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Cough

Cough

Definition

A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions.

Description

While people can generally cough voluntarily, a true cough is usually a reflex triggered when an irritant stimulates one or more of the cough receptors found at different points in the respiratory system. These receptors then send a message to the cough center in the brain, which in turn tells the body to cough. A cough begins with a deep breath in, at which point the opening between the vocal cords at the upper part of the larynx (glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved in breathing press against the lungs, the glottis suddenly opens, producing an explosive outflow of air at speeds greater than 100 miles (160 km) per hour.

In normal situations, most people cough once or twice an hour during the day to clear the airway of irritants. However, when the level of irritants in the air is high or when the respiratory system becomes infected, coughing may become frequent and prolonged. It may interfere with exercise or sleep , and it may also cause distress if accompanied by dizziness , chest pain , or breathlessness. In the majority of cases, frequent coughing lasts one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more than three weeks it is considered a chronic cough, and physicians try to determine a cause beyond an acute infection or irritant.

Coughs are generally described as either dry or productive. A dry cough does not bring up a mixture of mucus, irritants, and other substances from the lungs (sputum), while a productive cough does. In the case of a bacterial infection, the sputum brought up in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

Demographics

Formal statistics on coughs are not maintained. Virtually all persons will experience coughs several times each year throughout their lives.

Causes and symptoms

In the majority of cases, coughs are caused by respiratory infections, including the following:

  • colds or influenza , the most common causes of coughs
  • bronchitis , an inflammation of the mucous membranes of the bronchial tubes
  • croup, a viral inflammation of the larynx, windpipe, and bronchial passages that produces a bark-like cough in children
  • whooping cough, a bacterial infection accompanied by the high-pitched cough for which it is named
  • pneumonia , a potentially serious bacterial infection that produces discolored or bloody mucus
  • tuberculosis , another serious bacterial infection that produces bloody sputum
  • fungal infections, such as aspergillosis, histoplasmosis, and cryptococcosis

Environmental pollutants, such as cigarette smoke, dust, or smog, can also cause a cough. In the case of cigarette smokers, the nicotine present in the smoke paralyzes the hairs (cilia) that regularly flush mucus from the respiratory system. The mucus then builds up, forcing the body to remove it by coughing. Post-nasal drip, the irritating trickle of mucus from the nasal passages into the throat caused by allergies or sinusitis , can also result in a cough. Some chronic conditions, such as asthma , chronic bronchitis, emphysema, and cystic fibrosis , are characterized in part by a cough. A condition in which stomach acid backs up into the esophagus (gastroesophageal reflux) can cause coughing, especially when a person is lying down. A cough can also be a side-effect of medications that are administered via an inhaler. It can be a side-effect of beta-blockers and ACE inhibitors, which are drugs used for treating high blood pressure.

KEY TERMS

Antitussive A drug used to suppress coughing.

Expectorant A drug that promotes the discharge of mucus from respiratory system.

Gastroesophageal reflux The backflow of stomach contents into the esophagus.

Glottis The opening between the vocal cords at the upper part of the larynx.

Larynx Also known as the voice box, the larynx is the part of the airway that lies between the pharynx and the trachea. It is composed of cartilage that contains the apparatus for voice productionthe vocal cords and the muscles and ligaments that move the cords.

Sputum The substance that is coughed up from the lungs and spit out through the mouth. It is usually a mixture of saliva and mucus, but may contain blood or pus in patients with lung abscess or other diseases of the lungs.

When to call the doctor

A physician or other healthcare provider should be called when a cough does not subside after three or four days. Individuals such as smokers, who have chronic coughs, should consult a doctor if the nature of their cough changes or they produce blood when they cough.

Diagnosis

To determine the cause of a cough, a physician should take an exact medical history and perform an exam. Information regarding the duration of the cough, what other symptoms may accompany it, and what environmental factors may influence it aid the doctor in his or her diagnosis. The appearance of the sputum also helps determine what type of infection, if any, may be involved. The doctor may even observe the sputum microscopically for the presence of bacteria and white blood cells. Chest x rays may help indicate the presence and extent of such infections as pneumonia or tuberculosis. If these actions are not enough to determine the cause of the cough, a bronchoscopy or laryngoscopy may be ordered. These tests use slender tubular instruments to inspect the interior of the bronchi and larynx.

