cough
Introduction
Introduction to cough Cough is a protective respiratory reflex that removes secretions or foreign bodies from the respiratory tract. Although it has its beneficial side, severe long-term cough can cause respiratory tract bleeding. Correctly distinguish between general cough and cough variant asthma to prevent misdiagnosis. Treatment of cough should distinguish the type of cough, Western medicine, Chinese medicine can be, but the diet is the best. Pediatric patients are generally not suitable for the use of central antitussives, such as codeine, cough will clear, cough fen, etc., infants' respiratory system development is not mature, cough reflex is poor, airway lumen is narrow, blood vessels are rich, ciliated exercise Poor, sputum is not easy to discharge. If a cough is given, a strong cough medicine is given. Although the cough is temporarily stopped, the function of ciliated epithelial cells on the tracheal mucosa and the contractile peristalsis of bronchial smooth muscle are inhibited. Can not be discharged smoothly, a large amount of sputum accumulated in the trachea and bronchus, affecting respiratory function. basic knowledge The proportion of illness: 40% (40%) Susceptible people: no specific population Mode of infection: non-infectious Complications: chronic heart failure, hypertension
Cause
Cause of cough
Inhalation (20%):
Inhaled substances are classified into specific and non-specific. The former such as dust mites, pollen, fungi, animal dander, etc., non-specific inhalants such as sulfuric acid, sulfur dioxide, chloramine and the like. Specific inhalation of occupational cough such as toluene diisocyanate, phthalic anhydride, ethylenediamine, penicillin, protease, amylase, silk, animal dander or excrement, etc. In addition, non-specific formaldehyde, formic acid Wait.Infection (10%):
The formation and onset of cough is associated with repeated respiratory infections. In patients with cough, there may be specific IgE of bacteria, viruses, mycoplasmas, etc., and coughing may be induced if the corresponding antigen is inhaled. After the virus is infected, the airway epithelium can be directly damaged, resulting in increased respiratory responsiveness. Some scholars believe that interferon and IL-1 produced by viral infection increase the amount of histamine released by basophils. In the early childhood, respiratory viruses (especially respiratory syncytial virus) are also infected with cough symptoms. Cough caused by parasites such as mites and hookworms is still visible in rural areas.Food (20%):
The phenomenon of coughing due to eating relationships is often seen in cough patients, especially infants and young children are susceptible to food allergies, but gradually decrease with age. The most common foods that cause allergies are fish, shrimps, crabs, eggs, milk, etc. Climate change can cause cough when temperature, temperature, air pressure and/or airborne ions change, so it is more common in cold seasons or autumn and winter climate changes.Mental factors (10%):
Patients with emotional excitement, nervousness, anger, etc., can cause cough attacks, which are generally thought to be caused by reflexes or hyperventilation through the cerebral cortex and vagus nerve.Exercise (10%):
About 70% to 80% of cough patients induce cough after strenuous exercise, called exercise-induced cough, or exercise cough. Clinical manifestations include cough, chest tightness, shortness of breath, wheezing, auscultation audible and wheezing. Some patients have no typical asthmatic performance after exercise, but pulmonary function tests before and after exercise can detect bronchospasm.Cough and medication (10%):
Some drugs can cause coughing attacks, such as propranolol, which cause coughing by blocking 2-adrenergic receptors.Prevention
Cough prevention
Most coughs are caused by respiratory diseases, so preventing respiratory diseases is the key to preventing cough. Preventive measures
1. Strengthen exercise, carry out outdoor activities, and improve the body's disease resistance.
2. Increase or decrease clothes in time to prevent excessive cooling or overheating.
3. Take less children to crowded public places and reduce infection opportunities.
4. Always open windows and circulate fresh air. When the family has a cold, the room can be fumigated with vinegar to prevent viral infection.
5. Receive vaccination in a timely manner to reduce the incidence of infectious diseases.
6. Can take Chinese medicine prevention during the epidemic. The formula is: Guanzhong 12 grams, 12 grams of windproof, 10 grams of Nepeta, one post per day, and even served 2-3 days. For children who are often susceptible to cold, 15 grams of Astragalus and 7 red dates can be used every day. Decoction can be used for tea. Long-term use can increase the body's immunity and reduce the occurrence of colds.
7. Anti-cough first sense. Preventing coughs and preventing colds is very important, so children should pay attention to exercise, improve their ability to prevent evil, and avoid exogenous feelings to prevent aggravation.
8. Life needs to be conditioned. For children to strengthen life conditioning, diet is appropriate, to ensure sleep, the living environment should be quiet, the air should be fresh.
9. Less to public places. Try not to bring your child to a public place and less contact with coughing patients.
10. Eat pears and radishes. Appropriate consumption of pears and radishes has a certain preventive effect on cough.
Complication
Cough complications Complications chronic heart failure hypertension
Many diseases are associated with cough symptoms, and diseases that need to be differentiated from cough variant asthma include COPD, chronic bronchitis, cough caused by gastroesophageal reflux, recurrent respiratory tract infections (RRTI), typical asthma, and postnasal drip synthesis. Disease (PNDS), endobronchial tuberculosis, and angiotensin-converting enzyme inhibitor-induced cough, which are common causes of chronic cough, and need to be carefully excluded in the diagnosis of cough variant asthma. In addition, chronic heart failure, esophageal hiatal hernia, hypertension, airway inflammation, tumors, foreign bodies, and smoke stimuli, anxiety, etc. can lead to chronic cough.
