Cough is a symptom that is familiar to everyone.
It accompanies both the common cold and serious diseases, including: lung, heart and even stomach diseases.
Most people prefer to treat cough on their own. But not everyone knows that it is not the cough itself that needs to be treated, but the disease that led to its occurrence. A little bit of anatomy, a person takes about 20,000 breaths a day. At the same time, approximately 8000 liters of air enter the respiratory tract.
The respiratory tract is divided into upper and lower:
upper respiratory tract
- this is the nasal cavity
- of the pharynx (nasal, oral and laryngeal parts)
lower respiratory tract
- this is the trachea and bronchi
Normally, about 2 liters of mucus are formed in the respiratory tract per day, which contributes to the natural cleansing of the respiratory tract. The mucous membrane of the bronchi is arranged in such a way that the mucus with the help of special cilia rises up into the pharynx, and then swallowed. And from the upper respiratory tract (nose and nasopharynx), mucus flows freely down and is also swallowed.
If there is a violation of the mucous membrane (for example, smokers do not have cilia in the bronchial mucosa) or any factors cause thickening of mucus, then it cannot be freely excreted and stagnates. All this leads to irritation of the so-called cough receptors (special cells that are involved in the occurrence of the cough reflex). It turns out that cough receptors are present not only in the respiratory tract, but even in the heart and stomach. Ie, diseases of not only the respiratory tract will be accompanied by a cough.
So, a cough resulting from severe arrhythmia helps not to lose consciousness to the sick person and even helps to restore the normal rhythm of heart contractions. What kind of cough is there? The cough can be constant and short, barking and silent… And cough is also divided into wet (doctors call it “productive”) and dry (“unproductive”).
With a wet cough, sputum is released. It can be liquid or thick, mucous (transparent) or purulent (yellow, green). If the sputum is colored red or brown, contains streaks or blood clots, then this symptom is called hemoptysis. The amount and nature of sputum gives the doctor information about what is the cause of the cough. For example, thick green sputum indicates severe inflammation, which should be treated with antibiotics.
And depending on whether the sputum leaves at all, it will depend on which medications need to be prescribed. So, for example, with hemoptysis, expectorant drugs should not be taken, because they can increase the amount of blood in the sputum. And with a dry cough, the use of expectorants can increase the cough up to suffocation. A cough that is cured for up to 3 weeks is an “acute” cough, it most often accompanies ARVI. If the cough persists for longer than 3 weeks, then it is called “chronic”. Chronic cough is a sign of a serious illness.
Different diseases – different cough.
Diseases of the upper respiratory tract.
The most common cause of cough is the familiar acute respiratory illness (ARI). Cough, as a rule, is dry, accompanied by pain and sore throat. A runny nose with acute respiratory infections can also be the cause of coughing due to the runoff of mucus along the back wall of the pharynx.
In about 10% of cases, the only manifestation of bronchial asthma is a cough.
With exacerbation of bronchial asthma, the bronchial lumen narrows, which makes it difficult for air to pass mainly on exhalation and leads to coughing, wheezing or choking attacks. Characteristic of cough is its occurrence at night and in the early morning hours.
Inflammatory diseases of the bronchi and lungs: bronchitis and pneumonia.
Inflammation and the presence of sputum in the respiratory tract leads to irritation of cough receptors in bronchitis and pneumonia. In these diseases, cough is very rarely dry and is always accompanied by an increase in body temperature.
Smokers are characterized by coughing in the morning with the discharge of thick sputum and frequent coughing throughout the day.If smoking has not led to the development of a chronic disease, then it is enough to abandon the bad habit so that the cough itself comes to naught.
Gastro-esophageal reflux disease.
This disease leads to relaxation of the valve that separates the esophagus from the stomach. And reflux is the throwing of food from the stomach back into the esophagus. To provoke the ingestion of stomach contents into the esophagus can be abundant food, bending of the trunk and even singing. The acid contained in gastric juice irritates the esophagus and can lead not only to heartburn, but also to coughing. Sometimes coughing is the only sign that there is something wrong with your stomach.
Most heart diseases lead to the fact that the heart cannot cope with pumping the necessary amount of blood. Blood “stagnates” in organs, including in the lungs. This leads to irritation of cough receptors. There is a dry cough, which increases in a horizontal position. Cough may be accompanied by palpitations, a feeling of lack of air, shortness of breath. It is impossible to treat such a cough – it will disappear by itself if the signs of heart failure are eliminated.
