Cough: Causes, Mechanisms and Therapy


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This timely volume draws together a wealth of recent research into the mechanisms, pharmacology and therapies for cough, and places these in clinical context. The text incorporates guidelines on the most common causes of cough, discusses treatments and pitfalls in management, summarizes current research on physiology, pharmacology and treatment of cough, and gives practical advice on diagnosis and management issues for the clinician.

It will update clinical and basic medical scientists, and promote future research. Readers are encouraged to implement the clinical implications of the discussion into routine practice. This volume will appeal to all those involved in the treatment of respiratory disease, particularly those in hospital respiratory units, and will also be of use to interested general practitioners.

Read more Read less. Citations Publications citing this paper. Laryngeal dysfunction in chronic cough Nicole M Ryan. The effect of exhalation flow on endogenous particle emission and phospholipid composition Per J-W. Exhaled particles for monitoring of airway inflammation Sampling and analysis of endogenous particles from breath Per Larsson.


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Gunarathne , Amkb Attanayake , Duleepa Jayasundara. The chronic cough syndrome Raluca Enache , Dorin Sarafoleanu. References Publications referenced by this paper. Chronic cough and gastro-oesophageal reflux. Surinder S. Birring , Ian D. Assessment and management of respiratory symptoms of malignant disease. P Hoskin , SH Ahmedzai. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial Peter M. There are no studies on herbal therapies or on simple measures such as chest rubs.

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Common measures for cough management outlined below are also relevant for acute cough. Furthermore, there is considerable overlap between specific and nonspecific cough. The role of these tests for evaluation of lung disease is beyond the scope of this position statement; suggested situations or conditions for referring the child are haemoptysis, suppurative lung disease, suspected foreign body aspiration, congenital lung lesions or disease, non-resolution of cough despite simple management, immunodeficiency states, recurrent pneumonia, and cardiac abnormalities.

In some instances, particular characteristics of cough may be recognisable and suggestive of specific aetiology Box 3. In adults, the three most common causes of chronic cough are gastro-oesophageal reflux disease, asthma and postnasal drip; these are uncommon causes of cough in children E3. In children with nonspecific cough, apart from a chest x-ray and spirometry, investigations are rarely required. Specifically, investigation for gastro-oesophageal reflux in the absence of other symptoms , tests for airway hyper-responsiveness and radiological investigations for possible sinusitis, as a cause of isolated chronic cough, are largely unwarranted in children E3.

Aetiologies of paediatric cough have been reviewed elsewhere. Treatment for chronic cough should also be based on aetiology, and specific management of these is beyond the scope of this article. Diagnoses with simple treatment options include asthma, and complications of URTIs eg, protracted bronchitis, when antibiotics are appropriate: E1 Thus, any child on a trial of medications must be reviewed, and if minimal or no response is seen, the dose or frequency of the medication should not be escalated; instead, the medication should be withdrawn E3.

If asthma medications are trialled, and the cough resolves with inhaled corticosteroid ICS use, clinicians should not assume the child has asthma; rather, the child should be re-evaluated when off treatment. Resolution of cough may reflect the period effect or a transient state that is responsive to ICS E3.

10 Wet Cough Natural Remedies for Adults and Children

The influence of prenatal and postnatal environmental influences, especially tobacco smoke, on cough and other respiratory symptoms and frequency of respiratory infections is undoubtedly significant. Thus, in the management of any child with cough, irrespective of the aetiology, attention to exacerbating factors, especially environmental tobacco smoke, is encouraged. In contrast to adult data, there are no quality-of-life studies for parents and children with chronic cough. In adults there are no data in children , anxiety is a known independent risk factor for chronic cough.

Despite the high prevalence of cough in children, the subject is relatively poorly researched. Children with cough should be managed according to child-specific guidelines, which differ greatly from adult guidelines, as the aetiological factors and treatments in children differ from adults. Treatment of cough in children should be based on aetiology, and there is little evidence for using medications for symptomatic relief of cough.

If medications are used, it is imperative that the children are routinely followed up, and medications ceased if there is no effect on the cough within an expected timeframe. Objectives are to recommend a definitions of paediatric cough for clinical and research purposes, and b key management statements, with the aim of improving the clinical management and research outcomes of cough in children. The target readers are physicians who treat children. The group consists of an academic general practitioner N G and paediatric respiratory physicians, all with an interest in cough.

