Wu Yanbing
In autumn, the climate is dry and the temperature drops, and various symptoms of respiratory tract discomfort always come out to make trouble during this season.
Many people feel this way. Once in the fall, the throat feels like a plug, with hot, dry itching, and excessive phlegm. If you are not careful, you will be harassed by coughing and become annoying.
Today, let’s talk about why the respiratory tract is fragile in autumn and who is prone to coughing.
Coughing is not necessarily a bad thing
The respiratory tract is divided into the upper respiratory tract and the lower respiratory tract. The upper respiratory tract includes the mouth, nose, pharynx and larynx, and the lower respiratory tract consists of the trachea, bronchi, and lungs.
The respiratory tract is the internal organ that people have the most contact with the outside world every day, and is susceptible to various external stimuli, such as cold, heat, dryness, and infection.
But the lungs are also a relatively "sweet and cute" organ. They don't feel hot or cold, or pain or touch. To put it bluntly, they don't feel any. The biggest response to injury is coughing.
When the airway is stimulated, the neural reflex will cause the human body to produce a series of actions: the glottis is closed, and the breathing muscles contract rapidly to produce exhalation; because the glottis is closed, the breath cannot be exhaled, and the pressure in the thoracic cavity rises sharply, and then Rush to open the glottis; then, the gas is expelled at a high speed, taking the "bad" things out of the trachea-this is the protective defense mechanism of the lungs.
Therefore, coughing is not necessarily "sick", and coughing is not necessarily a bad thing when you are sick. Coughing can help people expel germs from the body, which is conducive to the improvement of the condition.
Of course, coughing is very annoying.
Coughing during the day; coughing at night; coughing when talking; coughing when inhaling cold air; especially severe coughing in public places, not only the patient feels uncomfortable, but others also feel nervous.
Some people will retching when coughing severely, affect sleep, and even develop pneumothorax. If the pleura on the surface of the lung ruptures, chest pain and suffocation will occur, which can be life-threatening in severe cases.
A severe cough in some patients can lead to loss of consciousness. It is medically called "cough syncope". This situation is very dangerous when driving or working at heights. Therefore, patients with relevant medical history should go to the hospital as soon as possible for symptomatic treatment.
Divided into 3 situations according to duration
When talking about coughing, we must first distinguish whether it is a real cough.
Some people call the action similar to "clearing the throat" a cough, usually one or two coughs, the reason is that the pharynx is uncomfortable or something is sticking; some coughs are habitual actions, common in smokers, and mostly caused by pharyngitis .
What is really called a cough is usually a "string" of coughs one after another.
In medicine, according to the length of coughing time, coughing is divided into three cases: acute cough, subacute cough and chronic cough.
1. Acute cough refers to cough within 3 weeks, most of which are cough after infection, caused by colds, tracheitis and other diseases;
2. Subacute cough refers to a cough that lasts from 3 to 8 weeks. In addition, this condition occurs in older patients, mainly coughing after infection;
3. Chronic cough refers to a cough with a course of more than 8 weeks. The main causes are cough variant asthma, postnasal drip syndrome (upper airway cough syndrome), eosinophilic bronchitis, gastroesophageal reflux cough , Allergic cough, etc.
Seasonal cough is mostly due to these conditions
Coughing can occur all year round, but it occurs frequently when the season changes.
Because of the obvious alternating between cold and hot during the season, especially in autumn, many people don’t pay attention to adding clothing and keeping warm in time, and their immunity will be reduced. This will create opportunities for various bacteria and viruses to invade the human body, and then cause respiratory bacterial or viral infections. The incidence of cough is higher, and respiratory tract infections can easily induce cough variant asthma.
This is also the main reason why people feel that it is easy to cough in autumn.
Why do I cough after a respiratory infection?
In fact, post-infection cough is a respiratory symptom caused during the repair of airway inflammation. After the infection improves, it can be cured by simply using antitussive drugs, and the course of the disease is relatively short.
The essence of cough variant asthma is increased airway sensitivity caused by chronic airway inflammation. This inflammation is non-infectious and does not require anti-inflammatory drugs, but can be induced by respiratory infections.
It can be allergic or not.
Although it is called "asthma", the patient is not wheezing and his lung function is normal.
However, some patients can transform into typical asthma.
Therefore, the correct treatment can reduce the incidence of typical asthma.
The dry and cold climate is very unfriendly to the airways. The cold itself is an irritation, and the low temperature reduces the water content in the air, making the airways more sensitive to water shortages, leading to coughing and wheezing.
The nasal cavity has the effect of warming and humidifying the inhaled air, but too dry, mouth breathing, and strenuous exercise may reduce airway humidity and increase airway sensitivity.
In addition, there are allergic factors.
Except when the flowers bloom in spring, pollen allergies are also very serious in autumn. Both spring and autumn are prone to allergic cough, allergic rhinitis and asthma.
It should be reminded that cough variant asthma, postnasal drip syndrome, eosinophilic bronchitis, allergic cough, etc. are more or less related to allergies.
If you still have symptoms such as sneezing, runny nose, itchy eyes and nose, and watery eyes while coughing, and if you go to the hospital to find high eosinophils and high total IgE (immunoglobulin E), then it will be very difficult to receive anti-allergic treatment. efficient.
Why CT is often used for diagnostic tests
In theory, lung CT is not a necessary examination for coughing.
In most cases, the lung CT examination results of patients with simple cough are normal.
