cough

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Definition

A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions.

Description

While people can generally cough voluntarily, a cough is usually a reflex triggered when an irritant stimulates one or more of the cough receptors found at different points in the respiratory system. These receptors then send a message to the cough center in the brain, which in turn tells the body to cough. A cough begins with a deep breath in, at which point the opening between the vocal cords at the upper part of the larynx (glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved in breathing press against the lungs, the glottis suddenly opens, producing an explosive outflow of air at speeds greater than 100 mi (160 km) per hour.

In normal situations, most people cough once or twice an hour during the day to clear the airway of irritants. However, when the level of irritants in the air is high or when the respiratory system becomes infected, coughing may become frequent and prolonged. It may interfere with exercise or sleep, and it may also cause distress if accompanied by dizziness, chest pain, or breathlessness. In the majority cases, frequent coughing lasts one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more than three weeks it is considered a chronic cough, and physicians will try to determine a cause beyond an acute infection or irritant.

Coughs are generally described as either dry or productive. A dry cough does not bring up a mixture of mucus, irritants, and other substances from the lungs (sputum), while a productive cough does. In the case of a bacterial infection, the sputum brought up in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

— Jeffrey P. Larson, RPT

1. To expel air from the lungs suddenly and noisily, often to keep the respiratory passages free of irritating material.
2. To make a noise similar to noisy expulsion of air from the lungs: The engine coughed and died.

To expel by coughing: coughed up phlegm.

1. The act of coughing.
2. An illness marked by frequent coughing.

cough up Slang.

1. To hand over or relinquish (money or another possession), often reluctantly.
2. To confess or disclose: When he saw that the police might arrest him, he coughed up the details of what he had seen.

[Middle English coughen, ultimately of imitative origin.]

Cough is an onomatopoeic word in most languages (e.g. kuchen, tosse, tossa, toux). It has been called the ‘watchdog of the lungs’. When it barks it warns you that there may be an intruder (inhalation of an irritant), there may be something wrong in the house (lung disease), or perhaps the dog is asking for attention (communication). Cough always requires interpretation.

A cough is a deep inspiration, followed by a powerful expiratory effort while the larynx (voicebox) is reflexly closed by bringing together the vocal cords; then the larynx suddenly opens, allowing a rapid flow of air from the lungs which will repel the intruder or expel the material in the airways that needs to be coughed up. Cough is the most violent of respiratory acts. Put your hands on your abdomen and cough and you will see. Expiratory pressures in the chest may be three times that of blood pressure (and occasionally coughing can break blood vessels), and the airflow velocity in the larynx may approach supersonic levels. During coughing the airways in the chest are squeezed, and the expiratory blast forces mucus secretions through these narrow passages out into the open air. The associated cough sound is part of the definition of cough. The sound varies, from a simple single or double pattern of ‘dry’ cough, due, for example, to laryngitis, to the bubbling, rumbling cough sound of disease with much mucus in the airways.

Cough is the commonest and sometimes the most distressing symptom of lung disease, far more so than breathlessness or pain, and can be caused by over 100 chest and lung diseases. Probably the most frequent cause of coughing is cigarette smoking, but this has never been assessed because smokers do not complain to the doctor; they would be told to stop smoking, which is not what they want to hear. Although only the first breaths of cigarette smoke cause cough, and the smoker rapidly becomes acclimatized, smoking causes mucus secretion in the bronchi, and this produces the typical early morning smokers' cough. Later, and unfortunately, the smoker may develop chronic bronchitis, characterized by chronic cough and phlegm production.

The commonest disease to cause cough is upper airway infection (due to influenza, sinusitis, etc.), but there are some bizarre causes, such as an earwig in the external ear (which is supplied by the same nerve as the lungs). Cough can be psychological, as Sigmund Freud recognized when some of his patients presented with ‘hysterical cough’, including the first historical case of psychoanalysis, Anna O. Unlike sneezing, hiccough, and yawn, cough can be voluntarily produced with its complete pattern, and we may use it as a form of communication. The speaker may cough (clear his throat) to attract the attention of his audience, and the audience may get its revenge by ‘coughing him down’. Voluntary or not, coughing can ‘drown the parson's saw’ (Macbeth).

