The probable causes of cough (see Table: Causes of cough) differ, depending on whether it occurs acutely (present <3 weeks) or chronic.
Cough is defined as explosive expiratory maneuvers to clean the airways that comes reflex or willingly about. Cough is one of the most common symptoms that leads to prospect a general practitioner. The probable causes of cough (see Table: Causes of cough) differ, depending on whether it occurs acutely (present <3 weeks) or chronic. In acute cough are the most common causes are infections of the upper respiratory tract (including acute bronchitis) postnasal drip COPD exacerbation pneumonia at chronic cough are the most common causes of chronic bronchitis postnasal drip Bronchial (ie cough after infection) are hyperreactivity after resolution of a viral or bacterial respiratory infection Gastroesophageal reflux causes of cough in children are similar to those in adults, but asthma and foreign body may occur more frequently. Very rarely can a cerumen graft or a foreign body in the ear canal due to irritation of the auricular branch of n. Vagus reflex cause persistent cough. Psychogenic cough is even more rare and is a diagnosis of exclusion. Patients with chronic cough can develop a secondary reflex or a psychogenic component to her cough. Even a lengthy coughing can injure the bronchial mucosa, which in turn can cause more coughing. Causes of cough cause suspicious findings diagnostic approach of acute treatment infections of the upper respiratory tract (including acute bronchitis) rhinorrhea red, swollen nasal mucosa sore throat discomfort Clinical evaluation pneumonia (viral, bacterial, aspiration, rare mushroom permitting) fever Productive cough dyspnea Pleuritic chest pain bronchial breath sounds or Ägophonie Chest x-ray cultures (eg. B. pleural fluid, blood, possibly bronchial lavage) in critically ill patients and patients with hospital-acquired pneumonia postnasal drip (allergic, viral or bacterial origin) headache sore throat nausea Cobblestoning the posterior oropharynx Pale, swollen nasal mucosa Clinical evaluation Sometimes response to empirical antihistamines and decongestant therapy CT Known in the sinuses unclear diagnosis COPD exacerbation diagnosis of COPD Weak respiratory sounds wheezing dyspnea breathing with lip brake use of the respiratory muscles Dreifußzeichen seat position of the arms against the legs or the Examination table chest X-ray foreign body * Sudden appearance in an infant that has no infection of the upper respiratory or constitutional symptoms chest x-ray (inspiratory and expiratory view) bronchoscopy pulmonary embolism * Pleuritic chest pain dyspnea tachycardia CT angiography Rare ventilation / perfusion scintigraphy and possibly arteriography of the pulmonary heart failure * dyspnea fine bubble RG Extrasystolischer Heartbeat Dependent peripheral edema chest x-ray natriuretic peptide level of the brain (B-type) Chronic Chronic bronchitis productive (in smokers) coughing on most days of the month or 3 months of the year for 2 consecutive years in a patient with known COPD or smoking in the past frequent throat clearing dyspnea chest X-ray pulmonary function test postnasal drip (most likely allergic) headaches sore throat Cobblestoning the posterior oropharynx Pale, swollen nasal mucosa To deteriorate Clinical evaluation Sometimes response to empirical antihistamines and decongestant therapy allergy tests Gastroesophageal Reflux Burning chest or abdominal pain, which neingen to the consumption of certain foods in certain activities or in certain positions. Sour taste, especially on waking hoarseness Chronic nocturnal cough or coughing in the early morning Clinical evaluation response to empirical H2 blockers or "proton pump inhibitor therapy" Sometimes 24-hour esophageal pH probe in unclear diagnosis of asthma (cough) cough as reaction to various causative factors (eg. as allergens, cold, physical activity) may wheezing and dyspnea pulmonary function tests methacholine provocation response to empirical Bronchodilatorentherapie Hyper reactive airways after the dissolution of respiratory infections dry, non-productive cough, which for weeks or months may persist after an acute respiratory infection Typically, chest x-ray ACE inhibitors dry, persistent cough, which can occur within days or months of initiation of ACE inhibitor therapy in response to the discontinuation of ACE inhibitors pertussis during a single expiration repeated bouts of ? 