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| __NOTOC__ | | __NOTOC__ |
| | {| class="infobox" style="float:right;" |
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| | | [[File:Siren.gif|30px|link=Cough resident survival guide]]|| <br> || <br> |
| | | [[Cough resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| | |} |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{Infobox_Disease |
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| Name = Cough |
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| ICD10 = {{ICD10|R|05||r|00}} |
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| ICD9 = {{ICD9|786.2}} |
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| }}
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| {{Cough}} | | {{Cough}} |
| {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} {{MUT}} | | |
| | {{CMG}}; {{AE}} {{CZ}} {{MUT}} {{AMA}} |
|
| |
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| {{SK}} Tussis | | {{SK}} Tussis |
| ==Cause== | | == [[Cough overview|Overview]] == |
| | |
| ==Complete List of Differential Diagnoses Sorted by Nonproductive vs Productive Nature of Cough==
| |
| === Nonproductive Cough ===
| |
| * [[Smoker's cough]]
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| * Aspiration
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| * [[Congestive heart failure]]
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| * [[Postnasal drip]]
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| *:* Most common cause of chronic cough in nonsmokers
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| * [[GERD]]
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| *:* Second most common cause of chronic cough in nonsmokers
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| * [[Asthma]]/reactive airway disease
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| * [[ACE inhibitor]] use
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| * [[Pneumonia]]
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| *:* ''Typical'' pneumonia is characterized by acute or subacute onset of fever, dyspnea, fatigue, pleuritic chest pain, and cough
| |
| *:* ''Atypical'' pneumoniais characterized by more gradual onset, dry cough,headache, fatigue, and minimal lung signs
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| * [[Acute bronchitis]]
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| *:* Most commonly caused by viruses
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| *:* Postviral bronchitis may last beyond 6 weeks
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| * Aspirated foreign body
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| * [[Lung cancer]]
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| * [[COPD]]
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| * [[Sarcoidosis]]
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| * [[Cryptogenic organizing pneumonia]]
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| * [[Filariasis|Filarial disease]]
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| | |
| ===Productive Cough===
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| * [[Postnasal drip]]
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| * [[Tuberculosis]]
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| * [[COPD]]
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| * [[Lung cancer]]
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| * [[Smoker's cough]]
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| * [[Asthma]] with secondary infection
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| * [[Pneumonia]]
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| * [[Bronchitis]]
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| | |
| ==Complete Differential Diagnosis of Cough Sorted by Frequency of Causes==
| |
| | |
| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| | |
| === Most Common Causes ===
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| | |
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| === Other Causes ===
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| | |
| ===Complete Differential Diagnosis of the Causes of Cough===
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| (By organ system)
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
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| [[Aortic arch anomalies]],
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| [[Atrial myxoma]],
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| [[Beriberi Heart Disease]],
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| [[Congestive Heart Failure]],
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| [[Hypotension]],
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| [[Mitral stenosis]],
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| [[Right Ventricular Outflow Tract Obstruction]],
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| [[Superior Vena Cava Syndrome]],
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| [[Thoracic Aortic Aneurysms]],
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| | |
| | |
| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
| |
| |bgcolor="Beige"|
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| [[Abrin]],
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| [[Cadmium poisoning]],
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| [[Polymer fume fever]],
| |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Drug Side Effect'''
| |
| |bgcolor="Beige"|
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| [[Abacavir ]],
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| [[Abatacept ]],
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| [[ABVD]],
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| [[ACE inhibitor]],
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| [[Acetylmorphone]],
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| [[Acyclovir ]],
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| [[Adalimumab ]],
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| [[Adefovir ]],