It seems common experience in concert halls and theatres that we cannot suppress a cough, although the cougher and his neighbours may disagree about this. However, cough due to upper airway infection can be suppressed for quite long (5-20 min) periods, so perhaps the old adage that ‘love and cough cannot be hid’ is wrong in both respects.

— John Widdicombe

A sudden, noisy expulsion of air from the lungs.

Definition

A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions.

Description

While people can generally cough on purpose, a cough is usually a reflex triggered when an irritant stimulates one or more of the cough receptors found at different points in the respiratory system. These receptors then send a message to the cough center in the brain, which in turn tells the body to cough. A cough begins with a deep breath in, at which point the opening between the vocal cords at the upper part of the larynx (glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved in breathing press against the lungs, the glottis suddenly opens, producing an explosive outflow of air at speeds greater than 100 mi (160 km) per hour.

In normal situations, most people cough once or twice an hour during the day to clear the airway of irritants. However, when the level of irritants in the air is high or when the respiratory system becomes infected, coughing may become frequent and prolonged. It may interfere with exercise or sleep, and it may also cause distress if accompanied by dizziness, chest pain, or breathlessness. In the majority cases, frequent coughing lasts one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more than three weeks, it is considered a chronic cough, and physicians will try to determine a cause beyond an acute infection or irritant.

Coughs are generally described as either dry or productive. A dry cough does not bring up a mixture of mucus, irritants, and other substances from the lungs (sputum), while a productive cough does. In the case of a bacterial infection, the sputum brought up in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

Causes & Symptoms

In the majority of cases, coughs are caused by respiratory infections, including:

• colds or influenza, the most common causes of coughs
• bronchitis, an inflammation of the mucous membranes of the bronchial tubes
• croup, a viral inflammation of the larynx, windpipe, and bronchial passages that produces a bark-like cough in children
• whooping cough, a bacterial infection accompanied by the high-pitched cough for which it is named
• pneumonia, a potentially serious bacterial infection that produces discolored or bloody mucus
• tuberculosis, another serious bacterial infection that produces bloody sputum
• fungal infections, such as aspergillosis, histoplasmosis, and cryptococcoses

Environmental pollutants, such as cigarette smoke, dust, or smog, can also cause a cough. In the case of cigarette smokers, the nicotine present in the smoke paralyzes the hairs (cilia) that regularly flush mucus from the respiratory system. The mucus then builds up, forcing the body to removed it by coughing. Post-nasal drip, the irritating trickle of mucus from the nasal passages into the throat caused by allergies or sinusitis, can also result in a cough. Some chronic conditions, such as asthma, chronic bronchitis, emphysema, and cystic fibrosis, are characterized in part by a cough. A condition in which stomach acid backs up into the esophagus (gastroesophageal reflux) can cause coughing, especially when a person is lying down. A cough can also be a side effect of medications that are administered via an inhaler. It can also be a side effect of beta-blockers and ACE inhibitors, which are drugs used for treating high blood pressure.

Diagnosis

To determine the cause of a cough, a physician should take an exact medical history and perform an exam. Information regarding the duration of the cough, what other symptoms may accompany it, and what environmental factors may influence it aid the doctor in his or her diagnosis. The appearance of the sputum will also help determine what type of infection, if any, may be involved. The doctor may even observe the sputum microscopically for the presence of bacteria and white blood cells. Chest x rays may help indicate the presence and extent of such infections as pneumonia or tuberculosis. If these actions are not enough to determine the cause of the cough, a bronchoscopy or laryngoscopy may be ordered. These tests use slender tubular instruments to inspect the interior of the bronchi and larynx.

Treatment

Coughs due to bacterial or viral upper respiratory infections may be effectively treated with complementary therapies. The choice of remedy will vary and be specific to the type of cough the patient has. Lingering coughs or coughing up blood should be treated by a trained practitioner.

Nutrition & Diet

Many health practitioners advise increasing fluid intake and breathing in warm, humidified air as ways of loosening chest congestion. Avoiding mucous-producing foods can be effective in healing a cough condition. These mucous-producing foods can vary, based on individual intolerance, but dairy products are a major mucous-producing food for most people. Other foods to avoid are sugar and foods high in sodium. Others recommend hot tea flavored with honey as a temporary home remedy for coughs caused by colds or flu.

