Pathophysiology of

Cough

Erwin Arief
Dept. of Internal Medicine-Hasanuddin University
Makassar

Histology of the lung

Respiratory epithelium

Connective tissue fibers and cartilage: support and

maintain opened air way

Alveolar cells (type I and type II)

INTRODUCTION

Coughing is a reflex of breath caused by

excitement at irritant receptors on airways

Mechanism of body defences to release

the mucous and foreign object particle
from airways

Duration cough :
Acute cough
: less than 3 weeks
Subacute cough : between 3 weeks to 8
weeks
Chronic cough : more than 8 weeks

Cough
Attempt to clear the lower respiratory
passages by abrupt and forceful expulsion
of air
Most common when fluid accumulates in
lower airways

Cough may result from:

Inflammation of lung tissue
Increased secretion in response to mucosal
irritation

Inhalation of irritants
Intrinsic source of mucosal disruption such as
tumor invasion of bronchial wall

Excessive blood hydrostatic pressure in

pulmonary capillaries
Pulmonary edema excess fluid passes into
airways

When cough can raise fluid into pharynx,

the cough is described as a productive
cough, and the fluid is sputum.
Production of bloody sputum is called
hemoptysis
Usually involves only a small amount of
blood loss
Not threatening, but can indicate a
serious pulmonary disease
(tuberculosis, lung abscess, cancer,
pulmonary infarction)

If sputum is purulent, and infection of lung

or airway is indicated.
Cough that does not produce sputum is
called a dry, nonproductive or hacking
cough.

Pathophysiology

Three main phase of cough: inspiration,

compression & expiration phase.

Five components of cough

mechanism:
Cough receptors
Afferent nerves
Brain
Efferent nerves
Effector organs

COUGH MECHANISM

Pathophysiology

ETIOLOGY

Acute respiratory tract infections

faringitis,
laryngitis,
bronchitis,
bronchiolitis

Chronic respiratory tract infection

bronchitis,
bronchiectasis

Parenchym Disease

pneumonia,
abscess,
parasite,
Intertitial disease

Cardiovascular Disease

oedema
infarc

Environment Irritans

Lung
Lung

dust
Change in temperature

Foreign object

membrane timpanic
Airways

Neoplasma

Lung
Lung

carsinoma
metastatic

Allergic

Fungers
Vasomotor rhinitis
Bronchial asthma

ANAMNESIS

Is the coughing acute, subacute and chronic ?

When is the onset attributed to symptom of
which releated with infection?
is it accompanied by wheezing?
What the relation between post nasal drip ,
GERD?
Is there any sputum ? What is characteristic of
the sputum ?
Is the risk factor corelated with cigarette
environmental exposured , infection of HIV
Are the patients using ACE inhibitor?

PHYSICAL EXAMINATIONS
Ear

Foreign particle in timpanic membrane

Inflamation of the tympanic membarane
Nasofaring

Sinus is observed with palpation if there any pain

Ostia is observed to cheked is there any mucous
mucossa oedema caused infection and allergy

PHYSICAL EXAMINATIONS

Neck
Elevated vein due to mass
Distended Jugular vein due to lung oedeme

Lung
o

Inspection, Palpation, Percussion , Auscultation

Abdomen
Obeserve is there any mass or subdiafragma
inflammation which leads irritation to diafragma.

ADDITIONAL EXAMINATIONS

Chest X- RAY
If conducted any abnormality at pleura
and parenchime, mediastinum
infiltrat Tuberkulosis is found and honey
comb appareance in bronkiectasis

Sinus X-Ray
Bacterial Sinusitis found thickness of
mucosa more than 5mm with the
picture air fluid level or opacity

Sputum examinations
Gram stanning and culture microbacterium is
found abnormality which is infiltrations at the
apex
Sitology examinations if suspected lung
cancer.

Spirometry
Spirometri identifies obstruction airways and
patient cough not responded with asthma
medication

Thorax CT-SCAN
important role to detect the bronchiectasis and
interstitial lung disease.

Bronchoscopy
If suspected by something process in
intrathoracal which is not found at radiology
examinations
Bronkoskopi can see abnormall of the airway
like endobronchial tumor, sarcoidosis, suppuratif
infection

SUPRESSION COUGH

ALG0RYTHM of MANAGEMENT

CAUSES

THERAPY

Common cold

Dexbrompherinamine 6 mg and
pseudoefedrine 120 mg 2x/days
for 1 week or naproxen 500 mg

Rhinitis alergic

Avoid Allergan
Loratidine 10 mg /days

Dexbrompherinamine 6 mg and
pseudoefedrine 120 mg 2x/days for
5 days
Antibiotic if infected H.
influenza ,S.pneumonia

Acute sinusitis bacterial

Acute exaserbation COPD

B. Pertusis

Antibiotik if H. influenza
,S.pneumonia dan corticosteroid
sistemic tapering off for 2mg
Ipatropium inhaler and albuterol
inhaler
Eritromisin 500 mg /4x/ days or
Trimethoprim-sulfamethoxasole
160- 800 mg 2x/day for 14 days

CAUSES
Post infectious

THERAPY

B .pertusis

Subacute bacterial sinusitis

Eritromisin for 14 hari or

Trimethoprin -sulfametoxasole

Dexbrompherinamine and
pseudoephedrin for 3 weeks
Oxymetazoline for 5 days
Antibiotic : if infected H.
influenza infection

Asthma

Dexbrompherinamine and
pseudoephedrin for 1 week
Ipatropium 4-18 ug ,4 x
puff/hari for 1 3 weeks
Corticosteroid sistemic
tapering off for 2-3 weeks
Antitusive

Beclometason 4-42 ug 2 x puff

/day

CAUSES

THERAPY

Post nasal drip syndrom

Dexbrompherinamine and
pseudoephedrin for 3 weeks
Ipatropium 0,06 % nasal spray
for 3 weeks

Alergic Sinusitis

Avoid allergen and

Loratidine 10 mg /time/day

Rhinitis Vasomotor

Ipatropium 0,06 % nasal spray

for 3 weeks

Chronic bacterial sinusitis

Dexbrompherinamine and
pseudoephedrin for 3 weeks
Oxymetazoline for 5 days
Antibiotic if infected with H.
Influenza ,S.pneuomococus dan
bakteri
anaerob in mouth

CAUSES

THERAPY

Asthma

Beclometason inhaler
Albuterol inhaler

GERD

Life style and diet

modification
Acid supression
Procinetic

Chronic bronchitis
Irittans eliminated
Ipatropium 2-18 ug 4x
puff / day
ACEI

change with another drug

Bronchitis eosinophilic

Budenosid inhalasi 400

ug/2x/days for 14 days

COMPLICATION

Musculosceletal
Broken ribs
Ruptur of M. rectus abdominalis,
Elevated serum creatinin phospokinase

Lung
Pneumothoracs,
Pneumomediastinum,
Larynx damage

Central nerves system

syncop
Dizziness
air emboli

Cardiovascular
Arrytmia ,
ruptur of the superficial vessels

Urine and feces incontinence, disruption,

irritation of mucosa airways , phetecia,
and purpura.

SUMMARY

Cough represent of the respiratory refleks that

happened caused by stimulations of the irritans
which found on entire airways
Cough duration is divided into

acute cough that goes on less than 3 week

subacute cough between 3 to 8 week and also
chronic cough more than 8 week.

According to history taking, physical examination

and supported by laboratory exmaination, radiology,
spirometry, and bronchoscopy, can determine the
diagnosis & the appropriate management.

THANK YOU