2024-01-21 08:24:00
Keypoint:
- Coughing is a mechanism to protect the respiratory system from harm. Normally, you breathe in and out of air through your lungs a lot per day (approximately 8,000 – 12,000 liters per day, depending on the amount of work and exercise).
- Meanwhile, in the air there are many pollutants that are harmful to the respiratory system. Coughing is one way to get rid of these things. But if your cough is chronic and lasts more than 8 weeks, it may be a chronic cough. and bring about various diseases
- When you have a cough Don’t be complacent. and viewed as normal Because coughing isn’t just the flu. But it can also cause serious diseases such as tuberculosis, lung cancer, and emphysema.
When ‘cough’ occurs, it is considered a response of the body to abnormalities in the respiratory tract. and the body’s defense mechanism by eliminating germs Mucus or foreign objects in the respiratory tract
Coughing starts when something stimulates the cough receptors. or there are irritants in the upper and lower respiratory tract, including the ear canal and tympanic membrane, nose, nasal cavities or sinuses, nasopharynx, pharynx, larynx, trachea, lungs, diaphragm, and pleura. Cough receptors are also found in the pericardium and stomach.
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What kind of ‘cough’ is this? You should see a doctor.
Dr. Winai Boveja, internist, pulmonary medicine clinic Phyathai 3 Hospital said that coughing It’s the body’s response. When there are foreign substances that irritate the airways, such as germs, mucus, or dust and smoke, the body tries to get rid of them by coughing them out. Most of the time, the continuous cough usually lasts no more than 3-4 weeks and it will go away.
If in some cases it is not caused by a foreign body that can be removed by coughing, for example, there may be something that wants to put pressure on the area of the lungs or bronchial tubes causing coughing, such as a lump or lung cancer. causing the body to try to expel it but can’t drive Therefore, it is the cause of chronic cough that does not go away.
Chronic cough is a cough that lasts for at least 8 weeks. Chronic cough has many different causes. May be caused by infection or conditions not related to infection such as allergies, bronchitis, asthma. In some cases, chronic cough may be caused by other diseases. that are not related to the respiratory tract, such as acid reflux, heart attack
Therefore, finding the cause of chronic cough may not be answered at the first visit to the doctor. Diagnosis planning and follow-up treatment therefore require a great deal of understanding and cooperation from the patient.
However, if you have the following symptoms of coughing: You should see a doctor immediately.
- Coughing for more than 8 weeks in a row
- The cough became more and more severe.
- Cough that is accompanied by other symptoms such as blood in the blood, weight loss, loss of appetite, shortness of breath, fatigue, and chest pain.
- Coughing up blood in mucus
- Cough from having contact with a TB patient or being close to a TB patient
- Have a congenital disease such as diabetes, kidney disease, or heart disease. When you have a cough, you should see a doctor immediately.
Chronic cough, don’t let it go..it might be a disease.
- pulmonary tuberculosis
Even though in the early stages there are no symptoms But as the disease progresses, there will be a chronic cough. Symptoms include fatigue, loss of appetite, weight loss. Some people may cough up blood, chest pain, and shortness of breath.
- lung cancer
When the disease becomes more Have a chronic cough Some people may cough up fresh blood. Some people may also have chest pain, fatigue, loss of appetite, weight loss, or fever.
- Emphysema
It is often found in people with a long history of heavy smoking. Patients often have a chronic cough with mucus. and easily panting There is noisy breathing.
There is often a cough, especially at night in cold weather. The severity of the disease depends on the size of the bronchioles, whether they are more or less constricted. Symptoms can range from difficulty breathing, excessive coughing, loud breathing, and labored breathing. Symptoms often worsen when respiratory infections are also present.
- air allergy
They often have an itchy nose, itchy throat, coughing, and sneezing. Some people also have clear mucus. Symptoms often occur when exposed to allergens such as dust mites, pollen, animal fur, cold air, etc.
- acid reflux
Have a dry cough especially after meals or when laying down to sleep There may or may not be a burning sensation in the chest or belching.
- sinusitis
It is often preceded by symptoms of a cold or air allergy. In some cases, cold symptoms may improve at first. and got worse later Often coughs at night because mucus flows down the throat.
- Respiratory hypersensitivity
Found after respiratory infections. That is, when the cold symptoms are gone. But there is still a cough. By coughing a lot at night or when the weather is cool and exposed to wind, etc.
Get to know the ‘body’s breathing system’
The human respiratory system has two functions: bringing oxygen to the body to maintain life and excreting waste. Carbon dioxide gas resulting from the combustion of fuel (sugar, etc.) to be used as energy. If the lungs cannot function normally Man cannot live. Because the body will not receive enough oxygen. and has hyperacidity due to the buildup of carbon dioxide in the blood
In general, the respiratory system is divided into 2 parts:
- The upper respiratory tract is the part from the larynx up, consisting of the nose, throat, and larynx.
- The lower respiratory tract (Lower Respiratory Tract) is the part below the larynx (Larynx) and consists of the trachea from the large bronchi (Trachea) down to the alveoli.
The duration of coughing is at risk of disease.