Various vitamins may be helpful in preventing or treating conditions (including colds and flu) that lead to coughs. They include vitamin C, vitamin E, zinc, vitamin A, and folic acid.

Herbal Medicine

There are many Western herbs, as well as herbs used in traditional Chinese medicine (TCM), that soothe the throat, quiet coughs, and act as expectorants. Some include:

• marsh mallow
• licorice
• aniseed
• fritillaria
• loquat

Homeopathic Remedies

Depending on the type of cough and its duration, several homeopathic remedies include:

• Aconite for dry coughs with fever
• Antimonium tartaricum for productive coughs
• Bryonia for intense, dry coughs accompanied by thirst
• Drosera for violent coughing
• Rumex crispus for tickling coughs

Allopathic Treatment

Treatment of a cough generally involves addressing the condition causing it. An acute infection such as pneumonia may require antibiotics, an asthma-induced cough may be treated with the use of bronchodialators, or an antihistamine may be administered in the case of an allergy. Cough medicines may be given if the patient cannot rest because of the cough or if the cough is not productive, as is the case with most coughs associated with colds or flu. The two types of drugs used to treat coughs are antitussives and expectorants.

Expected Results

Because the majority of coughs are related to the common cold or influenza, most will end in 7-21 days. The outcome of coughs due to a more serious underlying disease depends on the pathology of that disease.

Prevention

It is important to identify and treat the underlying disease and origin of the cough. Avoid smoking and coming in direct contact with people experiencing cold or flu symptoms. Wash hands frequently during episodes of upper-respiratory illnesses.

Resources

Books

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Tiburon, CA: Future Medicine Publishing Inc., 1999.

Chandrasoma, Parakrama, and Clive R. Taylor. Concise Pathology. East Norwalk, CT: Appleton and Lange, 1991.

Schumann, Lorna. "Alterations in Respiratory Function." In Perspectives on Pathophysiology. Lee-Ellen Copstead, ed. Philadelphia: W.B. Saunders, 1994.

Time-Life Books Editors. The Alternative Advisor. Alexandria, VA: Time-Life Books, 1997.

Periodicals

Philp, Elizabeth B. "Chronic Cough."American Family Physician 56 (October 1, 1997).

Organizations

National Heart, Lung, and Blood Institute Information Center. P.O. Box 30105, Bethesda, MD 20824. (301)251-1222.

Definition

A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions.

Description

While people can generally cough voluntarily, a true cough is usually a reflex triggered when an irritant stimulates one or more of the cough receptors found at different points in the respiratory system. These receptors then send a message to the cough center in the brain, which in turn tells the body to cough. A cough begins with a deep breath in, at which point the opening between the vocal cords at the upper part of the larynx (glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved in breathing press against the lungs, the glottis suddenly opens, producing an explosive outflow of air at speeds greater than 100 miles (160 km) per hour.

In normal situations, most people cough once or twice an hour during the day to clear the airway of irritants. However, when the level of irritants in the air is high or when the respiratory system becomes infected, coughing may become frequent and prolonged. It may interfere with exercise or sleep, and it may also cause distress if accompanied by dizziness, chest pain, or breathlessness. In the majority of cases, frequent coughing lasts one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more than three weeks it is considered a chronic cough, and physicians try to determine a cause beyond an acute infection or irritant.

Coughs are generally described as either dry or productive. A dry cough does not bring up a mixture of mucus, irritants, and other substances from the lungs (sputum), while a productive cough does. In the case of a bacterial infection, the sputum brought up in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

Demographics

Formal statistics on coughs are not maintained. Virtually all persons will experience coughs several times each year throughout their lives.