Cough due to medication.
Taking a number of medications can lead to such a side effect as cough. The reasons for this effect of medicines have not yet been sufficiently studied. It helps to recognize that taking medications led to the development of cough, because there was no cough before prescribing the medicine. Cough bothers mainly in the daytime, dry, more often it is a small but exhausting cough. After 3-7 days after discontinuation of the drug, the cough disappears. Cough with tumors, Some lung tumors can manifest for a long time only by coughing: dry or with the separation of a small amount of light sputum. Changes in the radiographs of the lungs are not detected at the same time. Only contacting a doctor and conducting special research methods helps to make a diagnosis at an early stage.
Cough with whooping cough.
Whooping cough is an infectious disease that occurs with a prolonged paroxysmal spastic cough. In the first 2 weeks, the cough is similar to a cough with a common cold, may be accompanied by a runny nose, a slight increase in body temperature. Starting from the third week, a period of debilitating cough begins. The cough “rolls over” with attacks that are repeated from 2 to 15 times in a row. Such a cough must be treated, because it leads to serious complications. Complications that coughing can lead to. Frequent persistent cough, especially in the form of prolonged seizures, leads to an increase in intra-thoracic pressure and can contribute to the development of: – emphysema of the lungs – complications from the heart (arrhythmias, increased ischemia, development of the pulmonary heart) – hemorrhage in the sclera of the eyes – dizziness – fainting – deterioration of cerebral circulation (especially if there have been previous strokes) – rupture of the lung
In addition, coughing can lead to headaches, vomiting, sleep disturbances, urinary and fecal incontinence in an elderly weakened patient. Chronic cough can lead to the formation or increase of existing hernias (diaphragmatic, inguinal, scrotal, etc.). Chronic cough can cause depression, complicating the patient’s relationship with others, which ultimately significantly worsens the quality of life. What kind of research needs to be done.
In order to avoid serious complications and make a timely diagnosis, it is necessary to consult a doctor.
Depending on the characteristics of the cough, its duration, based on the results of the examination, the doctor will prescribe an examination. As a rule, this is a clinical blood test, fluorography and a study of the function of external respiration. If the results of these studies do not help to determine the diagnosis, or already during the examination it may be suspected that they will not be enough, the doctor prescribes more complex studies (for example, bronchoscopy, computed tomography, lung scintigraphy) and consultations of narrow specialists. It is hardly possible to find a person who has never coughed. And, of course, there is no need to consult a doctor every time at the first signs of a slight sore throat or a slight cough. These disorders are transient. However, it should be remembered that only a doctor can reliably recognize the cause of a cough and prescribe the necessary treatment.
Symptoms that should alert and serve as a reason for immediate medical attention: – hemoptysis (sputum uniformly red or with red/ brown streaks) – fever for more than 3 days – suffocation or shortness of breath – cough for more than 3 weeks – chest pain – nausea and vomiting”
Doctor, listen to me! or what is heard there?
How often do patients complain after being examined by a doctor: “He didn’t even listen to me…”.
And it’s sad that a doctor who is ready to listen and has time for this within the reception needs to be searched for. But auscultation or listening to the chest organs (lungs and heart) does not take much time and is a mandatory manipulation for a therapist. Are you wondering what the doctor hears in his “ears”, called a stethoscope, and why does he need all this?
Breathing and wheezing
Everything that the doctor listens to above the surface of the lungs, he divides into the sounds of breathing and the sounds of wheezing. Breathing can be normal (vesicular) and pathological (rigid, bronchial, weakened, etc.). Wheezing in the lungs should not be normal.
Tough and not very
And we will start with breathing after all. It is quite difficult to switch to wheezing without it. Normally, no subsonics and special effects should be listened to in the lungs. The so-called vesicular respiration is considered “healthy”. It is so called because it occurs as a result of fluctuations in the walls of the pulmonary alveoli (vesicles) during inspiration. Naturally, not the entire volume of the lungs is filled at the same time, so we have a sound stretched over time and increasing in intensity.
Old professors explained what vesicular breathing looks like as follows: try to pronounce the letter “f” at the moment of inspiration – you will get the sound of vesicular breathing. Another option is drinking tea from a saucer with slurping.
