Classification

A cough can be classified by its duration, character, quality, and timing.[3] Th

e duration can be either acute (of sudden onset) if it is present less than thre
e weeks, subacute if it is present between three and eight weeks, and chronic wh
en lasting longer than eight weeks.[3] A cough can be non-productive (dry) or pr
oductive (when sputum is coughed up). It may occur only at night (then called no
cturnal cough), during both night and day, or just during the day.[3]
A number of characteristic coughs exist. While these have not been found to be d
iagnostically useful in adults, they are of use in children.[3] A barky cough is
part of the common presentation of croup,[4] while a staccato cough has been cl
assically described with chlamydia pneumonia.[5]
Differential diagnosis
A cough in children may be either a normal physiological reflex or due to an und
erlying cause.[3] In healthy children it may be normal in the absence of any dis
ease to cough ten times a day.[3] The most common cause of an acute or subacute
cough is a viral respiratory tract infection.[3] In adults with a chronic cough,
i.e. a cough longer than 8 weeks, more than 90% of cases are due to post-nasal
drip, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease.[3] T
he causes of chronic cough are similar in children with the addition of bacteria
l bronchitis.[3]
Infections
A cough can be the result of a respiratory tract infection such as the common co
ld, pneumonia, pertussis, or tuberculosis. In the vast majority of cases, acute
coughs, i.e. coughs shorter than 3 weeks, are due to the common cold.[6] In peop
le with a normal chest X-ray, tuberculosis is a rare finding. Pertussis is incre
asingly being recognised as a cause of troublesome coughing in adults.
After a respiratory tract infection has cleared, the person may be left with a p
ostinfectious cough. This typically is a dry, non-productive cough that produces
no phlegm. Symptoms may include a tightness in the chest, and a tickle in the l
ungs. This cough may often persist for weeks after an illness. The cause of the
cough may be inflammation similar to that observed in repetitive stress disorder
s such as carpal tunnel syndrome. The repetition of coughing produces inflammati
on which produces discomfort, which in turn produces more coughing. [7] Postinfe
ctious cough typically does not respond to conventional cough treatments. Treatm
ent consists of any anti-inflammatory medicine (such as ipratropium) [8] to trea
t the inflammation, and a cough suppressant to reduce frequency of the cough unt
il inflammation clears.[citation needed] Inflammation may increase sensitivity t
o other existing issues such as allergies, and treatment of other causes of coug
hs (such as use of an air purifier or allergy medicines) may help speed recovery
. A bronchodilator, which helps open up the airways, may also help treat this ty
pe of cough.[citation needed]
Reactive airway disease
When coughing is the only complaint of a person who meets the criteria for asthm
a (bronchial hyperresponsiveness and reversibility), this is termed cough-varian
t asthma. Two related conditions are atopic cough and eosinophilic bronchitis. A
topic cough occurs in individuals with a family history of atopy, abundant eosin
ophils in the sputum, but with normal airway function and responsiveness. Eosino
philic bronchitis is also characterized by eosinophils in the sputum, without ai
rway hyperresponsiveness or an atopic background. This condition responds to tre
atment with corticosteroids. Cough can also worsen in an acute exacerbation of c
hronic obstructive pulmonary disease.
Asthma is a common cause of chronic cough in adults and children. Coughing may b
e the only symptom the person has from their asthma, or asthma symptoms may also

