to cough

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Classification according to ICD-10
R05 to cough
ICD-10 online (WHO version 2019)

The term cough (Latin Tussis ), from Middle High German huoste , describes the voluntary or explosive expulsion of air triggered by a cough stimulus via the cough reflex , during which the glottis opens and the air expelled by the cough stimulus reaches a high speed.

Cough is a symptom and usually not a disease in itself . The function of the cough is to clear the airways of substances that could obstruct or narrow them. The causes can be diseases of the respiratory organs, the heart, the stomach, the use of medication or - rarely - mental disorders. The common cold is the most common cause. Cough is one of the most common symptoms to see a doctor for, be it because the cough is distressing, disturbs the night's sleep, or is a matter of deeper concern when coughing with bronchitis , Pneumonia or cancer , especially if the sputum ("sputum") is mixed with blood - see Coughing up blood .

Classification

A distinction is made between the productive cough, which is accompanied by expectoration of phlegm, and the so-called irritable cough. This denotes a dry cough without expectoration of bronchial mucus; this can occur in the early phase of a cold, in the event of allergies and also as an undesirable effect of drugs (e.g. ACE inhibitors ). This side effect is by no means always immediate. A prolonged cough can be an indication of whooping cough disease . The mentally caused (psychogenic) dry cough is less common in adults than in children.

Another important classification for the investigations distinguishes between acute cough, chronic cough and chronic cough without an identifiable cause (“ idiopathic ”) or not treatable ("refractory"):

Acute cough

Acute cough (lasting up to eight weeks) can be triggered by inflammation of the airways (sinusitis, laryngotracheitis, tracheobronchitis), in the course of bronchial asthma , aspiration of foreign material, inhalation of irritants. Deeper lung diseases can cause acute coughing, such as pneumonia , pleurisy and pulmonary embolism . Acute heart disease is also a possible cause.

Chronic cough

Chronic cough (lasting more than eight weeks) is usually caused by smoking or constant inhalation of other pollutants, by COPD , lung cancer , asthma, VCD , infections or chronic heart disease.

Chronic Idiopathic Cough (CIC) and Chronic Refractory Cough (CRC)

In March 2019, a new S2k guideline was presented at the 60th congress of the German Society for Pneumology and Respiratory Medicine ( DGP annual conference ) , which contains 48 recommendations agreed in the consensus procedure and 16 statements, which are explained in the background text in nine chapters. The chronic cough - as chronic idiopathic cough (CIC) (chronic idiopathic cough) and chronic refractory cough (CRC) - has been devoted to an extra chapter (i.e. 7th chapter).

Symptoms

Cough in the course of a cold

In the course of a cold, the cough is usually rather dry at the beginning (dry cough) and only turns into a slimy cough after one to three days, which can lead to the secretion of mucus particles. These can be clear or discolored. In the opinion of doctors, the thickness and color of the nasal secretion or sputum is not diagnostically relevant for differentiating between viral and bacterial infections. The cough may be accompanied by a coughing headache .

Unphysiological cough

If the cough no longer occurs as part of the physiological self-cleaning mechanism of the airways, the mucocillary clearance , this is often part of a symptom complex together with a. Sputum and shortness of breath . The cough can also be dry (unproductive) or productive and, in the course of the disease, lead to chronic inflammation with mucosal edema, obstructions and instability of the airways. A cough can often be identified by the coughing noises.

Coughing can be a symptom of left heart decompensation , bronchial asthma or exacerbated COPD .

Common symptoms accompanying cough

In connection with coughing, additional complaints with different risk potential often occur. Symptoms such as shortness of breath, bloody sputum, vomiting or severe chest pain during the cough are acute warning signals that require immediate clarification by a doctor. Side effects of persistent coughing such as a steady flow of mucus in the throat, weight loss or declining physical performance can indicate chronic diseases such as bronchial asthma or COPD.

examination

With the exception of coughing in the case of a harmless cold, the physical examination is an important part of the diagnosis and anamnesis . Auscultation of the lungs can provide an indication of the location of the disease. A chest x-ray is ordered in unclear cases or if a cough lasts longer than four weeks. The pulmonary function test can confirm a suspicion of chronic obstructive pulmonary disease or, in conjunction with a provocation test, lead to the diagnosis of bronchial asthma .