Treatment

Treatment of a cough generally involves addressing the condition causing it. An acute infection such as pneumonia may require antibiotics , an asthma-induced cough may be treated with the use of bronchodilators, or an antihistamine may be administered in the case of an allergy. Physicians prefer not to suppress a productive cough, since it aids the body in clearing respiratory system of infective agents and irritants. However, cough medicines may be given if the person cannot rest because of the cough or if the cough is not productive, as is the case with most coughs associated with colds or flu. The two types of drugs used to treat coughs are antitussives and expectorants .

Antitussives

Antitussives are drugs that suppress a cough. Narcoticsprimarily codeineare used as antitussives and work by depressing the cough center in the brain. However, they can cause such side effects as drowsiness, nausea , and constipation . Dextromethorphan, the primary ingredient in many over-the-counter cough remedies, also depresses the brain's cough center but without the side effects associated with narcotics. Demulcents relieve coughing by coating irritated passageways.

Expectorants

Expectorants are drugs that thin mucus in order to make it easier to cough up. Guaifenesin and terpin hydrate are the primary ingredients in most over-the-counter expectorants. However, some studies have shown that in acute infections, simply increasing fluid intake has the same thinning effect as taking expectorants.

Coughs due to bacterial or viral upper respiratory infections may be effectively treated with botanical and homeopathic therapies. The choice of remedy will vary and be specific to the type of cough the person has. Some combination over-the-counter herbal and homeopathic cough formulas can be very effective for cough relief. Lingering coughs or coughing up blood should be treated by a trained practitioner.

Many health practitioners advise increasing fluids and breathing in warm, humidified air as ways of loosening chest congestion. Others recommend hot tea flavored with honey as a temporary home remedy for coughs caused by colds or flu. Various vitamins , such as vitamin C, or minerals , such as zinc, may be helpful in preventing or treating conditions (including colds and flu) that lead to coughs. Avoiding of mucus-producing foods can be effective in healing a cough condition. These mucus-producing foods can vary, based on individual intolerance, but dairy products are a major mucus-producing food for most people.

Prognosis

Because the majority of coughs are related to the common cold or influenza, most will end in seven to 21 days. The outcome of coughs due to a more serious underlying disease depends on the pathology of that disease.

Prevention

It is important to identify and treat the underlying disease and origin of the cough. It is helpful to avoid cigarette smoke and coming in direct contact with people experiencing cold or flu symptoms. Hands should be washed frequently during episodes of upper-respiratory illnesses.

Nutritional concerns

Persons with coughs should be sure to maintain balanced and healthy diets.

Parental concerns

Parents of children under the age of five should closely monitor their children when they have a cough. Parents of children over five years of age must accept the fact that their children are likely to acquire coughs and related illnesses from schoolmates. They should remain vigilant and consider having their children seen by a physician if the cough does not resolve after five to seven days.

See also Common cold.

Resources

BOOKS

Boat, Thomas F. "Talipes Chronic or Recurrent Respiratory Symptoms." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al., Philadelphia: Saunders, 2003, pp. 140144.

Hanley, Michael E., and Carolyn Welsh. Current Diagnosis & Treatment in Pulmonary Medicine. New York: McGraw-Hill, 2003.

Weinberger, Steven E. Principles of Pulmonary Medicine. Little Rock, AR: Elsevier, 2003.

Weinberger, Steven E., and Eugene Braunwald. "Cough and Hemoptysis." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 2036.

PERIODICALS

Chow, P. Y., et al. "Chronic cough in children." Singapore Medical Journal 45, no. 10 (2004): 4629.

Franco, E., et al. "Pertussis vaccination for adolescents and adults." Expert Opinion on Biological Therapy 4, no. 10 (2004): 166976.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 662112672. Web site: <www.aafp.org/>.

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 600071098. Web site: <www.aap.org/default.htm>.

American College of Physicians. 190 N Independence Mall West, Philadelphia, PA 191061572. Web site: <www.acponline.org/>.