Coughing may be divided according to how long it lasts, including:
- Coughing for less than 1 week is called current coughing
- Coughing for more than 3 weeks is called chronic cough.
- Dry cough means no phlegm, cough with mucus coming out. and coughing up blood It must be seen that it is only blood and there is no mucus mixed in. or has mucus mixed in
What are the differences between the causes of cough and chronic cough?
There are many causes of coughing. Because almost every disease of the respiratory system and lungs can cause coughing. In addition, it may be caused by diseases of other systems such as nasal disease, stomach disease, heart disease, and many medications can cause coughing.
The most common type of coughing is usually caused by inflammation of the upper respiratory tract, such as bronchitis, and is most often caused by infections such as the common cold and influenza. In children, it is often caused by inflammation in the throat. or tonsillitis In elderly people, especially those with brain disease, it may be bronchitis. due to choking on food or saliva
As for chronic coughing
If excluding patients who smoke which usually has a chronic cough Because I already have chronic bronchitis. The most common cough among patients is: Chronic cough after a cold or flu These patients may have a chronic cough. Especially if the patient does not receive adequate rest. And there is a lot of sound used in the early stages of the disease. This causes symptoms of bronchitis to follow.
In addition, it was also found that After a viral infection, the bronchial tubes may become more sensitive to stimulation (Bronchial Hyperresponsiveness or BHR) and coughing will occur. This can take up to 3 – 4 weeks, especially if you don’t get enough rest or use a lot of noise.
What does the characteristic of coughing tell us about the nature of the cough sound?
Can be classified into many different formats such as
- Cough with phlegm
Found in infections of the respiratory system such as the common cold, influenza, pneumonia, acute bronchitis. Chronic obstructive pulmonary disease As a result of the body’s secretion of mucus. or secretions released into the respiratory system Until causing coughing with phlegm
Caused by irritation of the throat or lower respiratory system. until stimulating coughing without mucus Found causes such as acid reflux. Bronchitis ACEi inhibitors are blood pressure lowering drugs and are a common symptom in COVID-19 patients.
- Cough echoes
Found in children, caused by swelling of the upper respiratory tract. Area of the larynx and trachea, or what we know as Croif’s disease. Patients may have difficulty breathing, a dry voice, wheezing, and fever along with a rumbling cough.
- Nighttime coughing
It is the result of irritation of the respiratory system that is stimulated during the night. It may be related to posture, such as mucus flowing down the throat while sleeping. That is found in sinusitis, allergies, and cold air or allergens such as dust mites are factors that stimulate the constriction of the bronchi. This results in more coughing. Especially asthmatic patients
However, it is recommended to see a doctor. If the cough is a chronic cough or have other abnormal symptoms such as coughing up blood-tinged sputum, hoarseness, fever, weight loss, shortness of breath, frequent pneumonia, painful swallowing, difficulty swallowing, and choking. This is for diagnosis. and provide appropriate treatment
Guidelines for treating ‘cough’ and ‘chronic cough’
- Treat cough
Cough can be caused by many reasons. Therefore, treatment It is necessary to diagnose the cause of the cough. and provide treatment according to the cause The patient’s own behavior It is an important part in treating cough symptoms. By avoiding various stimuli that cause coughing. Such as irritants, dust, chemicals, cigarette smoke. Avoid direct contact with air from air conditioners or fans. This is because cold air stimulates the bronchi to contract. You should keep your body warm. Get enough rest. In the case of smoking You should refrain from smoking.
- Chronic cough treatment
In addition to treating the cause of the disease You still need to treat the symptoms that occur together. which in addition to taking history A preliminary physical examination was performed to diagnose the disease. Some cases may need to be sent for appropriate confirmation, such as examining the nasal cavity, throat, and x-ray of the sinus cavity. To see sinus syndrome Send for chest x-ray examination To see lung abnormalities, check sputum, check lung function. To see the chance of asthma Chest computed tomography In cases where abnormalities are detected on a lung X-ray, a Fiber Optic bronchoscopy may be required to confirm the diagnosis.
- Bronchoscopy can accurately detect abnormalities.
Currently, bronchoscopy has developed both methods and tools. To help doctors get accurate and accurate diagnoses. and safer for patients Bronchoscopy is a safe test. Rarely encountered serious complications.
- Indications for bronchoscopy
The doctor asked to divide the patients into two groups. In real life to make it easy to understand
The first group is the group without symptoms. But a chest X-ray found abnormalities, such as a lung X-ray found abnormalities in the form
- point (nodule)
- Single or multiple lumps (mass)
- Ceiling (ground grass opacity )
- consolidation
“I would like to emphasize that in cases where there are no symptoms The doctor must rely on history taking. Assess risk Smoking history Family history, occupational history, history of contact with patients with lung disease and physical examination To predict the probability of disease and plan diagnosis and follow-up. Not all patients in this group need to undergo endoscopy. but will be assessed on a case-by-case basis according to appropriateness and indications”
The second group is those who have symptoms or have a history of lung and respiratory disease. But cannot be diagnosed from preliminary examination. or after treatment the symptoms do not improve, such as the following symptoms:
- Chronic cough. Lung x-ray reveals narrowed bronchi.
