CoughPresented By-

Dr. Vinod K GuptaM.D. (Ayu.) Final Year

DEPARTMENT OF KAYA CHIKITSASTATE AYURVEDIC COLLEGE & HOSPITAL, LUCKNOW

Cough

DefinitionCough is physiological protective

mechanism which is characterized by explosive expectoration following a deep inspiration. Its function is to clear the tracheobronchial tree of excessive secretions and foreign body.

Cough is often a clue to presence of Respiratory disease.

Cough provide an essential protective function for human airways and lungs.

Withought an effective cough reflex we are at risk for -• retained airway secretion• Aspirated material• Predisposing infection• Respiratory compromise

At the other extreme, excessive coughing • can be exhausting• Can be complicated with – emesis, syncope, muscular

pain, rib fracture• And can aggravate hernia and urinary incontinence.

COUGH

Weak or ineffective cough compromises the ability to clear lower respiratory tract infection, predisposing to more serious infections and their sequelae.

Causes of impaired cough• Decrease respiratory muscle strength.• Chest wall deformity• Impaired glottic closure or tracheostomy• Abnormal airway secretions• Central respiratory depression (anesthesia, sedation or

coma)

Impaired cough

Cough mechanism Spontaneous cough is triggered by stimulation of sensory nerve endings that are thought to be Primarily Rapidly adopting receptor and C-fibers.

both chemical (Capsaician) and mechanical stimuli may initiate the cough.

Afferent nerve ending richly innervate the Pharynx, Larynx, Air way to the level of terminal bronchioles and also found in External auditory meatus & Esophagus.

Sensory signal travel via the Vagus and Superior laryngeal nerve.

transient upper airway occlusion

generating positive intra thoracic pressure as high as 300mmhg.

rapid expiratory flow are generated.

maximizes the velocity of exhalation

Cough reflex involve a highly orchestrated series of involuntary muscular actions.

Bronchial smooth muscle contraction together with dynamic compression of airway narrows airway lumen

Vocal cord adduct

Expiratory muscle contract

With sudden release of laryngeal contraction

Acute

Less than 3 wk

R.T.I. ,Aspiration,

Inhalation of noxious chemical

or smoke .

Sub-acute

3-8 wk

Tracheobronchitis-pertussis

post viral tussive syndrome

Chronic

More than 8 wk

Cardiopulmonary d’s- inflammatory,

infectious, neoplastic and cardiovascular

etiology.

Cough History

Cough of less than 8 wk duration may be the early manifestation of a disease causing chronic cough.

Acute cough occurring in context of more serious disease such as pneumonia, aspiration, CHF, pulmonary embolism is usually easy to diagnose due to the presence of other clinical features.

Assessment of chronic cough•Regardless of cause cough often worsen when one first lies down at night or with talking or in association with hyperpnea of exercise; it frequently improve with sleep.

Exception- pertusis, asthma

•Physical examination seeks clue to the presence of cardiopulmonary disease, including finding such as wheezing or crackles on chest examination.•Examination of auditory canal and tympanic membranes, nasal passage ways and nails.

•Cough may be manifestation of systemic disease such as Sarcoidosis or Vasculitis.

•In virtually all instances, evaluation of chronic cough merits a chest radiograph.

Chronic cough with a normal chest radiograph

When initial assessment with chest examination and radiograph is normal.

Cough variant asthmaGastro-esophageal reflux Post-nasal drainageMedication (ACE inhibitor)

The characteristic of cough originating at various level of RT

ORIGIN COMMON CAUSE CLINICAL FEATURE

Pharynx Post-nasal-drip History of chronic rhinitisLarynx Laryngitis, tumor Voice or swallowing altered, harsh or painful

voice

Whooping cough, croup Paroxysm of cough, often associated with striderTrachea Tracheitis Raw restrosternal pain with cough

Bronchi Bronchitis(acute), COPD Dry or productive, worse in morningAsthma Usually dry, worse at nightBronchial carcinoma Persistent (often with haemoptysis)

Lung Parenchyma

Tuberculosis Productive, often with haemoptysisPneumonia Dry initially, productive laterBoncheiectasis Productive, change in posture induce sputum

production

Pulmonary edema Often at night (may be productive of pink, frothy sputum)

Interstitial fibrosis Dry, irritant and distressing

DRY COUGH

•URTI•Initial phase of TB•TPE•Cigrette smooking•Brochogenic carcinoma•Compression of trachea•Funtional

WET COUGH(Foul smell)•Lung abscess•Bronceactasis•Infected cavity•Gangrene of lung•Fungal infection