The bronchoscopy - possibly with biopsy - is considered the gold standard for the diagnosis of pathological changes in the bronchial tract. If interstitial lung disease is suspected , computed tomography is available. If gastroesophageal reflux is suspected, gastroscopy can be performed.

treatment

Avoiding tobacco smoke and - if known and possible - allergens are a prerequisite for successful therapy.

Instead of the symptom, the underlying disease must be identified and treated. Since the cough is usually a protective reflex that is supposed to prevent the airways from being blocked, the productive cough should be treated especially in cases in which the night's rest is severely impaired. Expectorants ( secretolytics ) or finely nebulized inhalations help to cough up particularly tough secretions better.

The horehound was used as herbal expectorant due to its outstanding historical significance as well as the extensive documentation of its effects by scientists at the University of Wuerzburg to " Medicinal Plant of the Year selected 2018". The use of the herbaceous plant in catarrh of the respiratory tract, especially bronchitis, has been documented for over 2000 years.

In the case of a dry cough, antitussives are prescribed. There are centrally acting agents, especially agents containing codeine, which, however, are questionable in the case of prolonged treatment because of their addictive potential . Approved herbal products are not addictive, but less effective. If the inflammation of the mucous membranes is in the foreground, an attempt can be made to alleviate the urge to cough with inhaled glucocorticoids . In all cases, care must be taken to ensure that there is sufficient fluid intake, but a possible heart failure must be taken into account.

phylogenesis

Swallowing , vomiting (spitting) and breathing , which in vertebrates can easily "mix" (cross) because of the original gill gut, must be protected and controlled by strong reflexes as vital functions . In fish , disturbing particles and inedible items can be coughed out (spat out) from the gill basket by vigorous contraction of the pharynx muscles forward and through the mouth. In terrestrial vertebrates there is a separation into two functions: the lungs and throat are cleared by coughing, the esophagus and stomach by spitting, and the nasal cavity by sneezing . How far these three “reflexes” actually go to the amphibians , reptiles , birds and mammals in detail is still the subject of observation and investigation (in addition there are throat clearing , hiccups, etc.)

Similar diseases

Web links

Wiktionary: cough  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ According to W. Fink, G. Haidinger: The frequency of health disorders in 10 years of general practice . In: Z. Allg. Med. 83 (200) 102-108. Quoted from What family doctors mainly deal with. In: MMW update. Med. No. 16/2007 (149th year).
  2. ↑ "refractory" in the wiktionary. "
  3. ↑ MMW 3/2011 (153rd year), p. 44 ff.
  4. ↑ P. Kardos, QT Dinh, K.-H. Fuchs, A. Gillissen, L. Klimek, M. Koehler, H. Sitter, H. Worth: Guideline of the German Society for Pneumology and Respiratory Medicine for the Diagnosis and Therapy of Adult Patients with Cough In: Pneumology Volume 73, Number 3, 2019, Pp. 143–180, doi : 10.1055 / a-0808-7409 , accessed April 4, 2019
  5. ^ Herbert Renz-Polster , N. Menche, A. Schäffler: Health for children - prevent, recognize, treat teething problems. 2nd Edition. 2007, p. 262.
  6. ^ Jörg Braun: Lungs. In: Jörg Braun, Roland Preuss (Ed.): Clinic Guide Intensive Care Medicine. 9th edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8 , pp. 285-310, here: p. 286.
  7. ↑ Medicinal Plant of the Year 2018: Horehound - Marrubium vulgare. World Heritage Monastery Medicine, September 21, 2017.
  8. ↑ Committee on Herbal Medicinal Products : Community herbal monograph and assessment report on Marrubium vulgare L., herba. European Medicines Agency (EMA) 604273/2012 (2012).