American Lung Association. 1740 Broadway, New York, NY 10019. Web site: <www.lungusa.org>.

WEB SITES

"Cough." Brigham Young University, October 26, 2000. Available online at <www.byu.edu/shc/library/common/cough.html> (accessed January 5, 2005).

"Cough." MedlinePlus. Available online at <www.nlm.nih.gov/medlineplus/cough.html> (accessed January 5, 2005).

Holmes, Robert L., and Clare T. Fadden. "Evaluation of the Patient with Chronic Cough." American Academy of Family Practice, May 1, 2004. Available online at <www.aafp.org/afp/971001ap/cough.html> (accessed January 5, 2005).

L. Fleming Fallon, Jr., MD, DrPH

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"Cough." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Encyclopedia.com. 23 Aug. 2017 <http://www.encyclopedia.com>.

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"Cough." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Retrieved August 23, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/cough-0

Cough

Cough

Definition

A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions.

Description

While people can generally cough voluntarily, a cough is usually a reflex triggered when an irritant stimulates one or more of the cough receptors found at different points in the respiratory system. These receptors then send a message to the cough center in the brain, which in turn tells the body to cough. A cough begins with a deep breath in, at which point the opening between the vocal cords at the upper part of the larynx (glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved in breathing press against the lungs, the glottis suddenly opens, producing an explosive outflow of air at speeds greater than 100 mi (160 km) per hour.

In normal situations, most people cough once or twice an hour during the day to clear the airway of irritants. However, when the level of irritants in the air is high or when the respiratory system becomes infected, coughing may become frequent and prolonged. It may interfere with exercise or sleep, and it may also cause distress if accompanied by dizziness, chest pain, or breathlessness. In the majority cases, frequent coughing lasts one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more than three weeks it is considered a chronic cough, and physicians will try to determine a cause beyond an acute infection or irritant.

Coughs are generally described as either dry or productive. A dry cough does not bring up a mixture of mucus, irritants, and other substances from the lungs (sputum), while a productive cough does. In the case of a bacterial infection, the sputum brought up in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

Causes and symptoms

In the majority of cases, coughs are caused by respiratory infections, including:

  • colds or influenza, the most common causes of coughs
  • bronchitis, an inflammation of the mucous membranes of the bronchial tubes
  • croup, a viral inflammation of the larynx, windpipe, and bronchial passages that produces a bark-like cough in children
  • whooping cough, a bacterial infection accompanied by the high-pitched cough for which it is named
  • pneumonia, a potentially serious bacterial infection that produces discolored or bloody mucus
  • tuberculosis, another serious bacterial infection that produces bloody sputum
  • fungal infections, such as aspergillosis, histoplasmosis, and cryptococcoses

Environmental pollutants, such as cigarette smoke, dust, or smog, can also cause a cough. In the case of cigarette smokers, the nicotine present in the smoke paralyzes the hairs (cilia) that regularly flush mucus from the respiratory system. The mucus then builds up, forcing the body to remove it by coughing. Post-nasal drip, the irritating trickle of mucus from the nasal passages into the throat caused by allergies or sinusitis, can also result in a cough. Some chronic conditions, such as asthma, chronic bronchitis, emphysema, and cystic fibrosis, are characterized in part by a cough. A condition in which stomach acid backs up into the esophagus (gastroesophageal reflux) can cause coughing, especially when a person is lying down. A cough can also be a side-effect of medications that are administered via an inhaler. It can also be a side-effect of beta-blockers and ACE inhibitors, which are drugs used for treating high blood pressure.

Diagnosis

To determine the cause of a cough, a physician should take an exact medical history and perform an exam. Information regarding the duration of the cough, other symptoms may accompanying it, and environmental factors that may influence it aid the doctor in his or her diagnosis. The appearance of the sputum will also help determine what type of infection, if any, may be involved. The doctor may even observe the sputum microscopically for the presence of bacteria and white blood cells. Chest x rays may help indicate the presence and extent of such infections as pneumonia or tuberculosis. If these actions are not enough to determine the cause of the cough, a bronchoscopy or laryngoscopy may be ordered. These tests use slender tubular instruments to inspect the interior of the bronchi and larynx.

