TAILIEUCHUNG - Chapter 034. Cough and Hemoptysis

Theafferent limb includes receptors within the sensory distribution of the trigeminal, glossopharyngeal, superior laryngeal, and vagus nerves. The efferent limb includes the recurrent laryngeal nerve and the spinal nerves. The cough starts with a deep inspiration followed by glottic closure, relaxation of the diaphragm, and muscle contraction against a closed glottis. The resulting markedly positive intrathoracic pressure causes narrowing of the trachea. | Chapter 034. Cough and Hemoptysis Theafferent limb includes receptors within the sensory distribution of the trigeminal glossopharyngeal superior laryngeal and vagus nerves. The efferent limb includes the recurrent laryngeal nerve and the spinal nerves. The cough starts with a deep inspiration followed by glottic closure relaxation of the diaphragm and muscle contraction against a closed glottis. The resulting markedly positive intrathoracic pressure causes narrowing of the trachea. Once the glottis opens the large pressure differential between the airways and the atmosphere coupled with tracheal narrowing produces rapid flow rates through the trachea. The shearing forces that develop aid in the elimination of mucus and foreign can be initiated by a variety of irritant triggers either from an exogenous source smoke dust fumes foreign bodies or from an endogenous origin upper airway secretions gastric contents . These stimuli may affect receptors in the upper airway especially the pharynx and larynx or in the lower respiratory tract following access to the tracheobronchial tree by inhalation or aspiration. When cough is triggered by upper airway secretions as with postnasal drip or gastric contents as with gastroesophageal reflux the initiating factor can go unrecognized and the cough may persist. Additionally prolonged exposure to such irritants may initiate airway inflammation which can itself precipitate cough and sensitize the airway to other irritants. Cough associated with gastroesophageal reflux is due only in part to irritation of upper airway receptors or to aspiration of gastric contents as a vagally mediated reflex mechanism secondary to acid in the distal esophagus may also disorder resulting in inflammation constriction infiltration or compression of airways can be associated with cough. Inflammation commonly results from airway infections ranging from viral or bacterial bronchitis to bronchiectasis. In viral .

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