include wheezing, shortness of breath, and a tight feeling in their chest. Depe
nding on how severe the asthma is it can be treated with bronchodilators (medici
ne which causes the airways to open up) or inhaled steroids. Treatment of the as
thma should make the cough go away.
Chronic bronchitis is defined clinically as a persistent cough that produces spu
tum (phlegm) and mucus, for at least three months in two consecutive years. Chro
nic bronchitis is often the cause of "smoker's cough." The tobacco causes inflam
mation, secretion of mucus into the airway, and difficulty clearing that mucus o
ut of the airways. Coughing helps clear those secretions out. May be treated by
quitting smoking. May also be caused by pneumoconiosis and long-term fume inhala
tion.
Gastroesophageal reflux
In people with unexplained cough, gastroesophageal reflux disease should be cons
idered.[3] This occurs when acidic contents of the stomach come back up into the
esophagus. Symptoms usually associated with GERD include heartburn, sour taste
in the mouth, or a feeling of acid reflux in the chest, although, more than half
of the people with cough from GERD don t have any other symptoms. An esophageal p
H monitor can confirm the diagnosis of GERD. Sometimes GERD can complicate respi
ratory ailments related to cough, such as asthma or bronchitis. The treatment in
volves anti-acid medications and lifestyle changes with surgery indicated in cas
es not manageable with conservative measures.
Air pollution
Coughing may be caused by air pollution including tobacco smoke, particulate mat
ter, irritant gases, and dampness in a home.[3] The human health effects of poor
air quality are far reaching, but principally affect the body's respiratory sys
tem and the cardiovascular system. Individual reactions to air pollutants depend
on the type of pollutant a person is exposed to, the degree of exposure, the in
dividual's health status and genetics. People who exercise outdoors on hot, smog
gy days, for example, increase their exposure to pollutants in the air.
Foreign body
A foreign body can sometimes be suspected, for example if the cough started sudd
enly when the patient was eating. Rarely, sutures left behind inside the airway
branches can cause coughing. A cough can be triggered by dryness from mouth brea
thing or recurrent aspiration of food into the windpipe in people with swallowin
g difficulties.
Angiotensin-converting enzyme inhibitor
Angiotensin-converting enzyme inhibitors are drugs used in diabetics, heart dise
ase, and high blood pressure. In 10-25%[citation needed] of the people who take
it, it can cause them to have a cough as a side effect. Cessation of ACE Inhibit
or use is the only way to stop the cough. Such medicines for hypertension are ve
ry common in use such as ramipril and quinapril. There are cases of "cough of un
known origin" who had resolution with stopping the drug.[9]
Psychogenic cough
A psychogenic cough ("habit cough" or "tic cough") may be the cause in the absen
ce of a physical problem. In these instances, emotional and psychological proble
ms are suspected. However, other illnesses have to be ruled out before a firm di
agnosis of psychogenic cough is made. Psychogenic cough is thought to be more co
mmon in children than in adults. A possible scenario: psychogenic cough develops
in a child who has a chronically ill brother or sister.[10]
Other
Cough may also be caused by conditions affecting the lung tissue such as bronchi
ectasis, cystic fibrosis, interstitial lung diseases and sarcoidosis. Coughing c
an also be triggered by benign or malignant lung tumors or mediastinal masses. T

hrough irritation of the nerve, diseases of the external auditory canal (wax, fo
r example) can also cause cough. Cardiovascular diseases associated with cough a
re heart failure, pulmonary infarction and aortic aneurysm. Nocturnal cough is a
ssociated with heart failure, as the heart does not compensate for the increased
volume shift to the pulmonary circulation, in turn causing pulmonary edema and
resultant cough.[11] Other causes of nocturnal cough include asthma, post-nasal
drip and gastroesophageal reflux disease (GERD).[12] Another cause of cough occu
rring preferentially in supine position is recurrent aspiration.[11]
Coughing may also be used for social reasons, such as the coughing before giving
a speech. Cough may also be psychogenic, which is different from habit coughing
and tic coughing.[10] Coughing may occur in tic disorders such as Tourette synd
rome, although it should be distinguished from throat-clearing in this disorder.
Given its irritant nature to mammal tissues, capsaicin is widely used to determi
ne the cough threshold and as a tussive stimulant in clinical research of cough
suppressants. Capsaicin is what makes chili peppers spicy, and might explain why
workers in factories with these vegetables can develop a cough.
Coughing is not always involuntary, and can be used in social situations. Coughi
ng can be used to attract attention, release internal psychological tension, or
become a maladaptive displacement behavior. It is believed that the frequency of
such coughing increases in environments vulnerable to psychological tension and
social conflict. In such environments, coughing may become one of many displace
ment behaviors and/or defense mechanisms. Coughs can be a symptom to the common
cold.
Pathophysiology
Coughing is viewed as a public health issue.
A cough is a protective reflex in healthy individuals which is influenced by psy
chological factors.[3] The cough reflex is initiated by stimulation of two diffe
rent classes of afferent nerves, namely the myelinated rapidly adapting receptor
s, and nonmyelinated C-fibers with endings in the lungs. However it is not certa
in that the stimulation of nonmyelinated C-fibers leads to cough with a reflex a
s it's meant in physiology (with its own five components): this stimulation may
cause mast cells degranulation (through an asso-assonic reflex) and edema which
may work as a stimulus for rapidly adapting receptors.
Diagnostic approach
The determination of the cause of a cough usually begins by determining if it is
specific or nonspecific in nature.[3] A specific cough is one associated with o
ther symptoms and further workup is dependent on these symptoms while a non spec
ific cough occurs without other signs and symptoms.[3] Further workup may includ
e labs, x rays, and spirometry.[