Treatment

Treatment of a cough generally involves addressing the condition causing it. An acute infection such as pneumonia may require antibiotics, an asthma-induced cough may be treated with the use of bronchodialators, or an antihistamine may be administered in the case of an allergy. Physicians prefer not to suppress a productive cough, since it aids the body in clearing the respiratory system of infective agents and irritants. However, cough medicines may be given if the patient cannot rest because of the cough or if the cough is not productive, as is the case with most coughs associated with colds or flu. The two types of drugs used to treat coughs are antitussives and expectorants.

Antitussives

Antitussives are drugs that suppress a cough. Narcoticsprimarily codeineare used as antitussives and work by depressing the cough center in the brain. However, they can cause such side effects as drowsiness, nausea, and constipation. Dextromethorphan, the primary ingredient in many over-the-counter cough remedies, also depresses the brain's cough center, but without the side effects associated with narcotics. Demulcents relieve coughing by coating irritated passageways.

Expectorants

Expectorants are drugs that make mucus easier to cough up by thinning it. Guaifenesin and terpin hydrate are the primary ingredients in most over-the-counter expectorants. However, some studies have shown that in acute infections, simply increasing fluid intake has the same thinning effect as taking expectorants.

Alternative treatment

Coughs due to bacterial or viral upper respiratory infections may be effectively treated with botanical and homeopathic therapies. The choice of remedy will vary and be specific to the type of cough the patient has. Some combination over-the-counter herbal and homeopathic cough formulas can be very effective for cough relief. Lingering coughs or coughing up blood should be treated by a trained practitioner.

Many health practitioners advise increasing fluids and breathing in warm, humidified air as ways of loosening chest congestion. Others recommend hot tea flavored with honey as a temporary home remedy for coughs caused by colds or flu. Various vitamins, such as vitamin C, may be helpful in preventing or treating conditions (including colds and flu) that lead to coughs. Avoiding mucous-producing foods can be effective in healing a cough condition. These mucous-producing foods can vary, based on individual intolerance, but dairy products are a major mucous-producing food for most people.

Prognosis

Because the majority of coughs are related to the common cold or influenza, most will end in seven to 21 days. The outcome of coughs due to a more serious underlying disease depends on the pathology of that disease.

Prevention

It is important to identify and treat the underlying disease and origin of the cough. Avoiding smoking and direct contact with people experiencing cold or flu symptoms is recommended. Washing hands frequently during episodes of upper-respiratory illnesses is advised. Parents should follow recommended vaccination schedules for pertussion (whooping cough) to help prevent the disease from occurring.

KEY TERMS

Antitussives Drugs used to suppress coughing.

Expectorant Drug used to thin mucus.

Gastroesophageal reflux Condition in which stomach acid backs up into the esophagus.

Glottis The opening between the vocal cords at the upper part of the larynx.

Larynx A part of the respiratory tract between the pharynx and the trachea, having walls of cartilage and muscle and containing the vocal cords.

Sputum The mixture of mucus, irritants, and other substances expelled from the lungs by coughing.

Resources

PERIODICALS

"Whooping Cough on the Rise." Consumer Reports May 2004: 51.

ORGANIZATIONS

National Heart, Lung and Blood Institute. PO Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

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Cough

Cough

Definition

A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions.

Description

While people can generally cough on purpose, a cough is usually a reflex triggered when an irritant stimulates one or more of the cough receptors found at different points in the respiratory system. These receptors then send a message to the cough center in the brain, which in turn tells the body to cough. A cough begins with a deep breath in, at which point the opening between the vocal cords at the upper part of the larynx (glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved in breathing press against the lungs, the glottis suddenly opens, producing an explosive outflow of air at speeds greater than 100 mi (160 km) per hour.

In normal situations, most people cough once or twice an hour during the day to clear the airway of irritants. However, when the level of irritants in the air is high or when the respiratory system becomes infected, coughing may become frequent and prolonged. It may interfere with exercise or sleep, and it may also cause distress if accompanied by dizziness , chest pain , or breathlessness. In the majority cases, frequent coughing lasts one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more than three weeks, it is considered a chronic cough, and physicians will try to determine a cause beyond an acute infection or irritant.

