Superficial cough (coughing)
A superficial cough (coughing) is a coughing paroxysm without sputum separation or the discharge of a small amount of mucus when the upper respiratory tract is affected. It may have natural causes or indicate diseases of the oropharynx and larynx, allergies, complications when taking medications. To determine the causes of the symptom, instrumental examination of respiratory organs, esophagoscopy, contrast radiography of the esophagus, ultrasound of the thyroid gland, serological and microbiological methods, allergy tests are recommended. To alleviate the condition before diagnosis, it is permissible to use antiseptics, local anesthetics, inhalations.
Causes of superficial cough
The development of cough is associated with direct and indirect irritation of numerous receptors located in the upper respiratory tract. Natural factors that provoke a cough attack are choking, inhalation of strongly smelling or active substances. Sometimes the prerequisite for coughing is excitement. The pathological causes of cough are diseases in which the receptors of the mucous membrane of the respiratory organs are activated due to damage by infectious agents, aggressive gases and foreign bodies.
Acute viral infections
Dry unproductive cough manifests infectious diseases caused by viruses, which, when invaded, are introduced into the mucous membrane of the respiratory tract, irritating its receptors. Depending on the pathogen, the main inflammatory process is localized in various parts of the respiratory tract, which determines the specifics of the infection. With the appearance of a superficial cough, the classic flu and its serovariants (Hong Kong, swine), parainfluenza, and other acute respiratory infections occur.
The disease begins acutely. The appearance of cough, redness and sore throat, runny nose, and other catarrhal phenomena may be preceded by a short period of intoxication with fever, muscle pain, joints, headaches, and sometimes vomiting. When infected with adenoviruses, conjunctivitis and lymphadenopathy develop. Persistent unproductive cough is typical for respiratory syncytial infection, especially with subsequent penetration of the pathogen into the trachea and bronchi.
Childhood infections
Attacks of superficial cough are observed when infected with paracoccus bacteria. Coughing, and then coughing paroxysms occur with measles, rubella. When pathogens are introduced into the mucous membrane of the respiratory organs and viral particles multiply in the mucous layer, receptors that stimulate the cough reflex are irritated, catarrhal manifestations develop. The spread of viruses through the systemic bloodstream is accompanied by an increase in lymph nodes, a characteristic exentematous rash, moderate or severe intoxication.
Diseases of the nasopharynx
The reflex occurrence of constant superficial coughing is provoked by stimulation of the receptors of the posterior pharyngeal wall and palatine tonsils. Irritating factors are mediators released during infectious and inflammatory processes, secretions flowing from the nasal cavity, foci of tissue destruction. The causes of a superficial cough are:
Inflammation of the tonsils. Chronic tonsillitis during remission is characterized by obsessive coughing with moderate soreness in the throat, an unpleasant odor from the oral cavity. Possible subfebrile temperature, asthenia. During a strong cough, whitish dense masses with a putrid odor are released from the affected amygdalar lacunae.
Bacterial pharyngitis and rhinopharyngitis. Up to 20% of nasopharyngeal inflammations are caused by bacteria. Cough in acute and chronic rhinopharyngitis, pharyngitis is combined with dryness, perspiration, sore throat, nasal congestion. It is extremely difficult, with intoxication, hyperthermia and vomiting, nasopharyngitis occurs with meningococcal infection.
Postnasal congestion syndrome. For obsessive superficial coughing caused by irritation of the larynx and pharynx separated from the nose or paranasal sinuses, pathognomonic strengthening at night and after waking up. Patients complain of a burning sensation and dryness in the back of the nose, a “lump” in the area of the posterior pharyngeal wall. The voice changes frequently.
Tsenker’s hypopharyngeal diverticulum. At the initial stages, rare coughing, abundant formation of saliva, sore throat, bad breath, difficulty swallowing worries. Subsequently, dysphagia increases, there is a belching of eaten food, cacosmia, a feeling of a coma in the throat. A palpable asymmetric formation appears on the neck.
Allergy
Factors that provoke unproductive paroxysmal cough in allergies are non-microbial and microbial antigens that enter the body from the outside or are already present in it. Often, an allergic reaction from the respiratory system also reveals persistent itching without rash, lacrimation, redness of the eyes. Allergy to dust and other inhaled allergens is manifested by the clinic of diseases such as:
Allergic rhinitis. Cough develops against the background of attacks of repeated sneezing, nasal congestion, pronounced watery rhinorrhea. The manifestations are more noticeable in the morning and in contact with a possible allergen.
Allergic laryngitis. Typically, the occurrence of dry barking cough on the background of rapid swelling of the laryngeal mucosa after contact with an allergen. The patient is experiencing a lack of air, the nasolabial triangle turns blue. In severe cases, respiratory arrest occurs.
