Cough represents one of the most important mechanisms of reaction of respiratory organs to change of physiological balance. Process of a tussive reflex begins with irritation of irritantny receptors, located on the course of a nose, ears, a back wall of a throat, gullet, throat, trachea, large bronchial tubes, pleurae, a pericardium and a diaphragm.
Among them not only pathology of a bronchopulmonary system, but also heart disease, near-nasal bosoms, digestive tract, influence of some medicines and many other states.
The dust particles, microorganisms arriving with the inhaled air are normal, are besieged on mucous respiratory tract and removed thanks to sympathetic work of cilia of a ciliary epithelium of a trachea and bronchial tubes from there. At the same time an important role is played by the slime which is formed as a result of secretory activity of scyphoid cells of an epithelium, glands of a trachea and bronchial tubes and having bactericidal effect owing to the content of lysozyme, transferrin, immunoglobulins, inhibitors of proteases and fibropektin. Process of physiological clarification of airways is called mukotsiliarny clearance which is the main mechanism of clarification of a tracheobronchial tree.
Cough results from irritation of tussive receptors of a nasal cavity, a throat, a trachea, bronchial tubes, the sensitive terminations n. vagus innervating an external ear, a pleura, a diaphragm, a pericardium, a gullet, a stomach. The easiest cough is caused at irritation<кашлевых зон> of a back wall of a throat, glottis, trachea and pleura. The major irritativny factors - inflammatory (hypostasis mucous, a pathological secret), mechanical (a foreign body, the increased lymph nodes and tumors in mediastinum), chemical and temperature.
Cough can have and the central origin, irritation in this case goes from a cerebral cortex.
Cough is classified as follows:
on character - unproductive and productive;
on duration - incidental, short-term, paroxysmal and constant;
in a course - sharp, chronic.
It is necessary to pay attention to time of developing of cough - in the morning (at bronchiectasias, chronic bronchitis, a gastroesophagal reflux), at night (in bronchial asthma, heart failure, sinusitis, whooping cough) and also to morbidity (for example, in tracheitis) and other features (the barking cough, the accompanying short winds, goose breathing, etc.).
At diagnostics the productivity, that is existence of a phlegm, is an important indicator. The inefficiency of cough can be caused by insufficiently expressed tussive reflex, big viscosity of a phlegm, insufficiently deep breath, disturbance of bronchial passability and other reasons. In damp cough it is necessary to pay attention to color and the nature of a phlegm which often patogomonichna for any given disease. So, the viscous, vitreous phlegm is characteristic of bronchial asthma; rusty color - for heart failure; purulent (yellow-greenish) - for bacterial respiratory infections, and purulent, fetid, in a large number - for abscess of a lung and bronchiectasias.
Cough is considered sharp if its duration is less than three months. Infections (pneumonia, an acute bronchitis, acute respiratory diseases - a SARS, whooping cough, pleurisy), toxic and mechanical influences are basic reasons of acute cough (inhalation of toxic substances; inhalation of the irritating substances - smoke, dust; foreign body of a bronchial tube; aspiration). Careful poll of the patient and identification of the accompanying symptoms is necessary for differentiation of the causes of acute cough (existence of a phlegm, rhinitis, fever, weakness, head and muscular pains, etc.).
In most cases acute cough does not arise difficulties in diagnostics, and short not heavy cough usually does not involve serious consequences.
Chronic cough meets at<синдроме постназального затекания> (postnasal drip syndrom). At the same time there is a running off separated from a nose (owing to inflammatory process in a nasopharynx, a nose, near-nasal bosoms) on a back wall of a throat in a tracheobronchial tree. In this situation carrying out LOR-survey, allergological inspection, X-ray inspection of near-nasal bosoms is necessary.
At mental disturbances and simulation the cough arises in situations, standard for the patient (for example, a performance before audience), and expectation of cough inevitably provokes its emergence.
Treatment of cough should be begun with elimination of its reason. From the general recommendations it is possible to note sufficient consumption of liquid, the moistened air in the room. Are necessary evaluating nature of cough, and in productive cough - the nature of a bronchial secret, identification of existence or lack of a bronchospasm. It is necessary to remember that treatment of cough does not come down to its suppression.
Only when cough loses the physiological expediency and is painful, persuasive, unproductive, bringing physical and psychological discomfort, interrupting a sleep, significantly reducing quality of life of the patient, symptomatic treatment of cough is necessary.