Coughs are generally described as either dry or productive. A dry cough does not bring up a mixture of mucus, irritants, and other substances from the lungs (sputum), while a productive cough does. In the case of a bacterial infection, the sputum brought up in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

Causes & symptoms

In the majority of cases, coughs are caused by respiratory infections , including:

  • colds or influenza , the most common causes of coughs
  • bronchitis , an inflammation of the mucous membranes of the bronchial tubes
  • croup, a viral inflammation of the larynx, windpipe, and bronchial passages that produces a bark-like cough in children
  • whooping cough, a bacterial infection accompanied by the high-pitched cough for which it is named
  • pneumonia , a potentially serious bacterial infection that produces discolored or bloody mucus
  • tuberculosis , another serious bacterial infection that produces bloody sputum
  • fungal infections, such as aspergillosis, histoplasmosis, and cryptococcoses

Environmental pollutants, such as cigarette smoke, dust, or smog, can also cause a cough. In the case of cigarette smokers, the nicotine present in the smoke paralyzes the hairs (cilia) that regularly flush mucus from the respiratory system. The mucus then builds up, forcing the body to removed it by coughing. Post-nasal drip, the irritating trickle of mucus from the nasal passages into the throat caused by allergies or sinusitis, can also result in a cough. Some chronic conditions, such as asthma , chronic bronchitis, emphysema , and cystic fibrosis, are characterized in part by a cough. A condition in which stomach acid backs up into the esophagus (gastroesophageal reflux) can cause coughing, especially when a person is lying down. A cough can also be a side effect of medications that are administered via an inhaler. It can also be a side effect of beta-blockers and ACE inhibitors, which are drugs used for treating high blood pressure.

Diagnosis

To determine the cause of a cough, a physician should take an exact medical history and perform an exam. Information regarding the duration of the cough, what other symptoms may accompany it, and what environmental factors may influence it aid the doctor in his or her diagnosis. The appearance of the sputum will also help determine what type of infection, if any, may be involved. The doctor may even observe the sputum microscopically for the presence of bacteria and white blood cells. Chest x rays may help indicate the presence and extent of such infections as pneumonia or tuberculosis. If these actions are not enough to determine the cause of the cough, a bronchoscopy or laryngoscopy may be ordered. These tests use slender tubular instruments to inspect the interior of the bronchi and larynx.

Treatment

Coughs due to bacterial or viral upper respiratory infections may be effectively treated with complementary therapies. The choice of remedy will vary and be specific to the type of cough the patient has. Lingering coughs or coughing up blood should be treated by a trained practitioner.

Nutrition & diet

Many health practitioners advise increasing fluid intake and breathing in warm, humidified air as ways of loosening chest congestion. Avoiding mucous-producing foods can be effective in healing a cough condition. These mucous-producing foods can vary, based on individual intolerance, but dairy products are a major mucous-producing food for most people. Other foods to avoid are sugar and foods high in sodium . Others recommend hot tea flavored with honey as a temporary home remedy for coughs caused by colds or flu.

Various vitamins may be helpful in preventing or treating conditions (including colds and flu) that lead to coughs. They include vitamin C, vitamin E, zinc, vitamin A , and folic acid .

Herbal medicine

There are many Western herbs, as well as herbs used in traditional Chinese medicine (TCM), that soothe the throat, quiet coughs, and act as expectorants. Some include:

  • marsh mallow
  • licorice
  • aniseed
  • fritillaria
  • loquat

Homeopathic remedies

Depending on the type of cough and its duration, several homeopathic remedies include:

  • Aconite for dry coughs with fever
  • Antimonium tartaricum for productive coughs
  • Bryonia for intense, dry coughs accompanied by thirst
  • Drosera for violent coughing
  • Rumex crispus for tickling coughs

Allopathic treatment

Treatment of a cough generally involves addressing the condition causing it. An acute infection such as pneumonia may require antibiotics, an asthma-induced cough may be treated with the use of bronchodialators, or an antihistamine may be administered in the case of an allergy. Cough medicines may be given if the patient cannot rest because of the cough or if the cough is not productive, as is the case with most coughs associated with colds or flu. The two types of drugs used to treat coughs are antitussives and expectorants.

