Chest
Volume 114, Issue 2, Supplement, August 1998, Pages 133S-181S
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Managing Cough as a Defense Mechanism and as a Symptom: A Consensus Panel Report of the American College of Chest Physicians

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Summary and Recommendations

  • 1.

    Cough can (a) be an important defense mechanism to help clear excessive secretions and foreign material from airways; (b) be an important factor in the spread of infection; (c) maintain consciousness during potentially lethal arrhythmias and/or convert arrhythmias to more normal cardiac rhythms; and (d) present as one of the most common symptoms for which patients seek medical attention and spend health-care dollars.

  • 2.

    Cough involves a complex reflex arc that begins with the stimulation of an

Anatomy of the Cough Reflex

The very thin lining of mucus that normally coats the tracheobronchial epithelium is cleared by the centripetal movement of the mucociliary escalator.6, 7, 8 Cough serves to clear the airways when there are (1) large amounts of inhaled material, (2) large amounts of mucus due to excessive secretions or impaired mucociliary clearance, and (3) large amounts of abnormal substances such as edema fluid or pus. Each cough involves a complex reflex arc. The reflex begins with stimulation of a receptor.

Etiologies

Cough can be caused by a multiplicity of disorders located in a variety of locations. Literally hundreds of diseases can cause cough. Only the most common are discussed in this document.

Based on duration, there are two categories of cough that are not mutually exclusive: acute, lasting less than 3 weeks; or chronic, lasting 3 weeks or more. This definition of acute and chronic cough has been utilized in five prospective, descriptive studies (Grade II-2).3, 4,115, 116, 117

Acute cough is most

Chronic Cough in the Adult

The cause of chronic cough can be determined in most adult patients; specific therapy will be successful in the majority of patients when chronic cough is evaluated in a systematic manner. A diagnostic approach that systematically evaluates locations of the afferent limb of the cough reflex for diseases that might be causing cough has been utilized in one form or another in 11 published studies.3, 4,115, 116, 117, 118, 119, 120, 121,310, 311 All studies were descriptive in nature; seven were

Pharmacologic Treatment

The treatment of cough can be (1) therapy that controls, prevents, or eliminates cough (ie, antitussive therapy), or (2) therapy that makes cough more effective (ie, protussive therapy).

ACKNOWLEDGMENTS

The authors thank Dr. Sydney Parker, Vice President, ACCP Health and Science Policy, for organizational assistance; James Breeling for editorial assistance; and Beth Welch from the ACCP for administrative assistance.

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