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| [[Albuterol ]],
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| [[Alefacept ]],
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| [[Alfuzosin ]],
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| [[Aliskiren ]],
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| [[Amiodarone ]],
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| [[Amlodipine and Benazepril ]],
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| [[Amphotericin B ]],
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| [[Anagrelide ]],
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| [[Anastrozole ]],
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| [[Atazanavir ]],
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| [[Benazepril]],
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| [[Bepridil ]],
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| [[Bevacizumab ]],
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| [[Bitolterol ]],
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| [[Bortezomib ]],
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| [[Brimonidine ]],
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| [[Budesonide]],
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| [[Busulfan ]],
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| [[Captopril]],
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| [[Carvedilol ]],
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| [[Cetuximab ]],
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| [[Cevimeline]],
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| [[Chlorambucil ]],
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| [[Cladribine ]],
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| [[Clobutinol]],
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| [[Clofarabine ]],
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| [[Clofedanol]],
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| [[Co-trimoxazole ]],
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| [[Cromolyn Sodium ]],
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| [[Cytarabine ]],
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| [[Dacarbazine ]],
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| [[Dactinomycin ]],
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| [[Darbepoetin Alfa ]],
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| [[Diborane]],
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| [[Docetaxel ]],
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| [[Domiodol]],
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| [[Dornase alfa]],
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| [[DTPA]],
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| [[Efalizumab ]],
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| [[Efavirenz ]],
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| [[Emtricitabine ]],
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| [[Enalapril ]],
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| [[Enfuvirtide]],
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| [[Epinastine ]],
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| [[Eplerenone ]],
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| [[Epoetin Alfa ]],
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| [[Eprosartan ]],
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| [[Erlotinib ]],
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| [[Estradiol Topical ]],
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| [[Etanercept ]],
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| [[Fexofenadine ]],
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| [[Floxuridine ]],
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| [[Fludarabine Phosphate ]],
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| [[Fluorouracil ]],
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| [[Fluticasone and Salmeterol ]],
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| [[Fluvastatin ]],
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| [[Fosamprenavir ]],
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| [[Fosinopril ]],
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| [[Gabapentin ]],
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| [[Gefitinib ]],
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| [[Gemcitabine Hydrochloride ]],
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| [[Glyburide and Metformin ]],
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| [[Granisetron ]],
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| [[Histrelin ]],
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| [[Ibandronate ]],
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| [[Ifosfamide ]],
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| [[Iloprost]],
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| [[Imipramine]],
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| [[Insulin Human (rDNA Origin) ]],
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| [[Interferon beta-1a Intramuscular ]],
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| [[Isoproterenol ]],
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| [[Ketorolac]],
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| [[Lamivudine ]],
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| [[Lamotrigine ]],
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| [[Letrozole ]],
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| [[Levalbuterol ]],
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| [[Lisinopril ]],
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| [[Lomustine ]],
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| [[Mechlorethamine ]],
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| [[Melphalan ]],
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| [[Mercaptopurine ]],
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| [[Mesalamine ]],
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| [[Metaproterenol ]],
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| [[Methotrexate ]],