Causes and Symptoms

In the majority of cases, coughs are caused by respiratory infections, including the following:

• colds or influenza, the most common causes of coughs
• bronchitis, an inflammation of the mucous membranes of the bronchial tubes
• croup, a viral inflammation of the larynx, windpipe, and bronchial passages that produces a bark-like cough in children
• whooping cough, a bacterial infection accompanied by the high-pitched cough for which it is named
• pneumonia, a potentially serious bacterial infection that produces discolored or bloody mucus
• tuberculosis, another serious bacterial infection that produces bloody sputum
• fungal infections, such as aspergillosis, histoplasmosis, and cryptococcosis

Environmental pollutants, such as cigarette smoke, dust, or smog, can also cause a cough. In the case of cigarette smokers, the nicotine present in the smoke paralyzes the hairs (cilia) that regularly flush mucus from the respiratory system. The mucus then builds up, forcing the body to remove it by coughing. Post-nasal drip, the irritating trickle of mucus from the nasal passages into the throat caused by allergies or sinusitis, can also result in a cough. Some chronic conditions, such as asthma, chronic bronchitis, emphysema, and cystic fibrosis, are characterized in part by a cough. A condition in which stomach acid backs up into the esophagus (gastroesophageal reflux) can cause coughing, especially when a person is lying down. A cough can also be a side-effect of medications that are administered via an inhaler. It can be a side-effect of beta-blockers and ACE inhibitors, which are drugs used for treating high blood pressure.

When to Call the Doctor

A physician or other healthcare provider should be called when a cough does not subside after three or four days. Individuals such as smokers, who have chronic coughs, should consult a doctor if the nature of their cough changes or they produce blood when they cough.

Diagnosis

To determine the cause of a cough, a physician should take an exact medical history and perform an exam. Information regarding the duration of the cough, what other symptoms may accompany it, and what environmental factors may influence it aid the doctor in his or her diagnosis. The appearance of the sputum also helps determine what type of infection, if any, may be involved. The doctor may even observe the sputum microscopically for the presence of bacteria and white blood cells. Chest x rays may help indicate the presence and extent of such infections as pneumonia or tuberculosis. If these actions are not enough to determine the cause of the cough, a bronchoscopy or laryngoscopy may be ordered. These tests use slender tubular instruments to inspect the interior of the bronchi and larynx.

Treatment

Treatment of a cough generally involves addressing the condition causing it. An acute infection such as pneumonia may require antibiotics, an asthma-induced cough may be treated with the use of bronchodilators, or an antihistamine may be administered in the case of an allergy. Physicians prefer not to suppress a productive cough, since it aids the body in clearing respiratory system of infective agents and irritants. However, cough medicines may be given if the person cannot rest because of the cough or if the cough is not productive, as is the case with most coughs associated with colds or flu. The two types of drugs used to treat coughs are antitussives and expectorants.

Antitussives

Antitussives are drugs that suppress a cough. Narcotics—primarily codeine—are used as antitussives and work by depressing the cough center in the brain. However, they can cause such side effects as drowsiness, nausea, and constipation. Dextromethorphan, the primary ingredient in many over-the-counter cough remedies, also depresses the brain's cough center but without the side effects associated with narcotics. Demulcents relieve coughing by coating irritated passageways.

Expectorants

Expectorants are drugs that thin mucus in order to make it easier to cough up. Guaifenesin and terpin hydrate are the primary ingredients in most over-the-counter expectorants. However, some studies have shown that in acute infections, simply increasing fluid intake has the same thinning effect as taking expectorants.

Coughs due to bacterial or viral upper respiratory infections may be effectively treated with botanical and homeopathic therapies. The choice of remedy will vary and be specific to the type of cough the person has. Some combination over-the-counter herbal and homeopathic cough formulas can be very effective for cough relief. Lingering coughs or coughing up blood should be treated by a trained practitioner.

Many health practitioners advise increasing fluids and breathing in warm, humidified air as ways of loosening chest congestion. Others recommend hot tea flavored with honey as a temporary home remedy for coughs caused by colds or flu. Various vitamins, such as vitamin C, or minerals, such as zinc, may be helpful in preventing or treating conditions (including colds and flu) that lead to coughs. Avoiding of mucus-producing foods can be effective in healing a cough condition. These mucus-producing foods can vary, based on individual intolerance, but dairy products are a major mucus-producing food for most people.

Prognosis

Because the majority of coughs are related to the common cold or influenza, most will end in seven to 21 days. The outcome of coughs due to a more serious underlying disease depends on the pathology of that disease.

Prevention

It is important to identify and treat the underlying disease and origin of the cough. It is helpful to avoid cigarette smoke and coming in direct contact with people experiencing cold or flu symptoms. Hands should be washed frequently during episodes of upper-respiratory illnesses.