Expected results

Because the majority of coughs are related to the common cold or influenza, most will end in 7-21 days. The outcome of coughs due to a more serious underlying disease depends on the pathology of that disease.

Prevention

It is important to identify and treat the underlying disease and origin of the cough. Avoid smoking and coming in direct contact with people experiencing cold or flu symptoms. Wash hands frequently during episodes of upper-respiratory illnesses.

Resources

BOOKS

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Tiburon, CA: Future Medicine Publishing Inc., 1999.

Chandrasoma, Parakrama, and Clive R. Taylor. Concise Pathology. East Norwalk, CT: Appleton and Lange, 1991.

Schumann, Lorna. "Alterations in Respiratory Function." In Perspectives on Pathophysiology. Lee-Ellen Copstead, ed. Philadelphia: W.B. Saunders, 1994.

Time-Life Books Editors. The Alternative Advisor. Alexandria, VA: Time-Life Books, 1997.

PERIODICALS

Philp, Elizabeth B. "Chronic Cough."American Family Physician 56 (October 1, 1997).

ORGANIZATIONS

National Heart, Lung, and Blood Institute Information Center. P.O. Box 30105, Bethesda, MD 20824. (301)251-1222.

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cough

cough is an onomatopoeic word in most languages (e.g. kuchen, tosse, tossa, toux). It has been called the ‘watchdog of the lungs’. When it barks it warns you that there may be an intruder (inhalation of an irritant), there may be something wrong in the house (lung disease), or perhaps the dog is asking for attention (communication). Cough always requires interpretation.

A cough is a deep inspiration, followed by a powerful expiratory effort while the larynx (voicebox) is reflexly closed by bringing together the vocal cords; then the larynx suddenly opens, allowing a rapid flow of air from the lungs which will repel the intruder or expel the material in the airways that needs to be coughed up. Cough is the most violent of respiratory acts. Put your hands on your abdomen and cough and you will see. Expiratory pressures in the chest may be three times that of blood pressure (and occasionally coughing can break blood vessels), and the airflow velocity in the larynx may approach supersonic levels. During coughing the airways in the chest are squeezed, and the expiratory blast forces mucus secretions through these narrow passages out into the open air. The associated cough sound is part of the definition of cough. The sound varies, from a simple single or double pattern of ‘dry’ cough, due, for example, to laryngitis, to the bubbling, rumbling cough sound of disease with much mucus in the airways.

Cough is the commonest and sometimes the most distressing symptom of lung disease, far more so than breathlessness or pain, and can be caused by over 100 chest and lung diseases. Probably the most frequent cause of coughing is cigarette smoking, but this has never been assessed because smokers do not complain to the doctor; they would be told to stop smoking, which is not what they want to hear. Although only the first breaths of cigarette smoke cause cough, and the smoker rapidly becomes acclimatized, smoking causes mucus secretion in the bronchi, and this produces the typical early morning smokers' cough. Later, and unfortunately, the smoker may develop chronic bronchitis, characterized by chronic cough and phlegm production.

The commonest disease to cause cough is upper airway infection (due to influenza, sinusitis, etc.), but there are some bizarre causes, such as an earwig in the external ear (which is supplied by the same nerve as the lungs). Cough can be psychological, as Sigmund Freud recognized when some of his patients presented with ‘hysterical cough’, including the first historical case of psychoanalysis, Anna O. Unlike sneezing, hiccough, and yawn, cough can be voluntarily produced with its complete pattern, and we may use it as a form of communication. The speaker may cough (clear his throat) to attract the attention of his audience, and the audience may get its revenge by ‘coughing him down’. Voluntary or not, coughing can ‘drown the parson's saw’ (Macbeth).

It seems common experience in concert halls and theatres that we cannot suppress a cough, although the cougher and his neighbours may disagree about this. However, cough due to upper airway infection can be suppressed for quite long (5–20 min) periods, so perhaps the old adage that ‘love and cough cannot be hid’ is wrong in both respects.