(Mucoid)•Acute bronchitis•Bronchopneumonia•Post nasal drip and sinusitis

Color Condition

Reddish Hemoptysis

Blackish Industrial infections, Cole miner cough

Rusty/khaki Pneumonia

Yellow Actinomycosia

Creamy yellow Staphylococcal infection

Frothy pink Pulmonary edema

Mucoid brown to red Klebseila infection

Current jelly Bronchogenic carcinoma, influenza

Green Pseudomonas infection

Blood oyster TB

Sputum color associated with various conditions

Pharyngeal Demulcents•Lozenges •Glycerin •Linctuses containing syp

Expectorant (Mucokinetics)A-Directly acting

• Sodium and potassium citrate or accetate

• Potassium iodide• Guaiphenesin • Balsum of tolu• Vasaka• Terpin hydroid

B-Reflexly acting• Ammonium chloride or

carbonate• Potassium iodide

C-Mucolytics• Bromhexine• Ambroxol• Acetyl cysteine• carbocisteine

Antitussive (Cough center suppressants)A-Opioids

• Codeine• Pholcodeine• Ethylmorphine• Morphine

B-Non Opioids• Noscapine • Dextromethorphane• Oxyladine• Chlorphedianol

C-Antihistamines• Chlorpheniramine• Diphenhydramine• Promethazine

DRUGS FOR COUGH

Ayurvedic drugs for Cough

Kasahar mahakashaya1- Darksha – Vitis vinifera,2- Abhaya – Terminalia chebula,3- Amalaka - Emblica officinalis,4- Pippali– Piper longum,5- Duralabha -Fagonia cretica ,6- Shrungi -Rhus succedanea,7- Kantakarika – Solanum xanthocarpum,8- Vrushchira - White variety of Boerhaavia diffusa,9- Punarnava - Red variety of Boerhaavia diffusa10- Tamalaki -Phyllanthus niruri

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Kaphketu RasIngredients-Tankan-1 partsShankha-1Pippali-1Vatsnabh-1

Aardrak swaras bhawna

KaphasamakPinas, shwas, kasa, shirorog, galgrah.

Anupan- Aardrak swaras

Kaph kuthar ras

Contents-Parad-1 part Gandhak-1Lauha-1Tamra-1Trikatu-3

Kantakari , Kutaki, Dhatura

Expectorant, Kasa, Shwasa, Jwar, Kaphaj Vikar

Shwasakuthar ras

Ingadients-Parad- 1 partGandhak-1Tankan-1Vatsanabh-1Manahshila-1Shunthi-2Pippali-2Marich-10

Nagvel patra swaras

Ushna, tikshna, kaph shravak, shwasahar

Sitopaladi Churna

Sitopala– 16 partsVamshalochana– 8 parts Pippali – 4 parts Ela – 2 parts Twak – 1 part.

How dose work-Dilating respiratory tractExpectorant (moderate)Strengthening actionEnhancing immunityStimulate apatite and digestionReduce inflammation

Vata and kapha Shamak

dose – 1 – 3 grams two or three times a dayalong with half a teaspoon of ghee and a teaspoon of honey

Lavangadi Vati

Lavanga –10 gMaricha– 10 gAksha –10 gSara of Khadira–30 gWater decoction of Babbula – Acacia Arabica (Vaidyajivana, Shwasa Kasa Chikitsa, 7)

productive and non productive cough, cold and allergic rhinitis.

balances Vata and Kapha.

dosage:  1 – 2 tablets 2 – 3 times a day

Eladi Vati Ingredients:Ela–6gPatra –– 6 gTwak–6 gPippali–24 gSita –- 48 gMadhuka–48 gKharjura–48 gDraksha–48 gMadhu –48 g

balances Pitta.

cough, cold, fever, hiccups, hoarse voice, vomiting, dizziness, haematemesis, excessive thirst etc.

Usual dose is – 1 – 2 tablets 2 – 3 times a day

Talisadi Churna

Ingredients:Talisa – 1 partMaricha – 2 partShunti – 3 partPippali – 4 partVamshalochana – 5 partEla – ½ partTwak – ½ partSharkara – 32 part

BronchodialatorMucolyticAntitussiveAntiinflammatoryAntimicrobial

Vyaghri haritaki

Ingredients-Kantakari- 1 tula(54 ser)Haritaki-100Guna-100 pal

Trikatu-6 palChaturjat-1 palShahad-6 pal

All kasa, pinas, shwas, swarkshay, rajyakshma

Anupan- shritshit jal or dugdh

Agastya haritakiIngredients-Dashmul-20 palKronch-2Shankhpushpi-2Shati-2Bala-2Gajpippali-2Apamarg-2Pippalimul-2Chitrak-2Bharangi-2Pushkarmul-2

Haritaki-100 numberGhrit-32Tail-32Guna-1 tulaPippali-4

Use in- all kasa, shwas, hikka, kshaya, rasayan etc

Thank You