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| [[Metoprolol]],
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| [[Mitomycin ]],
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| [[Moexipril ]],
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| [[Moxifloxacin ]],
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| [[Mycophenolic acid]],
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| [[Natalizumab ]],
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| [[Nateglinide ]],
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| [[Nedocromil ]],
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| [[Nicotine nasal spray ]],
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| [[Nilutamide ]],
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| [[Nitrofurantoin ]],
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| [[Omeprazole ]],
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| [[Oxaliplatin ]],
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| [[Oxcarbazepine ]],
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| [[Paclitaxel]],
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| [[Pamidronate ]],
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| [[Peginterferon alfa-2a ]],
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| [[Pemetrexed ]],
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| [[Penbutolol ]],
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| [[Pentamidine]],
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| [[Perindopril]],
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| [[Pegaspargase ]],
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| [[Pimecrolimus topical ]],
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| [[Pirbuterol acetate ]],
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| [[Plicamycin ]],
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| [[Primaquine ]],
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| [[Procarbazine ]],
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| [[Prograf]],
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| [[Quinapril]],
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| [[Ramelteon ]],
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| [[Ramipril]],
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| [[Ribavirin ]],
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| [[Risedronate ]],
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| [[Risperidone ]],
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| [[Rosiglitazone ]],
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| [[Rosuvastatin ]],
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| [[Salmeterol ]],
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| [[Saquinavir ]],
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| [[Sevelamer ]],
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| [[Sirolimus ]],
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| [[Sodium stibogluconate]],
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| [[Spironolactone ]],
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| [[Sulindac ]],
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| [[Tacrolimus]],
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| [[Tamsulosin ]],
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| [[Thioguanine ]],
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| [[Thiotepa ]],
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| [[Tipranavir ]],
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| [[Tocainide ]],
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| [[Topotecan Hydrochloride ]],
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| [[Trandolapril]],
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| [[Trimetrexate Glucuronate ]],
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| [[Vinorelbine Tartrate ]],
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| [[Vorinostat ]],
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| [[Zanamivir ]],
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| [[Ziprasidone ]],
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| | |
| | |
|
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|
|
| | == [[Cough classification|Classification]] == |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Ear Nose Throat'''
| |
| |bgcolor="Beige"|
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| [[Acute viral nasopharyngitis (common cold)]], | |
| [[Adenoid hypertrophy]],
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| [[Allergic rhinitis]],
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| Atopic rhinitis,
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| [[Croup]],
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| [[Goiter]],
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| [[Laryngitis]],
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| [[Laryngopharyngeal Reflux Disease]],
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| [[Laryngotracheal cleft]],
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| [[Pharyngitis]],
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| [[Post-nasal drip]],
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| [[Strep throat]],
| |
| Subglottic hemangioma,
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| [[Subglottic stenosis]],
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| [[Tonsillolith]],
| |
|
| |
|
| |-
| | == [[Cough historical perspective|Historical Perspective]]== |
| |-bgcolor="LightSteelBlue"
| |
| | '''Endocrine'''
| |
| |bgcolor="Beige"| [[Goiter]],
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|
| |
|
| |-
| | == [[Cough pathophysiology|Pathophysiology]] == |
| |-bgcolor="LightSteelBlue"
| |
| | '''Environmental'''
| |
| |bgcolor="Beige"|
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| [[Caplan's Syndrome]], | |
| Chronic beryllium disease (CBD),
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| [[Hay fever]],
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| Low humidity,
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| Occupational exposure of irritants