John Widdicombe

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cough

cough, sudden, forceful expiration of air from the lungs caused by an involuntary contraction of the muscles controlling the process of breathing. The cough is a response to some irritating condition such as inflammation or the presence of mucus (sputum) in the respiratory tract, as in infectious disease, or to heavy dust or industrial or tobacco smoke. Coughing may also be a reflex action to factors outside the respiratory tract; diseases that are not respiratory in nature (e.g., congestive heart failure or mitral valve disease) often bring on coughing. If there is mucus or a foreign substance in the respiratory tract, the cough should not be hindered since by this action the offending matter is expelled from the body. If, however, the cough becomes exhausting, sedation is indicated.

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"cough." The Columbia Encyclopedia, 6th ed.. . Retrieved August 23, 2017 from Encyclopedia.com: http://www.encyclopedia.com/reference/encyclopedias-almanacs-transcripts-and-maps/cough

cough

cough / kôf/ • v. [intr.] expel air from the lungs with a sudden sharp sound. ∎  (of an engine) make a sudden harsh noise, esp. as a sign of malfunction. ∎  [tr.] force (something, esp. blood) out of the lungs or throat by coughing: he coughed up bloodstained fluid. ∎  [tr.] (cough something out) say something in a harsh, abrupt way. • n. an act or sound of coughing. ∎  a condition of the respiratory organs causing coughing. PHRASAL VERBS: cough something up (or cough up) give something reluctantly, esp. money or information that is due or required.

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"cough." The Oxford Pocket Dictionary of Current English. . Encyclopedia.com. 23 Aug. 2017 <http://www.encyclopedia.com>.

"cough." The Oxford Pocket Dictionary of Current English. . Encyclopedia.com. (August 23, 2017). http://www.encyclopedia.com/humanities/dictionaries-thesauruses-pictures-and-press-releases/cough-0

"cough." The Oxford Pocket Dictionary of Current English. . Retrieved August 23, 2017 from Encyclopedia.com: http://www.encyclopedia.com/humanities/dictionaries-thesauruses-pictures-and-press-releases/cough-0

cough

cough vb. XIV. ME. coʒe, cowhe, co(u)we, f. imit. base *koχ- repr. by OE. cohhetan shout, (M)LG., (M)Du. kuchen cough, MHG. kūchen breathe, exhale.
Hence as sb. XIV.

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"cough." The Concise Oxford Dictionary of English Etymology. . Encyclopedia.com. 23 Aug. 2017 <http://www.encyclopedia.com>.

"cough." The Concise Oxford Dictionary of English Etymology. . Encyclopedia.com. (August 23, 2017). http://www.encyclopedia.com/humanities/dictionaries-thesauruses-pictures-and-press-releases/cough-1

"cough." The Concise Oxford Dictionary of English Etymology. . Retrieved August 23, 2017 from Encyclopedia.com: http://www.encyclopedia.com/humanities/dictionaries-thesauruses-pictures-and-press-releases/cough-1

cough

coughboff, cough, doff, far-off, off, quaff, roll-on roll-off, scoff, telling-off, toff, trough •lay-off, payoff, playoff •show-off • Khrushchev • Gorbachev •stand-off • Meyerhof • Cracow •Schwarzkopf • Chekhov • Cherenkov •take-off • kick-off • Kalashnikov •Baryshnikov • Rimsky-Korsakov •Kirchhoff • Karloff • Wolof • spin-off •Rachmaninov • Ustinov • Godunov •Stroganoff • Romanov • rip-off •eavestrough • Sakharov • cut-off •Molotov

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"cough." Oxford Dictionary of Rhymes. . Encyclopedia.com. 23 Aug. 2017 <http://www.encyclopedia.com>.

"cough." Oxford Dictionary of Rhymes. . Encyclopedia.com. (August 23, 2017). http://www.encyclopedia.com/humanities/dictionaries-thesauruses-pictures-and-press-releases/cough

"cough." Oxford Dictionary of Rhymes. . Retrieved August 23, 2017 from Encyclopedia.com: http://www.encyclopedia.com/humanities/dictionaries-thesauruses-pictures-and-press-releases/cough