- Chronic cough
- Coughing up blood
- Coughing loudly (stridor or wheeze)
- Pneumonia, recurrent lung infections
- Lung infections are more common and do not respond to antibiotics.
- Pneumonia in immunocompromised patients or taking immune suppressant drugs regularly
- Assess the stage of lung cancer
- Assessing the spread of cancer to the lungs
- Have a suspected lung lump, lung cancer, pulmonary tuberculosis, or lung inflammation, etc.
- Suspected lump in the trachea Narrow airways or bronchial cartilage defects
Endoscopy procedures and patient care during endoscopy
While performing a bronchoscopy Patients will have an anesthetic sprayed into their nose and throat, which will make them feel numb and make swallowing difficult. And during the endoscopy, the patient will have their blood pressure measured. Pulse and blood oxygen level at all times for safety. Most endoscopies are performed in a lying position. Insert an oxygen tube through the nose. Cover your body and cover your eyes to prevent staining. In some cases, intravenous sedatives may be given before the endoscopy.
The doctor will insert a camera for the examination through one side of the nose or into the mouth. Passes through the throat and larynx into the trachea. During the endoscopy, the patient may feel some discomfort. And periodic anesthetic will be injected through the camera into the trachea. This can cause slight coughing or choking.
The patient can breathe normally. You will then be given intravenous sedatives to help you relax. During the examination, the patient will receive oxygen at all times to ensure that the body receives adequate oxygen.
Possible risks and complications
Some patients may bleed after the biopsy. Air leak in the pleural space Low blood oxygen Arrhythmias, etc. Complications of bronchoscopy are usually mild and disappear on their own, such as sore throat, coughing up blood.
After the endoscopy, the patient will be examined for observation. If there is no abnormality, the patient can go home. without the need to stay in the hospital and will make an appointment to listen to the examination results according to the next steps
How to prepare? Before undergoing ‘endoscopy’
- Abstain from all types of water and food after midnight the day before the colonoscopy. or at least 6 hours
- Clean your mouth and teeth properly.
- Report your medication history to your doctor. This is because some medicines must be stopped before undergoing the endoscopy.
- On the day of the colonoscopy, you must bring 1 relative with you.
In the past, the cause of lung nodules was proven. Often surgery is required to remove the tumor. which can provide diagnosis and treatment in a single surgery However, surgery is a major procedure that requires general anesthesia. The patient must recuperate for a long time. This is a waste of lung tissue that could have been lost.
Therefore, the cause of lung nodules can be determined using endoscopy. Causing the patient to have minimal pain or difficulty. and recover as quickly as possible Therefore it is useful.
Currently, this type of bronchoscopy is Both methods and tools have been developed. To help the procedure get an accurate and accurate diagnosis. and safer for patients
In addition to being easily tired and having chest pains Coughing is another symptom that indicates that The patient is suffering from a respiratory disease. Cough is the most common symptom of the disease. It is the body’s mechanism to try to expel foreign substances that may harm the respiratory system. including germs such as tuberculosis from the body While coughing reduces the amount of germs in the patient’s body. But it also spreads the infection to others.
Some diseases…can be known by observing the symptoms of coughing.
- Colds are characterized by a cough along with a stuffy nose, runny nose, sore throat, and fever.
- Pneumonia, coughing, wheezing, fever, and chest pain when breathing.
- Asthma, coughing, wheezing, and wheezing in the chest that comes and goes, often in the early morning or late at night.
- Pulmonary tuberculosis is characterized by a cough and fever in the afternoon. and sweat a lot in the evening along with symptoms of fatigue, loss of appetite, and weight loss
- chronic bronchitis Coughing up mucus almost every day continuously for more than 3 months and have had symptoms like this for at least 2 years in a row in people who have smoked for a long time
- Lung cancer, coughing for a long time, not producing much phlegm There may be blood in the mucus. Usually there is no fever.
- Bronchiectasis, coughing, thick, purulent sputum, has a bad odor, may contain blood, and has been present for years.
- Acid reflux disease, coughing while sleeping, feeling of sour fluid in the throat There may also be a burning sensation in the chest.
- heart failure Coughing and gasping when lying down When you sit up, it will be better.
Cough can be cured…if you know the cause.
If the patient coughs from an upper or lower respiratory tract infection And there’s not much coughing. Initial treatment such as cough relief medicine may be given first. In the case of coughing up mucus…very thick. Giving mucus thinners helps the mucus to be expelled more easily and relieves coughing. But if the patient receives the aforementioned medicine and the symptoms do not improve within 1 week, they should consult their doctor to find a new way forward.
If you have symptoms of a bacterial infection, such as yellow or green mucus The doctor may also prescribe antimicrobial medication.
The cause can be found for 80 percent of pediatric patients with chronic cough. And the results of treatment depend on the disease that the patient has. including the severity of the disease at that time
refer:Phyathai Hospital ,Nawawet Hospital ,Bangkok Hospital ,Chulalongkorn Hospital, Thai Red Cross Society
Treatment guidelines
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