Why do we cough?

Coughing occurs voluntarily or through the so-called cough reflex. Along the respiratory tract there are a number of receptors that are sensitive to chemical and mechanical stimuli.

As these receptors are stimulated, they send a nerve signal to the medulla that triggers a return nerve response that travels down the vagus nerve and superior laryngeal nerves, causing both the diaphragm and intercostal muscles to contract, creating negative pressure. around the lungs, which fill with air to counteract it as the glottis closes and the vocal cords contract.

After that moment, the muscles of the abdominal wall and other muscles involved in the expiration (exit) of air contract, increasing the pressure on the lungs. The glottis is then opened and the vocal cords are relaxed, thus allowing a sudden exit of the air, which is expelled at more than 150 km / h, thus dragging the irritants that may have triggered the cough reflex.

Cough can be caused by different pathologies, the main ones being:

• respiratory tract infections (viral or bacterial)
• Tobacco
• Chronic obstructive pulmonary disease (copd)
• Drugs, especially ACEIs
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• Rhinitis of any kind (allergic, vasomotor, with or without post nasal drip)
• Gastroesophageal reflux (GER)
• heart failure
• Air pollution or other chemical irritants
• Others: bronchiectasis, bronchial cancer, tuberculosis, postinfectious, psychogenic, ...

Types of cough

Depending on its duration, the cough can be acute (the most common) if it lasts less than three weeks and starts abruptly, subacute if it lasts between three and eight weeks, and chronic after eight weeks, being the The main causes of the latter are copd, asthma, tobacco and the use of ACE inhibitors.

An essential differentiation for the treatment of cough is whether it is productive, that is, if mucous material is expelled in the vast majority of times coughing, regardless of the color of this mucus, or non-productive (dry), a cough irritant with which mucus is not expelled, which is popularly called barking cough.

Diagnosis

The diagnosis of cough is obviously clinical, with the observation of the same and assessing its characteristics, both with regard to the production of mucus or not, and the duration of the same. It is always advisable to carry out a correct examination of the ENT area as well as a pulmonary auscultation.

Depending on the pathology that is suspected as causing the cough, other diagnostic tests can be performed if necessary, such as a chest X-ray, spirometry with bronchodilators, a computerized axial tomography (CT), a sputum study or a pH-test. 24-hour metry if there is suspicion that the cause is GER, in which case the cough is usually nocturnal or when it occurs when being stretched.

Treatment

Treatment of a cough will differ greatly depending on the cause and its characteristics. If the cough you have is productive, that is, mucus is removed with most coughing spells, it is not advisable to cut it, since it is the body's natural mechanism to get rid of the irritants that are causing it.

What you have to do in this case is to thin the mucous secretions so that the cough effort is as low as possible when expelling them. The best that exists for this is water, drink large amounts of water in any form (plain water, juices, infusions). There are mucolytic drugs such as acetylcysteine ​​or carbocysteine ​​that help to thin the mucus and allow more water to enter its composition and, therefore, it is easier to expel it.

On the contrary, if the cough is irritating, it does not contribute anything, it does not remove mucus, then drugs can be used to cut it, because the more you cough, the more irritated the airway and creates a vicious circle. There are several drugs, such as dextromethorphan or cloperastine, as well as opiate drugs such as codeine, which has more side effects as it is an opiate.

In cases of chronic cough that does not respond to treatment, inhaled corticosteroids or ipratropium bromide can also be tried, always under the supervision of a doctor. Cough caused by GER is usually treated with proton pump inhibitors such as omeprazole. Cough that is due to other more specific processes should always be treated by the otolaryngologist or pulmonologist with treatments aimed at eradicating the cause of it.

In the event of any symptoms, the most appropriate thing to do is to consult a doctor. MAPFRE includes a Precentive Medicine Program aimed at taking care of the health of the whole family.

General Medicine Specialist