5 rapid succession of strong coughing, followed by the typical wheezing, rapid, deep inspiration (wheezing) or posttussivem vomiting. Cultures of samples of nasopharyngeal aspiration wet-sounding cough after eating or drinking chest x-ray modified barium pharyngography bronchoscopy tumor * Atypical symptoms (eg. As weight loss, fever, hemoptysis, night sweats) lymphadenopathy chest X-ray, if positive, chest CT and biopsy bronchoscopy gained TB or fungal infections * Atypical symptoms (eg. as weight loss, fever, hemoptysis, night sweats) exposure history immunodeficiency chest x-ray Hau t test; if positive, sputum cultures and stains for acid-fast bacilli and fungi Sometimes chest CT or bronchoalveolar lavage * Indicates rare causes. Clarification history The history of the present illness should the duration and characteristics of the cough cover (eg. As dry or productive with sputum or blood and determine whether this is accompanied by shortness of breath, chest pain, or both). The question of triggering factors (eg. As cold air, strong smells) and the timing of the cough (z. B. especially at night) can be instructive. In the investigation of body systems should for symptoms of a possible cause, including runny nose, and throat (infections of the upper respiratory tract, postnasal drip); Fever, chills, and pleuritic chest pain (pneumonia); Night sweats and weight loss (tumor, TB), heartburn (gastroesophageal reflux) and swallowing and choking while eating or drinking (aspiration) are sought. The history should youngest respiratory infections (ie within the last 1-2 months..); past allergies, asthma, COPD and gastroesophageal reflux; note risk factors for (or known) TB or HIV infection, and history of smoking. The drug history should be taken into account in particular the use of ACE inhibitors. Patients with chronic cough should after exposure to potential irritants or allergens as well as travel or stays in regions with endemic fungal diseases interviewed werden.Körperliche examination Vital signs should be checked for tachypnea and fever. In the general examination for signs of respiratory distress and chronic disease (eg. As emaciation, lethargy) care should be taken. The examination of the nose and throat should be particularly on the nature of the nasal mucosa (eg. As color, congestion) and the presence of effluent concentrate (external or in the posterior pharynx). The ears should be examined for cause of cough reflex. The cervical and supraclavicular areas should be inspected for lymphadenopathy and palpated. It is carried out a full examination of the lungs, especially the scope of inhaled and exhaled air; Symmetry of breath sounds and whether wet RG, wheezing, or both are present. are signs of consolidation (. eg Ägophonie, dull head sound) to beobachten.Warnzeichen The following findings are of particular importance: dyspnea hemoptysis weight loss Persistent fever risk factors for TB or HIV infection interpretation of results Some results suggest certain diagnoses out (see table: causes of cough). Other key findings are less specific. For example, help paint does not (eg. As yellow, green) and thick sputum, to distinguish bacterial causes of others. can wheezing occur on multiple causes. Hemoptysis in small quantities can occur in severe cough of different etiology, although indicate larger amounts of hemoptysis on bronchitis, bronchiectasis, TB or primary lung cancer. Fever, night sweats and weight loss can Patients with serious findings of dyspnea or hemoptysis and in patients with reasonable suspicion of pneumonia, pulse oximetry and chest X-ray should be performed in many chronic infections and cancer auftreten.Tests. Patients with weight loss or risk factors should perform chest X-ray and tests for TB and HIV infection. In many patients, without serious findings, clinicians can support the diagnosis of the medical history and the results of the physical examination and begin treatment without further testing. In patients without clear cause, but without ernstzunehmnde findings, many doctors begin treatment empirically against postnasal drip (z. B. antihistamine and decongestant combinations, nasal corticosteroid) or gastroesophageal reflux (z. B. proton pump inhibitors, H2 blockers). An appropriate response to these measures usually makes further clarification unnecessary. Patients with chronic cough, in which a putative treatment is ineffective, should perform a chest x-ray. If the radiographic findings are normal, many doctors test sequentially on Asthma (pulmonary function tests with methacholine), sinuses (CT of the sinuses) and