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| [[Passive smoking]],
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| [[Sick building syndrome]],
| |
| [[Silicosis]],
| |
| [[Smoking]],
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|
| |
|
| |-
| | == [[Cough causes|Causes]] == |
| |-bgcolor="LightSteelBlue"
| |
| | '''Gastroenterologic'''
| |
| |bgcolor="Beige"|
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| [[Achalasia]], | |
| [[Esophageal atresia]],
| |
| [[Esophageal cancer]],
| |
| [[Esophageal dysmotility]],
| |
| [[Gastroesophageal reflux disease]],
| |
| [[Mallory-Weiss syndrome]],
| |
|
| |
|
| | == [[Cough differential diagnosis|Differentiating Cough from other Diseases]] == |
|
| |
|
| |-
| | == [[Cough epidemiology and demographics|Epidemiology and Demographics]] == |
| |-bgcolor="LightSteelBlue"
| |
| | '''Genetic'''
| |
| |bgcolor="Beige"|
| |
| [[Cystic fibrosis]], | |
| [[Juvenile Myelomonocytic Leukemia (JMML)]],
| |
|
| |
|
| |-
| | == [[Cough risk factors|Risk Factors]] == |
| |-bgcolor="LightSteelBlue"
| |
| | '''Hematologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
| |
| |bgcolor="Beige"|
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| [[Chest tube]], | |
| [[Thoracentesis]],
| |
| [[Transfusion-associated graft versus host disease]],
| |
|
| |
|
| |-
| | == [[Cough natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
| |-bgcolor="LightSteelBlue"
| |
| | '''Infectious Disease'''
| |
| |bgcolor="Beige"|
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| [[Adenoviridae]], | |
| [[Aphthovirus]],
| |
| [[Ascaris infection]],
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| [[Aspergillosis]],
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| [[Blastomycosis]],
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| [[Bordetella pertussis]],
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| [[Byssinosis]],
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| [[Chickenpox]],
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| [[Chlamydophila pneumoniae]],
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| [[Cladosporium]],
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| [[CMV Pneumonitis]],
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| [[Coccidioidomycosis]],
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| [[Community-acquired pneumonia]],
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| [[Cryptococcosis]],
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| [[Fasciolosis]],
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| [[Filariasis]],
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| [[Gnathostomiasis]],
| |
| [[Histoplasmosis]],
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| [[Human ehrlichiosis]],
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| [[Infectious mononucleosis]],
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| [[Influenza]],
| |
| [[Lady Windermere syndrome]],
| |
| [[Lassa fever]],
| |
| [[Legionellosis]],
| |
| [[Measles]],
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| [[Melioidosis]],
| |
| [[Miliary tuberculosis]],
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| [[Mucor stolonifer]],
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| [[Mycoplasma pneumoniae]],
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| [[Nocardiosis]],
| |
| [[Paprika splitter's lung]],
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| [[Paracoccidioidomycosis]],
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| [[Papillomatosis]],
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| [[Paragonimus Infection]],
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| [[Pneumocystis jirovecii pneumonia]],
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| [[Psittacosis]],
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| [[Q Fever]],
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| [[Rhinovirus]],
| |
| [[Saccharopolyspora rectivirgula]],
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| [[Schistosomiasis]],
| |
| [[Sporotrichosis]],
| |
| [[Strep throat]],
| |
| [[Thermoactinomyces sacchari]],
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| [[Thermoactinomyces vulgaris]],
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| [[Trichinosis]],
| |
| [[Tuberculosis]],
| |
| [[Tularemia]],
| |
| [[Typhoid fever]],
| |
| [[Upper respiratory tract infection]],
| |
| [[Yersinia Pestis Infection]],
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|
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|
| | == Diagnosis == |
|
| |
|
| | | [[Cough history and symptoms|History and Symptoms]] | [[Cough physical examination|Physical Examination]] | [[Cough laboratory findings|Laboratory Findings]] | [[Cough electrocardiogram|Electrocardiogram]] | [[Cough chest x ray|Chest X Ray]] | [[Cough CT|CT]] | [[Cough MRI|MRI]] | [[Cough echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Cough other imaging findings|Other Imaging Findings]] | [[Cough other diagnostic studies|Other Diagnostic Studies]] |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Musculoskeletal / Ortho'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Neurologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Nutritional / Metabolic'''
| |
| |bgcolor="Beige"|
| |
| [[Beriberi Heart Disease]], | |
| [[Cholesterol pneumonia]], | |
| | |
| | |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Obstetric/Gynecologic'''
| |
| |bgcolor="Beige"|
| |
| [[Bronchogenic cyst]], | |
| [[Pulmonary sequestration]], | |
| [[Esophageal atresia]],
| |
| [[Peripartum cardiomyopathy]],
| |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Oncologic''' | |
| |bgcolor="Beige"|
| |
| Cervical mass,
| |
| [[Esophageal cancer]],
| |
| [[Kaposi's sarcoma]],
| |
| [[Laryngeal cancer]],
| |
| [[Lymphangitis carcinomatous]],
| |
| [[Mediastinal tumor]],
| |
| [[Mesothelioma]],
| |
| [[Papillomatosis]],
| |
| [[Thymoma]],
| |
| | |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Opthalmologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Overdose / Toxicity'''