Nutritional Concerns

Persons with coughs should be sure to maintain balanced and healthy diets.

Parental Concerns

Parents of children under the age of five should closely monitor their children when they have a cough. Parents of children over five years of age must accept the fact that their children are likely to acquire coughs and related illnesses from schoolmates. They should remain vigilant and consider having their children seen by a physician if the cough does not resolve after five to seven days.

See also Common cold.

Resources

Books

Boat, Thomas F. "Talipes Chronic or Recurrent Respiratory Symptoms." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al., Philadelphia: Saunders, 2003, pp. 1401–44.

Hanley, Michael E., and Carolyn Welsh. Current Diagnosis & Treatment in Pulmonary Medicine. New York: McGraw-Hill, 2003.

Weinberger, Steven E. Principles of Pulmonary Medicine. Little Rock, AR: Elsevier, 2003.

Weinberger, Steven E., and Eugene Braunwald. "Cough and Hemoptysis." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 203–6.

Periodicals

Chow, P. Y., et al. "Chronic cough in children." Singapore Medical Journal 45, no. 10 (2004): 462–9.

Franco, E., et al. "Pertussis vaccination for adolescents and adults." Expert Opinion on Biological Therapy 4, no. 10 (2004): 1669–76.

Organizations

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211–2672. Web site: www.aafp.org/.

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007–1098. Web site: www.aap.org/default.htm.

American College of Physicians. 190 N Independence Mall West, Philadelphia, PA 19106–1572. Web site: www.acponline.org/.

American Lung Association. 1740 Broadway, New York, NY 10019. Web site: www.lungusa.org.

Web Sites

"Cough." Brigham Young University, October 26, 2000. Available online at www.byu.edu/shc/library/common/cough.html (accessed January 5, 2005).

"Cough." MedlinePlus. Available online at www.nlm.nih.gov/medlineplus/cough.html (accessed January 5, 2005).

Holmes, Robert L., and Clare T. Fadden. "Evaluation of the Patient with Chronic Cough." American Academy of Family Practice, May 1, 2004. Available online at www.aafp.org/afp/971001ap/cough.html (accessed January 5, 2005).

[Article by: L. Fleming Fallon, Jr., MD, DrPH]

Pertaining to cough.

Cough

A young boy coughing due to pertussis. Coughing The sound of a person coughing. Problems listening to this file? See media help.
ICD-10	R05.
ICD-9	786.2
MedlinePlus	003072
eMedicine	ENT/1048560

A cough ( pronunciation (help·info) Latin: tussis), in medicine, is a sudden and often repetitively occurring defense reflex which helps to clear the large breathing passages from excess secretions, irritants, foreign particles and microbes. The cough reflex consists of three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound.^[1] Coughing can happen voluntarily as well as involuntarily, though for the most part, involuntarily.

Frequent or severe coughing usually indicates the presence of a disease. Many viruses and bacteria benefit by causing their host to cough, which helps to spread the disease to new hosts. Coughing is classified as acute (of sudden onset) if it is present less than three weeks, subacute if it is present between three and eight weeks, and chronic when lasting longer than eight weeks. A cough can be dry or productive, depending on whether sputum is coughed up. Most of the time, coughing is acute and caused by a respiratory tract infection. Coughing can be triggered by food entering the windpipe rather than the esophagus due to a failure of the epiglottis in patients who have difficulties swallowing. Smoking and air pollution are common causes of coughing.^[1] Provided the patient is a non-smoker and has a normal chest X-ray, the three most common causes of chronic cough are asthma, gastroesophageal reflux disease and post-nasal drip. Other causes of chronic cough include chronic bronchitis, heart failure and medications such as ACE inhibitors.

Since cough is a natural protective reflex, suppressing the cough reflex might have deleterious effects, especially if the cough is productive.^[2] Nonetheless, coughing might be severe enough (in terms of psychological, physical and social distress) to warrant treatment. This should be targeted towards the cause as much as possible, for example by smoking cessation and discontinuing ACE inhibitors. Some patients may only be worried about serious illnesses, and reassurance may suffice. Cough suppressants (or antitussives) such as codeine or dextromethorphan are frequently prescribed although scientific evidence supporting their use is often of poor quality. Other treatment options may target airway inflammation or may promote mucus expectoration.