Suggested revisions were incorporated into subsequent drafts, and the final draft represents all relevant evidence obtained by the literature search in conjunction with final recommendations, annotated to reflect level of evidence as used in the position statement and guidelines of TSANZ. E1: Systematic review of all relevant randomised controlled trials RCTs. E3: Well designed cohort or case—control studies. E4: Consensus opinion of authors. Asthma, bronchitis, congenital lung disease, foreign body aspiration, airway abnormality. Cough characteristics eg, cough with choking, cough quality, cough starting from birth.

See text; congenital lung abnormalities. Cardiac abnormalities including murmurs.

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Daily moist or productive cough. Chronic bronchitis, suppurative lung disease. Dyspnoea exertional or at rest. Compromised lung function of any chronic lung or cardiac disease.

Product description

Compromised lung function, immunodeficiency, cystic fibrosis. Compromised lung function, primary aspiration. Atypical and typical respiratory infections. Angiotensin-converting enzyme ACE inhibitors, puffers, illicit drug use. Primary or secondary aspiration. Immunodeficiency, congenital lung problem, airway abnormality.

Symptoms of upper respiratory tract infection. May coexist or be a trigger for an underlying problem.

Croup, tracheomalacia, habit cough. Chronic wet cough in mornings only. Key clinical issues of cough studies. A detailed clinical history is of key importance when evaluating a child with cough E4. While parental reporting of wet or dry cough has good reliability, parental reporting of nocturnal cough has poor reliability when compared with objective measures E3.

As reporting of cough is prone to large placebo and time-period effects, observational studies non-randomised controlled trials on interventions for cough are of very limited value E3. Key recommendations for acute cough in children. Although most children with acute cough are likely to have an acute upper respiratory tract infection, all should be evaluated for the possibility of a more serious problem E4 :. Are there symptoms or signs of a lower respiratory disease tachypnoea, dyspnoea, wheeze or other chest auscultation abnormalities; eg, crackles, asymmetric breath sounds?

Both over-the-counter OTC and prescription medications are generally ineffective for the symptomatic relief of acute cough and should be rarely used E1. There are no non-OTC medications that have a registered indication in Australia for the relief of cough. Serious adverse events and accidental poisoning have been reported with use of OTC medications for cough E3. Key recommendations for chronic cough in children. Children with chronic cough should E4 :. The three most common causes of chronic cough in adults gastro-oesphogeal reflux disease, asthma and postnasal drip are relatively uncommon causes of chronic cough in children.

Empirical treatment for these conditions is largely unsuitable in children E3. OTC or prescription medications are ineffective for chronic cough and should be rarely used for the symptomatic treatment of cough E4. If medication trials are undertaken, a response should not be assumed to be due to the medication tried. An isolated chronic cough in children is unlikely to be asthma without other specific pointers to this disease.

Asthma medication, especially high doses of inhaled corticosteroids, can have adverse effects. If there is no improvement, the treatment should be stopped rather then escalated E2. A history of environmental exposures, particularly tobacco smoke exposure, should be sought and intervention initiated if appropriate E3. Exploration of parental concerns and expectations is beneficial, and specific education is more beneficial than nonspecific education E3. Data limitation and considerations.

Pathophysiology

RCTs 23, Systematic review Single open trial RCTs 28, Systematic review; 30 RCT Not beneficial; 28 adverse events. Leukotriene receptor antagonist. Observational studies Gastro-oesophageal reflux disease therapy. Systematic review; 33 single controlled trial. No RCT on proton pump inhibitors, adverse events. Food thickening or antireflux formula. No benefit, systematic review showed no benefit for gastro-oesphageal reflux, but cough was not an outcome measure.

Over-the-counter cough medications. Systematic review; 17,18 RCT Not beneficial, adverse events 19, No RCTs, adverse events eg, burns. No data in cough that is not related to suppurative-like lung diseases. Anne Chang has received an educational grant from GlaxoSmithKline. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted.

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Cough in children: definitions and clinical evaluation

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