Pharmacy Clinic
Cough
What systems can cause a cough?
•        Respiratory
•        ENT
•        Gastrointestinal
•        Cardiovascular
•        Neurologic
•        Psychologic

Causes of cough:
i) In pathological states (e.g. asthma, COPD) cough reflex  serves to maintain airway patency by removing excessive
secretions (protective mechanism)
ii) Environmental irritants
iii) Inhalation of allergens
iv) "Postnasal drip"
v) "Common Cold" most common cause of transient cough

Types of Cough
•        Acute: Lasts less than 3 weeks
•        Chronic: Lasts 3 to 8 weeks, or longer
Causes of Acute Cough
•        Common Cold
•        Allergies
•        Bronchitis/Pneumonia
•        Congestive Heart Failure
•        Pulmonary Embolus (low on the differential)

Causes of Chronic Cough
•        Asthma
•        Gastroesophageal reflux disease (GERD)
•        Postnasal drip syndrome
•        Drugs (ACE inhibitors): ACE is identical to kinin-prostaglandin system , since ACE is identical to kininase II, one
of the enzyme responsible .for the degradation of bradykinin. Kallikrein-Kinin prostaglandin systems Kallikreins catalyze
the formation of plasma Kinins bradykinin, alpha 2 globulin is the precursor of kininogens which produce plasma Kinins.
Kinin are powerful algesic agents; by the stimulation of nerve ending. Kinins have many potent biological activities,
including dilatation of blood vessels, contraction of smooth muscles, and  enhancement of capillary permeability,
constrict airway smooth muscles, and have many similar actions like histamine. ACE inhibitors stimulate kinin in the
blood by the inhibition of the degradation factors in the body. Some of the adverse effects of ACE inhibitors like cough,
rash, angio-edema may caused due to the inhibition of endogenous breakdown.

•        Chronic Bronchitis (COPD)
•        Bronchiectasis: it is an abnormal dilatation of the bronchi, may be produced in different ways; congenital “ciliary
dysfunction syndrome”, pneumonia, TB…..etc.
•        Post-infectious
•        Bronchogenic carcinoma
•        Psychogenic

Elements of the history
•        Duration
•        Time of occurrence (e.g. seasonal, day/night, related to meals, related to changes in position)
•        Sputum production and character of sputum
•        Associated Symptoms (dyspnea, hemoptysis, wheezing, chest pain, fever, hoarseness)
History
•        Previous episodes of coughing
•        Alleviating and relieving factors
•        Quality or character of cough
•        Smoking history (Number of years, number of packs per day)
•        Occupational exposure
•        Allergies
•        Previous history of frequent URIs
Review of Systems
•        Weight loss
•        Fever
•        GI Symptoms - heartburn, bloating, nausea; metallic or brackish taste at the back of the throat
•        Chest pain
Family history
•        Asthma
•        Tuberculosis
•        Malignancies



Iron Supplementation May Help Patients With ACE Inhibitor
Diet High in Fruit Fiber and Flavonoids May Prevent Chronic Productive Cough
Case Report