Normally, in the presence of vesicular respiration, the entire inhalation and about a third of the exhalation should be listened to. This is where the norm ends.
There are a lot of variations – weakening or strengthening of vesicular respiration, but this is already a propaedeutic jungle and we will not climb there.
As soon as any troubles begin in the lungs or bronchi, this immediately affects the nature of breathing. For example, when bronchitis (inflammation of the mucous membrane + bronchospasm) makes it difficult for air to pass through the small bronchi, so-called hard breathing can be heard in the stethoscope, when both inhalation and exhalation are heard very well, completely.
There are still many different pathological breaths, but we will talk about them sometime next time. You just need to learn that there is ALWAYS some basic breathing, and already various additional sound effects are layered on it.
Wheezing little by little
Wheezing occurs against the background of a pathological process in the trachea, bronchi or lungs. They are divided into dry and wet, and this division is not conditional, the mechanisms of their occurrence differ significantly.
Let’s start with dry wheezing.
The main condition for the occurrence of dry wheezing – there should be a narrowing of the bronchial lumen. It is not so important what it will be – total as with bronchial asthma or focal as with tuberculosis.
As a result , we get three mechanisms for the occurrence of dry wheezing:
- Swelling of the bronchial mucosa with inflammation
- Accumulation of viscous sputum in the bronchial lumen
Then everything is simple: the larger the bronchus is involved, the lower the sound of wheezing will be. If the small bronchi have narrowed, we will hear whistling wheezes, if the “strings” of viscous sputum are in the large-caliber bronchus, bass buzzing wheezes will be heard. Dry wheezing is usually very clearly audible not only to the patient himself, but also to the people around him, even without any stethoscopes.
From all that has been said, one more conclusion follows: dry wheezing will be clearly audible both on inhalation and exhalation.
We turn to wet wheezing.
The main condition for the occurrence of wet wheezing is the presence of fluid in the bronchial lumen (sputum, blood, edematous fluid, etc.). When air passes through this secret, many bubbles of different diameters are formed. Overcoming the liquid layer and getting into the bronchus, the bubbles burst, making a characteristic sound. Take a thin straw and blow through it into the water – that’s the model for the occurrence of wet wheezing.
Wet wheezing is better heard on inspiration, because on inspiration the speed of air movement through the bronchi will be greater.
Wet wheezes are divided by bubbliness. Depending on the caliber of the bronchi, you can hear small-bubbly, medium-bubbly and large-bubbly wet wheezes. They occur, respectively, in bronchioles and small bronchi, medium-caliber bronchi and main-caliber bronchi. The larger the blistering, the louder the wheezing. Large-bellied ones, for example, are very well audible at a distance.
For example, with pneumonia, you can hear small-bubbly wet wheezes.
It is very difficult for a novice doctor to distinguish small bubbly wet wheezes from another sound effect – crepitation. Crepitation is not a wheeze. It comes from the alveoli. When a certain amount of secret accumulates in them, the alveoli stick together. And when they inhale, they break up. And that’s the sound we hear.
Why it is important to find out whether it is crepitation or small-bubbly wheezing. Let me explain by the example of pneumonia: if we hear crepitation, it’s bad, pneumonia is in full swing, and if small-bubbly wheezing is already good, the resolution phase has started, or it’s bronchitis in general, not pneumonia.
When you hear this damn crepitation ten times, you start to wonder – and how can it be confused with wheezing? Crepitation occurs only at the height of inspiration, it does not disappear after coughing and the sound is very sharp. The same old professors advised to rub the hair at the temple with your fingers – the resulting sound is very similar to crepitation.
Here she is, dear, against the background of bronchial breathing that I did not mention. But you will hear its peculiarity anyway.
But with bronchiectatic disease or if there is a cavity with fluid in the lung (abscess, cavern) that connects to the bronchus, you can hear medium- and large-bubbly wheezing. Bubbles with such wheezing burst noticeably less often, but noticeably louder and more spectacular.
Breathing with swirls and friction
Chief, can I hear you
Bronchial respiration is a sound phenomenon that occurs when air swirls passing through the larynx, as well as the place of separation of the trachea into two main bronchi (tracheal bifurcation). Since turbulence zones occur both on inhalation and exhalation, bronchial breathing is clearly audible both in the first phase of breathing and in the second.