gastroesophageal reflux disease (monitoring the pH in the esophagus). A sputum culture is useful in patients with a possible indolent infection such as whooping cough, tuberculosis or non-tuberculous mycobacterial infection. The sputum cytology is noninvasive and should be performed in cases of suspected cancer, and if the patient produces sputum or hemoptysis has. A chest CT and possibly bronchoscopy should be performed in patients with lung cancer, or if another bronchial tumor is suspected (eg. As in patients who have smoked for many years or have non-specific constitutional symptoms) and in patients in whom a empiric therapy has failed and where the preliminary tests have provided inconclusive results. Treatment Treatment consists of treating the causes. There is little evidence to support the use of cough relievers or expectorant agent. Coughing is an important endogenous mechanism to remove secretions from the respiratory tract and can help treat respiratory infections. Therefore - even if the patients often expect to get a cough suppressant or even ask for it - should only be done very carefully and be restricted to patients with infections of the upper respiratory tract and patients such treatment who are receiving treatment for the underlying disease and the continued strong suffer from their cough. Cough suppressants can help some patients with chronic cough who have a reflex or a psychogenic component to her cough, or develop the violations of the bronchial mucosa. Antitussives suppress the medullary cough center (dextromethorphan and codeine) or anesthetize the stretch receptors in the bronchi and alveoli of afferent Vagusanteile (benzonatate). Dextromethorphan is chemically related to the opioid levorphanol and p.o. as a tablet or juice in a dose of 15-30 mg administered 4 times / day for children 1 to 4 times / day in adults or 0.25 mg / kg body weight. Codeine acts antitussive, (n. D. Talk .: weak) analgesic and sedative, but can in rare cases lead to dependence. Nausea, vomiting, constipation and tolerance development are possible side effects. The usual dose for adults is 10-20 mg p.o. every 4-6 hours and for children from 0.25 to 0.5 mg / kg body weight 4 times / day. Other opiates (hydrocodone, hydromorphone, methadone, morphine) also acting antitussive, but not used because of its high dependence and abuse potential. The related with tetracaine benzonatate, which is available in liquid-filled capsules, is effective at a dose of 100-200 mg p.o.2 times / day. Expectorants are intended to reduce the viscosity of the bronchial secretions and promotion facilitate (coughing), but are, if any, of limited effectiveness. Guaifenesin (200-400 mg po every 4 hours as juice or tablet) is used most frequently because it has no serious side effects. In addition, numerous other secretolytics, including bromhexine, Ipecac and saturated potassium iodide exist (SSKI). The use of inhaled expectorants such as isoproterenol, N-acetylcysteine ??and DNase is generally on the stationary portion for the treatment of cough in patients with limited bronchiectasis or cystic fibrosis. Adequate hydration, the secretion promotion easier, as well as the inhalation of vapor, but neither of those measures has been tested enough. Local treatment with cough drops or juices (Demulzentia) containing acacia, licorice, glycerin, honey and Wild Cherry, soothes irritations and possibly emotionally soothing. Your benefit, however, is not scientifically proven. Protussiva that promote cough are indicated for cystic fibrosis and bronchiectasis, so in diseases where an adequate sputum for Sekretclearance and preservation of lung function is regarded as important. DNase or hypertonic saline solutions are used in connection with vibration massage, physiotherapy equipment breath (n. D. Übers .: VRP1-Flutter, RC-Cornet) and postural drainage to promote cough and sputum. This therapeutic approach appears in cystic fibrosis (n. D. Red .: and bronchiectasis) is advantageous, but not in most other causes of chronic cough. Bronchodilators, such as salbutamol and ipratropium bromide or inhaled corticosteroids may be associated with cough therapeutic utility in a persistent cough for infections of the upper respiratory tract and asthma. Conclusion alarms include breathlessness, chronic fever, weight loss and coughing up blood. The clinical diagnosis is usually sufficient. An occult gastroesophageal reflux sufferers awareness should remain as a possible cause in memory. Antitussives and expectorants should be focused.