Cough smoker

The efficiency of mucociliary transport depends on the force of kinociUary motion and the viscosity of bronchial mucus. Both factors can be altered pathologically (e.g., in smoker s cough, bronchitis) or can be adversely affected by drugs (atropine, antihistamines). 

After acute exposures to chlorine gas, both obstructive and restrictive abnormalities on pulmonary function tests have been observed. Eighteen healthy subjects exposed after a leak from a liquid storage tank had diminished FEVi, EEF 25-75%, and other flow rates within 18 hours of exposure. Follow-up studies at 1 and 2 weeks demonstrated resolution of these abnormalities in the 12 subjects with an initial chief complaint of cough, whereas the 6 subjects with a chief complaint of dyspnea had persistently reduced flow rates. Repeat studies in 5 months were normal in all patients studied except for mildly reduced flow rates in two patients who were smokers. ... 

Desflurane does not have a marked bronchodilator effect and in cigarette smokers it is associated with significant bronchoconstriction. In clinical practice, both humidification of inspired gases and opioids are thought to reduce airway irritability but even at moderate concentrations (2 MAC), desflurane is more likely to cause coughing than sevoflurane. In common with other volatile agents, desflurane causes dose-related respiratory depression. Tidal volume is reduced and respiratory rate increases, initially. As inspired concentrations of desflurane increase, the trend is to hypoventilation and hypercardia and apnoea is to be expected at concentrations of 1.5 MAC or greater. 

SMOKER S COUGH Recurring cough experienced by smokers because damaged tiny hair-like structures (cilia) in airways can not move mucus and debris up and out efficiently. 

Nicotine causes local irritation in the respiratory system, as well as decreased motion of the cilia, the tiny hairs that sweep debris and mucus upward, out of the respiratory tract. A recurrent smoker s cough results as the body tries to rid itself of accumulated mucus. Breathing is accelerated by nicotine. 

Bronchitis—inflammation of the bronchi (lung airways) resulting in persistent cough that produces considerable quantities of sputum (phlegm). Bronchitis is more common in smokers and in the areas with high atmospheric pollution. 

Smoker or ex-smoker Symptoms under age 35 Chronic productive cough Breathlessness... 

Dust particles inhaled in tobacco smoke, together with bronchial mucus, must be removed by the ciliated epithelium from the airways. However, ciliary activity is depressed by tobacco smoke and mucociliary transport is impaired. This favors bacterial infection and contributes to the chronic bronchitis associated with regular smoking (smoker s cough). Chronic injury to the bronchial mucosa could be an important causative factor in increasing the risk in smokers of death from bronchial carcinoma. 

Q8 The two major types of COPD are chronic bronchitis and emphysema. It is not possible to determine which of these two conditions is responsible for the problems of this patient from the information given, but they often coexist. Chronic bronchitis is characterized by recurrent chest infections with a productive cough and sputum production for at least three months in two or more consecutive years. In chronic bronchitis there is hypertrophy of the mucous glands in the airways and production of a thick, tenacious mucus that is difficult to remove from the lung and which easily becomes infected. The incidence of bronchitis is increased in smokers. 

Q3 Chandra has suffered recurrent chest infections for three years and has had a chronic cough with sputum production during this time. Although he is not a smoker, he has been exposed to occupational dusts in the mining industry, which is known to be associated with development of COPD. His lung function test results are consistent with this diagnosis (see Part 2 of the case study). 

A 37-year-old man who had taken lithium and sulpiride for 14 years and who was a long-time smoker without respiratory symptoms or a history of asthma had lithium withdrawn because of an asymptomatic bradycardia (44 beats/minute) (125). Six weeks later, he developed symptoms of asthma, including nocturnal cough, exertional wheezing, increased airway resistance, and a low FEV1, attributed to lithium withdrawal. 

Capsaicin causes transient bronchoconstriction and induces coughing, especially in individual with severe asthma, potentially triggering fatal crises [37]. These adverse respiratory effects are probably due to the limited capacity of respiratory tissues to metabolize capsaicin (see Section 4.3) [38], and are a major problem with the use of pepper sprays as antiriot agents [37]. Smokers are less sensitive to the respiratory effects of capsaicin, but asthmatic patients should avoid chilies and hot cuisine, as should people using drugs such as ACE-inhibitors, which have an intrinsic capacity to induce cough. 

In 3402 patients with hypertension taking trandolapril, cough, assessed by visual analogue scale, was less common in smokers than in non-smokers (2). 

Chronic obstructive pulmonary disease is a respiratory condition characterized by irreversible airway obstruction caused by chronic bronchitis or emphysema. The major symptoms of COPD include chronic cough, increased sputum production, and dyspnea. The vast majority of patients with COPD are those who are current or former heavy smokers. Other risk factors for the development of COPD include occupational exposure (dusts, chemicals) and rare genetic disorders (a -antitrypsin deficiency). The medical management of COPD includes pharmacotherapy (bronchodilators, corticosteroids, and antibiotics) in combination with interventions to reduce risk factors for disease progression (e.g., smoking cessation). Some patients require long-term administration of supplemental oxygen. 

On questioning the patient you discover that he has a productive cough and the sputum is a yellowish colour and there have been tinges of blood apparent. The coughing has been evident for about six months. He is tired and has lost his appetite and with it some weight too. He also complains of shortness of breath. He is a smoker who smokes about 40 cigarettes a day and has done since he was a teenager. He has already tried Benylin Expectorant but that has not worked. 

He has had the cough for a month or so. It is really irritating but he does not have any phlegm. He is a smoker but had never had any problems with his chest. He has never had asthma or anything similar. He does take blood pressure tablets. The doctor changed him onto enalapril a couple of months ago. 

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