| |
| |bgcolor="Beige"|
| |
| [[Ganciclovir ]], | |
| [[Nickel carbonyl]],
| |
| [[Valganciclovir ]],
| |
| [[Salicylate sensitivity]],
| |
| | |
| | |
| |- | |
| |-bgcolor="LightSteelBlue"
| |
| | '''Psychiatric'''
| |
| |bgcolor="Beige"| Psychogenic cough,
| |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Pulmonary'''
| |
| |bgcolor="Beige"|
| |
| [[Acute bronchitis]],
| |
| [[Acute Chest Syndrome]],
| |
| [[Allergic bronchopulmonary aspergillosis]],
| |
| [[Asthma]],
| |
| [[Atelectasis]],
| |
| [[Atypical pneumonia]],
| |
| [[Aspergillosis]],
| |
| [[Blastomycosis]],
| |
| Bronchial stenosis,
| |
| Bronchial web,
| |
| [[Bronchiectasis]],
| |
| [[Bronchiolitis]],
| |
| [[Bronchitis]],
| |
| [[Bronchogenic cyst]],
| |
| [[Chronic Obstructive Pulmonary Disease]],
| |
| [[Ciliary dyskinesia]],
| |
| [[Cystic fibrosis]],
| |
| [[Goodpasture's syndrome]],
| |
| [[Hamman-Rich syndrome]],
| |
| [[Idiopathic Pulmonary Fibrosis]],
| |
| [[Interstitial pneumonia]],
| |
| [[Lady Windermere syndrome]],
| |
| [[Lung abscess]],
| |
| [[Pleurisy]],
| |
| [[Pleuropulmonary blastoma]],
| |
| [[Pulmonary alveolar proteinosis]],
| |
| [[Pulmonary Embolism]],
| |
| [[Pulmonary hypertension]],
| |
| [[Severe acute respiratory syndrome]],
| |
| [[Tracheal stenosis]],
| |
| [[Tracheitis]],
| |
| [[Tracheoesophageal fistula]],
| |
| [[Tracheomalacia]],
| |
| | |
| | |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Renal / Electrolyte'''
| |
| |bgcolor="Beige"|
| |
| [[Congenital nephrotic syndrome]],
| |
| [[Rapidly progressive glomerulonephritis]],
| |
| | |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Rheum / Immune / Allergy'''
| |
| |bgcolor="Beige"| [[Sarcoidosis]],
| |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Sexual'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Trauma'''
| |
| |bgcolor="Beige"| Post cerebrovascular accident, | |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Urologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Miscellaneous'''
| |
| |bgcolor="Beige"|
| |
| [[Alcoholism]],
| |
| Aspirated foreign bodies,
| |
| Cerumenosis,
| |
| [[Choking]],
| |
| [[Chronic Fatigue Syndrome]],
| |
| Ear foreign body,
| |
| Hair in the ear canal,
| |
| | |
| | |
| | |
| |-
| |
| |} | |
| | |
| == Complications ==
| |
| The complications of coughing can be classified as either [[Acute (medical)|acute]] or [[Chronic (medicine)|chronic]]. Acute complications include ''cough syncope'' ([[fainting]] spells due to decreased blood flow to the brain when coughs are prolonged and forceful), [[insomnia]], cough-induced [[vomiting]], rupture of [[bleb]]s causing [[spontaneous pneumothorax]], [[subconjunctival hemorrhage]] or "[[red eye (medicine)|red eye]]", coughing [[defecation]] and in women with a [[prolapse]]d [[uterus]], cough [[urination]]. Chronic complications are common and include abdominal or pelvic [[hernia]]s, fatigue [[fracture]]s of lower ribs and [[Tietze's syndrome|costochondritis]].
| |
|
| |
|
| == Treatment == | | == Treatment == |
| Coughs can be treated with [[cough medicine]]s. Dry coughs are treated with cough suppressants (antitussives) that suppress the body's urge to cough, while productive coughs (coughs that produce [[phlegm]]) are treated with expectorants that loosen [[mucus]] from the [[respiratory tract]]. Centrally acting cough suppressants, such as [[codeine]] and [[dextromethorphan]] reduce the urge to cough by inhibiting the response of the sensory endings by [[depolarization]] of the vagus nerve. A recent study indicates that, because of the presence of [[theobromine]] in chocolate, 50 [[gram]]s of dark [[chocolate]] may be an effective treatment for a persistent cough.<ref name="omaretal"/>
| |
|
| |
|
| Gargling with salt and warm water can also be helpful by reducing phlegm.
| | [[Cough medical therapy|Medical Therapy]] | [[Cough surgery|Surgery]] | [[Cough primary prevention|Prevention]] | [[Cough future or investigational therapies|Future or Investigational Therapies]] | [[Cough cost-effectiveness of therapy | Cost Effectiveness of Therapy]] |
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| |
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| ==During injections== | | ==Case Studies== |
| Coughing during an injection can lessen the pain of the needle stick caused by a sudden, temporary rise in pressure in the chest and spinal canal, inhibiting the pain-conducting structures of the spinal cord.<ref>{{cite journal | pmid = 14742367 | title = Reducing venipuncture pain by a cough trick: a randomized crossover volunteer study | last = Usichenko | first = TI | coauthors = Pavlovic D, Foellner S & Wendt M. | year = 2004 | journal = Anesthesia and Analgesia | pages = 952-3 | volume = 99 | issue = 3 | accessdate = 2007-07-16 }}</ref>
| | [[Cough case study one|Case #1]] |
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| == See also == | | == Related Chapter == |
| *[[Whooping cough]] | | *[[Whooping cough]] |
| *[[Kennel cough]] | | *[[Kennel cough]] |
| *[[Cough medicine]] | | *[[Cough medicine]] |
|
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| ==References==
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| {{reflist|2}}
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|
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| ==Additional Resource==
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| * {{cite journal | author = McCool F | title = Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice guidelines. | journal = Chest | volume = 129 | issue = 1 Suppl | pages = 48S-53S | year = 2006 | id = PMID 16428691}}''[http://www.chestjournal.org/cgi/content/full/129/1_suppl/48S Full text]''
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| == External links ==
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| *[http://familydoctor.org/handouts/237.html FamilyDoctor.org – Chronic cough: causes and cures]
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| *[http://www.buteykoscotland.co.uk/healthtips1.htm Coughing]:Quick tips to help stop a coughing fit.
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