Contents 1 Physiology 2 Causes 3 Complications 4 Treatment 5 During injections 6 Psychological causes 7 Social aspects of coughing 8 See also 9 References

Physiology

A cough is a protective, primitive reflex in healthy individuals, and thus can occur while a person is unconscious. The cough reflex is initiated by stimulation of two different classes of afferent nerves, namely the myelinated rapidly adapting receptors, and nonmyelinated C-fibers with endings in the lungs. However it is not certain that the stimulation of nonmyelinated C-fibers leads to cough with a reflex as it's meant in physiology (with its own five components): this stimulation may cause mast cells degranulation (through an asso-assonic reflex) and edema which may work as a stimulus for rapidly adapting receptors.

Causes

Cough can be a sign of respiratory tract infections such as the common cold, pneumonia, pertussis, and tuberculosis. In patients with a normal chest X-ray, tuberculosis is a rare finding. Pertussis is increasingly being recognised as a cause of troublesome coughing in adults. Cough can also worsen in an acute exacerbation of chronic obstructive pulmonary disease. In dogs, kennel cough, or tracheobronchitis, can be a cause of coughing.

The common causes of chronic dry coughing include post-nasal drip, gastroesophageal reflux disease, asthma, post viral cough and ACE inhibitors. When coughing is the only complaint of a person who meets the criteria for asthma (bronchial hyperresponsiveness and reversibility), this is termed cough-variant asthma. Two related conditions are atopic cough and eosinophilic bronchitis. Atopic cough occurs in individuals with a family history of atopy, abundant eosinophils in the sputum, but with normal airway function and responsiveness. Eosinophilic bronchitis is also characterized by eosinophilia in the sputum, without airway hyperresponsiveness or an atopic background. This condition responds to treatment with corticosteroids.

Individuals who smoke often have a smoker's cough, a loud, hacking cough which often results in the expiration of phlegm. Coughing has also been linked to air pollution.

A foreign body can sometimes be suspected, for example if the cough started suddenly when the patient was eating. Rarely, sutures left behind inside the airway branches can cause coughing. A cough can be triggered by dryness from mouth breathing or recurrent aspiration of food intro the windpipe in people with swallowing difficulties.

Cough may also be caused by conditions affecting the lung tissue such as bronchiectasis, cystic fibrosis, interstitial lung diseases and sarcoidosis. Coughing can also be triggered by benign or malignant lung tumors or mediastinal masses. Through irritation of the nerve, diseases of the external auditory canal (wax, for example) can also cause cough. Cardiovascular diseases associated with cough are heart failure, pulmonary infarction and aortic aneurysm.

Coughing may also be used for social reasons, such as the coughing before giving a speech. Cough may also be psychogenic, which is different from habit coughing and tic coughing.^[3] Coughing may occur in tic disorders such as Tourette's syndrome, although it should be distinguished from throat-clearing in this disorder.

Given its irritant nature to mammal tissues, capsaicin is widely used to determine the cough threshold and as a tussive stimulant in clinical research of cough suppressants. Capsaicin is what makes chilli peppers spicy, and might explain why workers in factories with these vegetables can develop a cough.

Complications

The complications of coughing can be classified as either acute or 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 blebs causing spontaneous pneumothorax (although this still remains to be proven), subconjunctival hemorrhage or "red eye," coughing defecation and in women with a prolapsed uterus, cough urination. Chronic complications are common and include abdominal or pelvic hernias, fatigue fractures of lower ribs and costochondritis.

Treatment

Coughs can be treated with cough medicines. 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.

Cough suppressants act to reduce the urge to cough. Centrally acting cough suppressants, such as codeine and dextromethorphan, work by depolarization, or a dulling, of the vagus nerve, the nerve leading from the brain stem and serving the chest area. Benzonatate, sold under the brand names Tessalon Perles or Tessalon Capsules, works by anesthetizing stretch receptors in the lungs.

