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Chapter 034. Cough and Hemoptysis (Part 3)

Complications Common complications of coughing include chest and abdominal wall soreness, urinary incontinence, and exhaustion. On occasion, paroxysms of coughing may precipitate syncope (cough syncope; Chap. 21), consequent to markedly positive intrathoracic and alveolar pressures, diminished venous return, and decreased cardiac output. Although cough fractures of the ribs may occur in otherwise normal patients, their occurrence should at least raise the possibility of pathologic fractures, which are seen with multiple myeloma, osteoporosis, and osteolytic metastases. Cough: Treatment Definitive treatment of cough depends on determining the underlying cause and then initiating specific therapy. Elimination of an exogenous inciting agent (cigarette smoke, ACE. | Chapter 034. Cough and Hemoptysis Part 3 Complications Common complications of coughing include chest and abdominal wall soreness urinary incontinence and exhaustion. On occasion paroxysms of coughing may precipitate syncope cough syncope Chap. 21 consequent to markedly positive intrathoracic and alveolar pressures diminished venous return and decreased cardiac output. Although cough fractures of the ribs may occur in otherwise normal patients their occurrence should at least raise the possibility of pathologic fractures which are seen with multiple myeloma osteoporosis and osteolytic metastases. Cough Treatment Definitive treatment of cough depends on determining the underlying cause and then initiating specific therapy. Elimination of an exogenous inciting agent cigarette smoke ACE inhibitors or an endogenous trigger postnasal drip gastroesophageal reflux is usually effective when such a precipitant can be identified. Other important management considerations are treatment of specific respiratory tract infections bronchodilators for potentially reversible airflow obstruction inhaled glucocorticoids for eosinophilic bronchitis chest physiotherapy and other methods to enhance clearance of secretions in patients with bronchiectasis and treatment of endobronchial tumors or interstitial lung disease when such therapy is available and appropriate. In patients with chronic unexplained cough an empirical approach to treatment is often used for both diagnostic and therapeutic purposes starting with an antihistamine-decongestant combination nasal glucocorticoids or nasal ipratropium spray to treat unrecognized postnasal drip. If ineffective this may be followed sequentially by empirical treatment for asthma nonasthmatic eosinophilic bronchitis and gastroesophageal reflux. Symptomatic or nonspecific therapy of cough should be considered when 1 the cause of the cough is not known or specific treatment is not possible and 2 the cough performs no useful function or causes .