You probably noticed that the doctor does not listen to the lungs at one point, but tries to poke the stethoscope all over the back, and in young beautiful girls he listens especially intently to the lungs in front. In general, it’s not from a good life that he does it, believe me. Our lungs are rather big, and the doctor needs to determine whether noise is heard over their entire surface or it is localized. Is one type of breathing heard everywhere, or is there an alternative somewhere.
Bronchial respiration is a striking example of such an alternative. As we have already said, normally vesicular breathing should be heard over the entire surface of the lungs. To clarify: almost all of it. Above the larynx, in the projection of the trachea and especially in the projection of its bifurcation – the level IV-V of the thoracic vertebrae (in young beautiful girls – this is just at the very top of the hollow;)) normally, it is bronchial breathing that is heard. Sometimes, to distinguish it from pathological bronchial, it is called laryngotracheal breathing. That is, laryngotracheal is the norm, and bronchial is no longer the norm.
I would like to emphasize once again that normally bronchial breathing should not be heard over other parts of the lungs. If it appeared somewhere else, then there are problems in the lungs. Most often, they are associated with the compaction of lung tissue (under such conditions, sounds are carried out much better than by air lungs).
Depending on the severity of the process, bronchial respiration may overlap with vesicular respiration, or it may completely displace it. What can cause lung tissue to thicken? Pneumonia, first of all. Especially massive, shared, for example.
In addition to pneumonia, compaction of lung tissue can cause tuberculosis, lung infarction, compression atelectasis of the lung (collapse of lung tissue and compression of the lung to its root), pneumosclerosis (when lung tissue is replaced by connective tissue).
In fairness, it should be noted that bronchial breathing can rarely be heard over the entire surface of the lungs. Most often, it is perfectly audible over the hearth of the seal, and if you go to the side, its volume drops exponentially. This fact helps the doctor to say with a certain degree of probability exactly where the problem is localized.
Amphoric respiration is also a variant of pathological bronchial respiration. It can be heard if a cavity in the lung (5-6 cm in diameter, usually smooth-walled) connects to the bronchus. The cavity may appear, for example, with an abscess of the lung.
In fact, we get the Pan flute element. The air passes over the opening of the cavity – and we hear a loud enough and in some ways even musical sound.
The old professors mentioned more than once suggested taking an empty champagne bottle and blowing over its neck. The sound is obtained almost one-on-one as with amphoric breathing.
Quite rarely, fortunately, there are violations of the innervation of the respiratory muscles. With such a pathology, they do not work all at the same time, but in turn, stepwise. As a result, we get a step-by-step inhale. Exhalation is passive, muscles are not particularly needed there, so the second phase of breathing is usually not changed.
This type of breathing is called saccoded.
But in the vast majority of cases, saccoded breathing is explained by quite normal and not at all pathological reasons. First of all – cold. It’s good for the doctor, he can have not only a fiery heart under his robe, but also, for example, a woolen vest. And the patient has no choice, he has to be naked to the waist (from above), even if it’s not hot in the office or ward, to put it mildly. The muscles begin to engage in tremulous thermogenesis, as a result of which, during auscultation, we will receive saccoded respiration.
Therefore, it is recommended to examine patients in a more or less warm room. And warm the phonendoscope head in your hands before applying it to the patient’s skin. For experienced therapists, this is already at the level of automatism: you interview a person, and a stethoscope is warming in your hand.
Another option is people who start to worry terribly at the sight of the doctor. And we hear the saccoded breathing again. Again, if the patient cries before the arrival of the doctor, then for some time he will again have saccoded breathing. And again, the reason is not the disease at all, it’s just the consequences of crying.
Well, to figure out whether it is a violation of the innervation of the respiratory muscles or a recent crying – this is exactly the art of the diagnostician.
And now we turn to the most notable noise in the field of lungs. As you know, our lungs are covered with a kind of elastic film – pleura. And the chest cavity is lined from the inside with the same pleura. There is a small cavity between these two leaves, which is called pleural. Both sheets are covered with a small amount of lubricant to facilitate breathing movements.
If the pathological process is localized not in the depth of the lungs, but on the surface, the pleura covering the lungs may also become inflamed. At the same time, the lubricant can either disappear (as with the rapid loss of a tangible amount of fluid by the body – cholera, blood loss, indomitable.