Most chronic coughs, such as cough variant asthma, eosinophilic bronchitis, allergic cough, etc., have no obvious lesions in the lungs.
Then why do doctors often recommend a CT scan of the lungs when you go to the hospital to see a cough?
Because the doctor must first rule out some serious diseases, such as tuberculosis, lung cancer, bronchiectasis and so on.
The treatment of these diseases is mainly to treat the primary disease, not to cough alone. The doctor must first see if the lungs are diseased. The best way to "see" the lungs is lung CT and X-ray chest X-ray.
Which of lung CT or chest X-ray is better?
Lung CT is relatively clear. X-ray chest radiographs will produce many artifacts. Cardiovascular and bone may also obscure the lesion. Therefore, bronchiectasis and lung cancer are mostly diagnosed by lung CT, while infectious diseases such as tuberculosis and pneumonia can be diagnosed. Diagnose based on chest X-ray.
The receiving doctor usually asks the patient's medical history in detail first, makes a preliminary judgment on the nature of the cough, and considers what examinations to be done.
For the elderly, long-term coughing patients who do not relieve after treatment, and hemoptysis, lung CT examination is the first choice.
Since the X-ray absorbed dose of lung CT examination is higher than that of chest X-ray, it is recommended to bring recent imaging results when patients visit different hospitals to avoid repeated examinations.
Do I have to take medicine for coughing?
Many elderly people see their children coughing and take medicine, saying "to suppress the disease"; some patients are afraid of bronchitis and then turn into chronic cough, and take medicine immediately as soon as the cough occurs.
But as long as it is medicine, there are side effects, especially for children.
Therefore, if you are not coughing violently, do not take cough medicine in a hurry, but seek medical treatment in time for the cause of the disease.
For patients with cough, the doctor's first concern is whether there is a respiratory infection.
If a severe cough occurs, the stimulation of the airway may aggravate the inflammatory response and delay the improvement of the condition. In this case, symptomatic medication is required.
Let’s talk about the medicines that may be used for coughing.
●Antitussive
Antitussive drugs work quickly, but do not target the cause.
Commonly used antitussives mainly include compound methoxamine, licorice tablets, dextromethorphan, compound codeine syrup and traditional Chinese medicine lung cough, loquat syrup, etc. They are achieved by inhibiting the central and peripheral cough reflex, anti-allergic, and expanding bronchi. Antitussive purpose.
Among them, the compound methoxyphenamine is used to treat acute and chronic coughs, and the compound dextromethorphan solution is often used for coughs after a cold.
Most antitussives of western medicine are compound preparations, which may include antitussive, chlorpheniramine, pseudoephedrine, etc., with relatively more side effects, but the effect is not significant, so you can take it with confidence.
Taking chlorpheniramine can cause drowsiness. It is not suitable for professionals who need to concentrate on work, such as drivers. They can change to other antitussives as directed by a doctor.
It should be noted that most western medicine compound antitussives have the same ingredients or alternative ingredients, and do not take them at the same time.
●Anti-allergic drugs
Commonly used anti-allergic drugs are loratadine, cetirizine, etc., which are suitable for coughs caused by allergic factors, especially patients with allergic rhinitis.
Among them, montelukast is used to treat asthma and allergic rhinitis. It is a safer drug and can be used at the same time as other anti-allergic drugs.
In addition, among inhaled hormones and bronchodilators, salmeterol, ticasone, budesonide formoterol, etc. are more commonly used for the treatment of cough variant asthma, eosinophilic bronchitis, allergic cough, etc. , While relieving cough, it can also reduce the chance of patients developing typical asthma.
Many patients are worried about side effects when they hear of hormones. In fact, these drugs have been on the market for a long time, and the observed incidence of serious side effects is very low. It is relatively safe. It should be noted that the mouth should be rinsed in time after inhalation to remove excess drugs in the oral cavity.
●Acid inhibitors
Including omeprazole, lansoprazole, etc., can inhibit gastric acid secretion, mainly used for gastroesophageal reflux cough.
● Antibiotics
Including cephalosporin, azithromycin, etc., mainly used for cough caused by infection.
●Phlegm Resolving Medicine
Including Eucalyptus Capsules, Acetylcysteine Capsules, Ambroxol Hydrochloride, Fresh Bamboo Leachate, etc., which can dilute sputum, which is not easy to cough up, and is suitable for postnasal drip syndrome.
However, routine use is not recommended for dry coughs.
Health tips
How to distinguish "new crown" cough from ordinary cough
China is now doing its utmost to prevent and control the new crown epidemic. The mention of "cough" inevitably makes people nervous.
So, what is the difference between a cough caused by the new coronavirus and a cough caused by a common respiratory infection?
In view of the complexity of the symptoms caused by the new coronavirus, it is unlikely that patients will be screened for infection by themselves.
From a clinical point of view, in addition to fever, the new coronavirus infection can sometimes be a simple cough (mostly without sputum) as the main symptom, which can also be the only first symptom of patients with new coronavirus.
Therefore, if a cough occurs, in the case of a history of epidemiological contact, attention should be paid to the symptoms of cough, and timely treatment should be given to a regular hospital.
At this time, do not buy or use medicine yourself, so as not to delay the diagnosis of the disease and cause the spread of the virus.
(Author's unit: Beijing Chaoyang Hospital, Beijing Institute of Respiratory Diseases)