What additional information would assist with the diagnosis?
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Abstract Cough is the most common symptom for which medical treatment is sought in the outpatient setting. Chronic dry cough poses a great diagnostic and management challenge due to myriad etiologies. Chronic cough has been commonly considered to be caused by gastroesophageal reflux, post-nasal drip or asthma.
However, recent evidences suggest that many patients with these conditions do not have cough, and in those with cough, the response to specific treatments is unpredictable at best.
This raises questions about the concept of a triad of treatable causes for chronic cough. This article discusses the mechanism and etiology of cough, along with recent advances in the field of cough, highlighting some of the diagnostic and management challenges.
Chronic cough, in more severe cases, can also cause rib fractures, pneumothorax, pneumomediastinum PMand subcutaneous emphysema. It poses a great diagnostic and management challenge, due to the myriad etiologies.
This review will discuss the mechanism and etiology of the cough, along with recent advances in the field of cough, highlighting some of the diagnostic and management challenges. Also, any references from these studies that were pertinent to the topic were obtained. Mechanisms of chronic cough: Peripheral reflex and brain control In general, coughing is characterized by a reflex-evoked modification of the normal breathing pattern.
However, coughing can also be initiated and suppressed voluntarily. Stimulation of the peripheral sensory nerves is the first step that drives resultant cough. These sensory neurons can be divided into two types: These receptors react to touch-like mechanical stimuli, but are not chemically reactive, and therefore, do not respond to the capsaicin test.
Both these sensory afferent pathways finally terminate at the brainstem, at the nucleus of the solitary tract, and the spinal trigeminal tract.
Second-order neurons from the solitary nucleus and the trigeminal nucleus are connected to neurons of the brainstem and the spinal respiratory circuit, which coordinate the efferent cough response. The common causes of chronic cough include viral infections of the upper respiratory tract, upper airway cough syndrome UACS; postnasal drip syndromegastroesophageal reflux disease GERDcough-variant asthma, eosinophilic bronchitis, mediastinal tumors, pleural diseases, early interstitial fibrosis, use of an angiotensin converting enzyme-inhibitor ACEIand psychogenic and idiopathic or unexplained cough.
On the basis of these findings, ACCP recommends investigation and systematic treatment of this triad of underlying triggers in the absence of other disorders.bottom line, the end is in sight, prepare, dont be fooled by the masses. I am the only son of a high powered retired naval intelligence officer.
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1 I. IABPA An introduction to the analysis of the leadership formed in , now listing objectives, training workshops, annual conference on research in a comparison of the ideas of liberalism and conservatism A diagnostic essay assignment on the . Cough is the most common symptom for which medical treatment is sought in the outpatient setting.
Chronic dry cough poses a great diagnostic and management challenge due to myriad etiologies. Download-Theses Mercredi 10 juin