Laryngitis
The main features of a superficial dry or unproductive cough with inflammation of the larynx are a barking character, changes in voice (hoarseness, hoarseness, weakening up to aphonia — complete disappearance). Often worried about the feeling of dryness, burning, foreign matter in the throat. All types of inflammatory lesions of the larynx occur with cough attacks:
Acute laryngitis. The leading signs are hoarseness, weakening or disappearance of the voice against the background of a barking surface cough. Possible subfebrile fever, mild or moderate intoxication with general malaise. In young children, the disease is sometimes manifested by false croup, in which the clinic is aggravated by inspiratory shortness of breath with noisy wheezing, paleness of the skin, the risk of respiratory arrest.
Chronic laryngitis. The catarrhal form of the disease is characterized by a combination of discomfort in the throat, cough with rapid fatigue of the voice, paresthesia. Outside of exacerbation, cough attacks are replaced by constant coughing. Special signs of chronic atrophic laryngitis are increased manifestations when inhaling cold air, a feeling of a lump of mucus in the throat, which the patient tries unsuccessfully to cough up.
Foreign bodies of the pharynx and larynx
If food or a foreign object accidentally enters the upper respiratory tract, the cough often becomes convulsive, exhausting, accompanied by a bluish face. Breathing and swallowing are difficult. Saliva secretion is noticeably increased. The patient experiences a sore throat, which can give into the ear. Painful sensations are especially intense when a sharp object hits or gets stuck in the tonsils. Reflex vomiting is possible, and when filling the larynx with soft elastic food, asphyxia is possible. The cough persists for some time after coughing up or removing a foreign body.
Pharyngeal neurosis
Specific changes in the sensitivity of the mucosa with its decrease or increase, pain, tickling, itching, burning, dryness, lump predispose to the occurrence of constant coughing or episodes of superficial nasal cough with pharyngoneurosis. “Imaginative”, vivid complaints with a pronounced emotional reaction and vegetative symptoms (tachycardia, sweating) are characteristic. With a decrease in the sensitivity of the mucosa, choking, difficulty swallowing is possible. In patients with increased pharyngeal reflex, coughing can provoke vomiting.
Thyroid cancer
Unproductive cough is one of the first symptoms of medullary thyroid cancer sprouting into the larynx. The stage of superficial coughing is preceded by an increase in cervical lymph nodes, which are probed as immobile or sedentary dense formations forming conglomerates with the skin. In the future, due to the defeat of the larynx, the voice becomes hoarse. Pressure on the organ from the outside provokes shortness of breath, difficulty breathing and passing food, an irritating sensation of the presence of a foreign body in the throat.
Complications of pharmacotherapy
Most often, unproductive cough is complicated by taking some groups of antihypertensive and antiarrhythmic drugs. A side effect in the form of cough syndrome is observed on average in 15% of patients who use drugs to reduce blood pressure. In the group of patients who have been ill for a long time, this figure reaches 26%. For a drug-induced superficial cough, the appearance after taking the remedy is typical, strengthening in the morning, when lying down, movements and physical exertion. Usually he is provoked:
ACE inhibitors: captopril, kapoten, irumed, zocardis.
beta-blockers: atenolol, bisoprolol, metoprolol, trazicor.
Angiotensin receptor blockers: losartan, irbesartan, candesartan, valsartan.
Antiarrhythmic drugs: amiodarone, cardiodarone, arrhythmil.
Exam
Since in most cases the presence of a superficial cough indicates a lesion of the upper respiratory tract, at the first stage of the diagnostic search, the condition of the nasal cavity, pharynx, larynx is clarified and only after that other possible causes are excluded. The organization of the examination is usually carried out by an ENT doctor, who, according to indications, prescribes consultations of specialized specialists. Recommended as screening:
Instrumental methods of inspection. During rhinoscopy, pharyngoscopy and laryngoscopy, the condition of the mucosa of the upper respiratory tract is assessed. The examination reveals inflammatory processes, erosive changes, volumetric formations.
Microbiological and serological studies. To search for pathogens, sowing smears from the nose, pharynx and laryngeal mucosa is used. Effective ways to confirm the infectious nature of cough and identify the pathogen are ELISA, RIF, PCR.
At the next stages of diagnosis, contrast radiography of the esophagus and esophagoscopy are performed to exclude the Cenker diverticulum. With a suspected allergic origin of a superficial cough, allergy tests are prescribed. An informative method of diagnosing thyroid malignancies is ultrasound of the organ. In the absence of organic causes of coughing, a neurological examination is recommended.