Symptom
Cough symptoms common symptoms dry cough coughing cough
1. The nature of cough is coughing or sputum, which is called dry cough. Dry cough or irritating cough is common in acute or chronic pharyngitis, laryngeal cancer, early stage of acute bronchitis, tracheal compression, bronchial foreign body, bronchial tumor, pleural disease, primary pulmonary hypertension, and mitral stenosis. Cough with cough is called wet cough, common in chronic bronchitis, bronchiectasis, pneumonia, lung abscess and hollow tuberculosis.
2. Time and regular coughing Sudden cough is often caused by inhalation of irritating gases or foreign bodies, lymph nodes or tumors that compress the trachea or bronchial bifurcation. Paroxysmal cough can be seen in pertussis, endobronchial tuberculosis, and bronchial asthma (variable asthma) with cough as the main symptom. Long-term chronic cough, more common in chronic bronchitis, bronchiectasis, lung abscess and tuberculosis. Nighttime cough is common in patients with left heart failure and tuberculosis, causing nighttime cough, which may be related to increased nighttime pulmonary congestion and increased vagal excitability.
3. The sound of cough refers to the characteristics of coughing sound. Such as a cough sound hoarseness, mostly caused by inflammation of the vocal cords or tumor compression of the recurrent laryngeal nerve. 2 chicken-like cough, manifested as continuous paroxysmal cough with high-intensity inhalation echo, more common in pertussis, epiglottis, laryngeal disease or tracheal compression. 3 metal tone cough, common in cough caused by mediastinal tumor, aortic aneurysm or bronchial carcinoma directly compressing the trachea. 4 cough sound is low or weak, seen in severe emphysema, vocal cord paralysis and extreme weakness.
Examine
Cough examination
1. Increased airway reactivity, mostly light-moderate increase. The test procedure can induce irritating coughs at similar onset.
2. Pulmonary function damage is between normal people and typical asthma.
3. The skin allergen test can be positive.
4. Increased serum IgE levels.
5. Some patients may be positive for bronchiectasis test. When a positive reaction occurs, it indicates that there is a certain degree of paralysis and obstruction in the airway.
Diagnosis
Cough diagnosis
diagnosis
Because cough is a non-specific symptom of many diseases, it is necessary to ask for detailed medical history, comprehensive physical examination, chest X-ray or CT, airway responsiveness measurement, pulmonary function, electrocardiogram, fiberoptic bronchoscopy and some special cases. Check to rule out other diseases that can cause chronic, intractable cough.
Differential diagnosis
Many diseases are associated with cough symptoms, and diseases that need to be differentiated from cough variant asthma include COPD, chronic bronchitis, cough caused by gastroesophageal reflux, recurrent respiratory tract infections (RRTI), typical asthma, and postnasal drip synthesis. Disease (PNDS), endobronchial tuberculosis, and angiotensin-converting enzyme inhibitor-induced cough, which are common causes of chronic cough, and need to be carefully excluded in the diagnosis of cough variant asthma. In addition, chronic heart failure, esophageal hiatal hernia, hypertension, airway inflammation, tumors, foreign bodies, and smoke stimuli, anxiety, etc. can lead to chronic cough.
Thrombotic cough is the most easily overlooked cough, especially to the attention of doctors and patients. The following example shows: an old man with a long-term cough, taking various antitussives, anti-infectives, still not improving, go to the hospital No abnormalities were found in the chest. The patient's self-reported temper is not good at the moment, and it is easy to get angry. When standing with closed eyes, the whole body is swaying, and the movement of one hand is somewhat slow. The doctor suspected that the brain tissue may be ill, and was diagnosed as mild cerebral embolism after cerebral tomography. The cough stopped after 8 days of treatment with a thrombotic cough.
Cerebral embolism is a neoplasm that forms a thrombus on the basis of cerebral arteriosclerosis or is detached by subacute bacterial endocarditis. It blocks the branch of the cerebral artery and causes the brain tissue under its control to suffer from hypoxia and necrosis and serious systemic symptoms. However, in recent years, along with modern examination techniques, many elderly people have found asymptomatic cerebral embolism, mainly because small blood vessels are blocked. Human swallowing reflexes and coughs are dominated by the central nervous system, and swallowing reactions are an extremely complex process involving multiple aspects of the cranial nerves. In the old age, the swallowing reflex and cough reflex function are all decreased. When the brain tissue shows a slight small embolism, although there is no systemic symptoms, the swallowing reflex function is further reduced, so that it cannot be cleaned when ingesting or swallowing saliva. Both enter the esophagus, and often a small amount enters the respiratory tract, and the cough reflex function is also slow, and can not be coughed out immediately, so long-term stimulation causes long-term cough.
For the above reasons, if the elderly have a long-term cough, and after various examinations to rule out various diseases related to cough, you should think about the possibility of mild cerebral embolism. Further examination of the brain should be carried out. Once an embolized lesion is found, regardless of its The size should be treated by improving the cerebral circulation drugs such as drugs. When the blood at the embolization site is unblocked, the cough can stop.