During injections

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.^[4]

Psychological causes

Sometimes a cough can be found to have no apparent physical or medical cause. In these instances emotional and psychological problems are likely causes and the cough is often called a "psychogenic cough" (also known as a "habit cough" or "tic cough"). However, other illnesses have to be ruled out before a firm diagnosis of psychogenic cough is made. Psychogenic cough is thought to be more common in children than in adults. A possible scenario: psychogenic cough develops in a child who has a chronically ill brother or sister.^{[citation needed]}

Social aspects of coughing

Coughing is not always involuntary, and can be used in social situations. Coughing can be used to attract attention, release internal psychological tension, or become a maladaptive displacement behavior. It is believed that the frequency of such coughing increases in environments vulnerable to psychological tension and social conflict. In such environments, coughing may become one of many displacement behaviors and/or defense mechanisms.

As coughing involves the release of high velocity saliva, common courtesy involves covering ones mouth during the cough, to avoid coughing on anyone nearby. Traditionally, this covering of the mouth was done with the hand, although in the early 21st century, a trend developed towards covering the mouth with the arm and elbow instead. This is considered more hygienic, as coughing on the hand while suffering a cold merely passes germs on to the hand, which can then be transferred to anything touched by the sufferer: doorknobs, telephones, shopping carts, etc.

See also

• Croup
• Pertussis
• Kennel cough
• Tic

References

1. ^ ^{a b} Chung KF, Pavord ID (April 2008). "Prevalence, pathogenesis, and causes of chronic cough". Lancet 371 (9621): 1364–74. doi:10.1016/S0140-6736(08)60595-4. PMID 18424325. http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60595-4. 
2. ^ Pavord ID, Chung KF (April 2008). "Management of chronic cough". Lancet 371 (9621): 1375–84. doi:10.1016/S0140-6736(08)60596-6. PMID 18424326. http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60596-6. 
3. ^ Irwin RS, Glomb WB, Chang AB (January 2006). "Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines". Chest 129 (1 Suppl): 174S–179S. doi:10.1378/chest.129.1_suppl.174S. PMID 16428707. http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=16428707. 
4. ^ Usichenko, TI; Pavlovic D, Foellner S & Wendt M. (2004). "Reducing venipuncture pain by a cough trick: a randomized crossover volunteer study". Anesthesia and Analgesia 99 (3): 952–3. doi:10.1213/01.ANE.0000131941.61962.09. PMID 14742367. 

• McCool F (2006). "Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice guidelines.". Chest 129 (1 Suppl): 48S–53S. doi:10.1378/chest.129.1_suppl.48S. PMID 16428691. Full text
• Irwin, RS, Glomb, WB, Chang, AB (2006). "Habit Cough, Tic Cough, and Psychogenic Cough in Adult and Pediatric Populations.". Chest 129 (1 Suppl): 174S–179S. doi:10.1378/chest.129.1_suppl.174S. PMID 16428707. [1]

^ Arella, A. (nd), Coughing as an Indicator of Displacement Behaviour, <http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ33337.pdf> (Unpublished thesis)

Look up cough in Wiktionary, the free dictionary.

v • d • e Symptoms and signs: circulatory and respiratory systems (R00-R09 · 785-786) Cardiovascular system Heart Tachycardia/Bradycardia · Palpitation Heart sounds: Heart murmur (Systolic, Diastolic, Continuous) · Gallop rhythm (Third heart sound, Fourth heart sound) · Pericardial friction rub · Split S2 · Heart click Pulse abnormalities Pulsus alternans · Pulsus bigeminus · Pulsus bisferiens · Pulsus tardus et parvus · Pulsus paradoxus Other peripheral blood flow Bruit/Carotid bruit · Gangrene · Cannon A waves Respiratory system Hemorrhage Epistaxis · Hemoptysis Abnormalities of breathing Respiratory sounds: Stridor · Wheeze · Rales · Rhonchi · Hamman's sign Dyspnea · Hyperventilation/Hypoventilation · Hyperpnea/Tachypnea/Bradypnea · Orthopnea/Platypnea Biot's respiration · Cheyne-Stokes respiration · Kussmaul breathing Hiccup · Mouth breathing/Snoring Other Asphyxia · Cough · Pleurisy · Sputum Respiratory arrest · Hypercapnia/Hypocapnia Whispered pectoriloquy · Egophony · Bronchophony Chest, general Chest pain see also eponymous medical signs for circulatory and respiratory systems

v • d • e Common cold Viruses Rhinovirus - Coronavirus - Human parainfluenza viruses - Human respiratory syncytial virus - Adenovirus - Enterovirus - Metapneumovirus Symptoms Pharyngitis - Rhinorrhea - Nasal congestion - Sneezing - Cough - Muscle aches - Fatigue - Malaise - Headache - Weakness - Loss of appetite Complications Acute bronchitis - Bronchiolitis - Croup - Pneumonia - Sinusitis - Otitis media - Strep throat Antiviral drugs Pleconaril (experimental)

