cough does not originate in the bronchi, but in the throat or larynx. The aim of the therapy is to reduce the secretion formation in the nasopharynx. As a rule, glucocorticoids to be applied nasally are used.
Cough from stomach acid
Typical indications of reflux-associated respiratory diseases are clearing the throat, "lump in the throat", chronic cough and nocturnal or morning asthma attacks. Gastroesophageal reflux of gastric acid stimulates receptors in the upper respiratory tract and larynx and promotes microaspiration. Since the reflux is promoted by lying down, patients often complain of coughing at night.
In addition to microaspiration, the symptoms can also be traced back to reflex arcs mediated by the vagus nerve. Because the acid in the wrong place, i.e. in the esophagus, leads to contractions of the smooth muscles in the lower third. If the spinal cord is switched incorrectly, its readiness for cramps is passed on to the bronchial muscles as well as to those of the coronary arteries. This explains why some of the patients complain of sudden retrostenal pain, which primarily suggests coronary heart disease or angina pectoris. This non-cardiac chest pain, as well as the other complaints mentioned above, respond well to proton pump blockers.
Gastroesophageal reflux is still too rarely considered a cause of coughing today. The connections have been known for around ten years.
A chronic inflammation of the airways underlies bronchial asthma. Wheezing and paroxysmal shortness of breath usually determine the symptoms. But there is also a variant of asthma that manifests itself primarily through coughing ("cough variant asthma"). This is more often the case with children and adolescents. Those affected cough especially at night, usually between two and four o'clock. Sometimes glassy, tough mucus comes off. Therapy with oral and inhaled steroids as well as leukotriene antagonists stops the cough symptoms in most cases.
Chronic inflammation of the airways is also the cause of chronic obstructive bronchitis (COPD), the most common chronic lung disease. In 80 percent of the cases, cigarette smoke corroded the bronchi and set the inflammation. COPD is characterized by an irreversible decrease in respiratory flow. It has been proven that the progression of airway obstruction goes hand in hand with the daily number of cigarettes consumed, the time at which smoking started and the depth of inhalation.
The smoker's cough and the subsequent chronic bronchitis are typically accompanied by a usually productive morning cough. But because the cough develops gradually over a long period of time, the patient classifies it as "normal" and acceptable. Since there is usually no awareness of the disease, those affected rarely go to the doctor. In addition to not smoking, the therapy consists of substances that dilate the airways and inhaled steroids. However, in most cases, COPD progresses incessantly.
Drugs as a trigger
In the case of inexplicable chronic coughs, drug side effects should also be considered, especially those caused by ACE inhibitors. Up to 15 percent of those treated with it can develop a dry cough. It is unclear why there are twice as many women as men. Asthmatics are no more likely to be affected. ACE inhibitors inhibit kininase II, which is responsible for breaking down bradykinin. Bradykinin builds up and presumably stimulates afferent C-fibers of the bronchial system, which are responsible for the urge to cough.
There is no dose-response relationship. The cough begins within a week or two, but may not appear until six months after starting therapy. After stopping the inhibitor, the cough will go away within one to four weeks. In most cases, switching to an angiotensin II blocker will solve the problem. Other drugs can also cause a cough, such as cytostatics such as methotrexate, beta blockers and amiodarone. In the case of inhaled glucocorticoids, it should also be remembered that they are deposited in the larynx area and can therefore cause hoarseness and coughing attacks. /
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