Pathophysiology and clinical presentations of cough☆,☆☆,★
Section snippets
CLINICAL PRESENTATIONS OF CHRONIC DRY COUGH
The cough reflex can be initiated at numerous anatomic sites, and it is therefore not surprising that chronic cough may have a variety of causes. Irrespective of the site of the pathologic disorder, patients with a chronic dry cough invariably have a persistent tickle or irritation in the throat, a condition described as sensory hyperalgesia, which is akin to sensory hyperalgesia of the skin.16 Two and sometimes three conditions may occur together in the same patient, thus complicating the
GER
GER has been found to be a common cause of chronic dry cough in published case series. Routine investigations for chronic cough are incomplete without a search for GER when other causes have been excluded.8 Until recently, it was uncertain whether the association of cough with GER is coincidental or pathologically related. Although cough resulting from GER may present with typical symptoms of dyspepsia, it is occult in the majority of patients.43 Although some patients may have reflux up to the
CONCLUSIONS
Chronic dry cough is an important clinical problem. Sensitization of the cough reflex is a common feature in these patients irrespective of the underlying cause. The pathogenetic mechanism of sensitization is unclear. A better understanding of the cough reflex is necessary to help answer this question and to devise appropriate antitussive agents. The synthesis of neuropeptide antagonists that can be used safely in human beings may open new research opportunities in the investigation of the
References (46)
- et al.
The treatment of cough: a comprehensive review
Chest
(1991) - et al.
Chronic cough
Prim Care
(1985) Chronic cough: mechanisms and management
Respir Med
(1993)- et al.
Inhaled sodium cromoglycate in angiotensin-converting enzyme inhibitor cough
Lancet
(1995) - et al.
Angiotensin-1-converting enzyme gene polymorphism and susceptibility to cough
Lancet
(1994) - et al.
Postnasal drip causes cough and is associated with reversible upper airway obstruction
Chest
(1984) - et al.
An algorithmic approach to chronic cough
Ann Intern Med
(1993) Cough
- et al.
Afferent neural pathways in cough and reflex bronchoconstriction
J Appl Physiol
(1988) - et al.
Sensitivity of the cough reflex in patients with chronic cough
Eur Respir J
(1992)
Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder
Eur Respir J
Chronic cough: the spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy
Am Rev Respir Dis
Capsaicin cough decreases with successful treatment of cough
Am Rev Respir Crit Care Med
Neuropeptides in the respiratory tract: I
Am Rev Respir Dis
Pulmonary reflexes: neural mechanisms of pulmonary defense
Ann Rev Physiol
Lack of importance of the superior laryngeal nerves in citric acid cough in man
J Appl Physiol
Effects of 8- hydroxy-2-(di-n-propylamino) tetralin, a selective antagonist of 5-HT1A receptors, on the cough reflex in rats
Eur J Pharmacol
Effects of 5-hydroxytryptamine and 5-hydroxytryptophan infusion on the human cough reflex
J Appl Physiol
Reflexes evoked from the tracheobronchial tree and lungs
Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy: a review of the literature and pathophysiology
Ann Intern Med
Increased cough reflex associated with angiotensin converting enzyme inhibitor therapy
Br Med J
Comparative study of the effects of three angiotensin converting enzyme inhibitors on the cough reflex
Am J Hypertens
Effect of dose adjustment on enalapril-induced cough and the response to inhaled capsaicin
Br J Pharmacol
Cited by (69)
Determinants of response to bronchodilator in patients with cough variant asthma- A randomized, single-blinded, placebo-controlled study
2020, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :Satia et al. in a recent study showed that an acute bronchoconstriction with allergen challenge increases the cough response to capsaicin, implying a role of bronchoconstriction may be involved in heighten cough responses [23]. On the other hand, chemical stimulation such as inflammatory mediators released by inflammatory cells will increase cough sensitivity due to stimulation of C-fiber might contribute to cough of CVA [11,24,25]. We found that cough did not relieve in more than one-third patients with CVA after the treatment of bronchodilator.
Cough: A Practical and Multifaceted Approach to Diagnosis and Management
2020, Medical Clinics of North AmericaCitation Excerpt :It is essential to understand the mechanism of the cough reflex in order to explore potential causes and appropriate management. Cough serves as a protective reflex to aid in the detection and clearance of debris and excess secretions from the respiratory tract.3,12,14 The vagus nerve supplies a majority of cough receptors, which are found throughout both the upper and lower airways, spanning from the pharynx to the terminal bronchioles.3,14
The History and Physical Examination
2019, Kendig's Disorders of the Respiratory Tract in ChildrenImpaired cough-related quality of life in patients with controlled asthma with gastroesophageal reflux disease
2012, Annals of Allergy, Asthma and ImmunologyThe History and Physical Examination
2012, Kendig and Chernick's Disorders of the Respiratory Tract in Children
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From the Department of Thoracic Medicine, National Heart and Lung Institute.
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Reprint requests: K. Fan Chung, MD, FRCP, Department of Thoracic Medicine, National Heart and Lung Institute, Dovehouse St., London SW3 6LY, United Kingdom.
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