[Coughing. Pathognomic significance and therapeutic options]

A wide range of disease processes may present with cough and definitive treatment depends on making an accurate diagnosis of the cause. Acute or short-lived cough, which most commonly occurs in association with viral upper respiratory tract infection, is of a little consequence, usually resolving in a matter of days. The most common chronic causes of cough are post-nasal drip, asthma, gastro-esophageal reflux and chronic bronchitis. The different conditions that cause cough have in common the fact that are mediated by the vagus nerves, with sensory receptors in and under the epithelium from the larynx to the smaller bronchii. The receptors are polymodal, responding to a large variety of stimuli, including mechanical and chemical irritants, inflammatory mediators, intraluminal material and large volume changes of the lung. Intensive treatment of underlying cause usually leads to improvement or resolution of cough. However, in a minority of patients, no underlying cause is identified despite appropriate investigation: in these subjects or when cough interferes with patient's health or sleep is indicated a non specific treatment with antitussive therapy.