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Dansk (Danish)
v. intr. - hoste, gå uregelmæssigt
v. tr. - host, gøen
n. - host, hosten, hoste

idioms:

• cough drop    hostepastil
• cough mixture    hostesaft
• cough up    hoste op med, punge ud med, spytte ud med

Nederlands (Dutch)
hoest, bekentenis, hoesten, sputteren, bekennen

Français (French)
v. intr. - tousser
v. tr. - tousser, cracher, expectorer
n. - toux

idioms:

• cough drop    pastille pour la toux
• cough mixture    préparation contre la toux, antitussif
• cough something out    cracher (qch)
• cough up    (lit) cracher (sang), (fig) cracher (information)

Deutsch (German)
n. - Husten
v. - husten, aushusten

idioms:

• cough drop    Hustenbonbon
• cough mixture    Hustensaft
• cough something out    aushusten
• cough up    heraushusten, widerwillig (preis)geben

Ελληνική (Greek)
n. - βήχας, βήξιμο
v. - βήχω, (για όπλα κ.λπ.) εκπυρσοκροτώ

idioms:

• cough drop    παστίλια του βήχα/λαιμού
• cough mixture    σιρόπι για το βήχα
• cough up    αποχρέμπτομαι, βήχω και βγάζω φλέματα, (καθομ.) τα σκάω, πληρώνω

Italiano (Italian)
espettorare, tossire, perdere colpi, tosse

idioms:

• cough drop    pasticca contro la tosse
• cough mixture    sciroppo contro la tosse
• cough up    sborsare, espettorare

Português (Portuguese)
n. - tosse (f)
v. - tossir

idioms:

• cough drop    pastilha (f) para tosse
• cough mixture    mistura (f) para tosse
• cough up    expelir tossindo

Русский (Russian)
кашлять, кашель

idioms:

• cough drop    таблетка от кашля
• cough mixture    микстура от кашля
• cough up    отхаркнуть, заплатить, расколоться, скинуться

Español (Spanish)
v. intr. - toser, carraspear
v. tr. - chisporrotear, expectorar
n. - tos, carraspeo, chisporroteo

idioms:

• cough drop    pastilla para la tos
• cough mixture    jarabe para la tos
• cough something out    escupir algo , expectorar
• cough up    expectorar, escupir, apoquinar, aflojar la bolsa

Svenska (Swedish)
n. - hosta
v. - hosta, punga ut med (vard.)

中文（简体）(Chinese (Simplified))
咳嗽, 咳出

idioms:

• cough drop    止咳药片, 咳嗽糖
• cough mixture    止咳药
• cough up    咳出, 勉强说出

中文（繁體）(Chinese (Traditional))
v. intr. - 咳嗽
v. tr. - 咳出
n. - 咳嗽

idioms:

• cough drop    止咳藥片, 咳嗽糖
• cough mixture    止咳藥
• cough up    咳出, 勉強說出

한국어 (Korean)
v. intr. - 기침하다, 불연소음을 내다, 자백하다
v. tr. - 기침하여 ~을 하다, 털어놓다
n. - 기침, 기침병, 기침소리

idioms:

• cough up    심히 기침하다

日本語 (Japanese)
n. - せき, せき払い, せきの出る病気
v. - せきをする, せき払いする, せきをして吐き出す

idioms:

• cough drop    咳止めドロップ
• cough mixture    咳止め薬
• cough up    しぶしぶ渡す, 白状する
• hacking cough    短い空咳
• whooping cough    百日咳

العربيه (Arabic)
‏(الاسم) سعال, كحه (فعل) سعل, كح‏

עברית (Hebrew)
v. intr. - ‮השתעל, הודה‬
v. tr. - ‮הודה‬
n. - ‮הודאה בפשע, שיעול‬

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