COUGH AND COLDS

1) Cough

A) Introduction

• Is a protective reflex

• Its purpose is expulsion of respiratory Secretions or foreign particles from the airway

• Occurs due to stimulation of mechano-or chemoreceptor's in throat, respiratory passage or stretch receptors in the lung

• Cough may be useful or useless

• Classification of Cough

-Useless (non-productive)

-Useful ( productive Cough).

• Investigations required in patients with cough : Chest xray, sputum for organisms etc bronchoscopy

B) Causes of Cough• Due to specific disease Conditions like :-

- Tuberculosis

-Bronchial asthma

-Bronchiectasy Productive Cough

-Lung abscess etc

• Due to irritation to bronchial tree caused by the following irritants

-Smoking

-dust

-Allergens

-Irritative food etc

c)Specific Management of Cough

Investigate and treat specific causes of cough eg. If Tuberculosis , bronchial asthma lung abscess etc. treat with specific drugs ( refer to anti Tb and anti- asthmatics drugs

d) Symptomatic management of Cough

• Productive Cough in principle should not be suppressed, it is useful

• Cough of only few days duration is usually due to irritation ( dry cough therefore useless cough) and must be Suppressed.

• Avoid irritating factors like smoking

• Use Cough suppressants including

i) Antitussives ( Cough Center suppressants)

a) Antihistamines eg. Promethazine chlorpheniramine , Diphenhydramine. (These are Sedating)

b) Opioids eg. Codeine , Pholcodeine, morphine

c) Non-Opioids eg. Noscapine, dextromethorphan etc.

ii) Pharyngeal demulcents eg . These are soothing and inhibit irritation like : Lozenges, Cough drops, linctuses containing symp

iii) Expectorants ( Mucokinetics) not very popular

a) Mucolytics eg, Bromhexine , Acetyl Cysteine

b) Directly acting : Na +, K + Citrate

c) Reflex acting : NH4 Cl

2) COMMON COLD ( Coryza)

• A viral infection affecting the membranes of the nose, throat and bronchial tree

• Symptoms of Common cold include:

- Watery discharge from the nose

- Oedema of the nasal mucosa

- Difficult in breathing via the nose

- ? Headache and fever.

• Management of common Cold

-Self limiting (viral infection), may need no specific treatment

-Antipyretics like Aspirin, paracetamal to relieve congestion fever and headache

-Antihistamines ( HI blockers) to reduce production of mucus by nasal mucosa eg, Chlorpheniramine

- Decongestants eg. Ephedrine nasal drops

These act by stimulating αI adrenoceptors resulting in constriction of blood vessels in the nasal mucous membranes thus reducing oedema and congestion of the nostrils.