Deep dry cough is periodic or persistent coughing attacks without sputum, which occur when the lower respiratory system is irritated. They develop with infectious or non-infectious lesions of the trachea, bronchi, lungs, pleura, pathological processes in the mediastinum. To determine the causes of the symptom, a chest X-ray or fluorography, serological methods, a tuberculin test, bronchography, bronchoscopy, ultrasound of the mediastinum and pleura are recommended. To alleviate the condition before diagnosis, humidification of the air, copious warm drinking, rest with restriction of external stimuli are indicated.
Causes of deep dry cough
Debilitating attacks of deep convulsive cough are a characteristic sign of whooping cough. Paroxysm is provoked by any external stimuli: conversation, laughter, pain, touch, etc. The attack consists of 2-15 series of short coughing jerks, continuously following each other. After each episode, the child sharply inhales air, which whizzes through the narrowed glottis. After the end of the attack, a small amount of transparent viscous sputum is separated, resembling thick mucus. Sometimes, after a deep cough, reflex vomiting occurs. Whooping cough is called “one hundred days” – it persists for three months, the intensity and frequency of attacks decreases gradually.
With paroxysm, the child is excited. His face turns red, his eyes are bloodshot, the swelling of the cervical veins is noticeable. Due to the protrusion of the tongue, a tear or rupture of the frenulum is possible. Muscle tension is accompanied by damage to capillaries, the formation of many small hemorrhages on the sclera and facial skin. In severe cases, an attack provokes tonic and clonic convulsions, loss of consciousness, respiratory arrest (apnea), involuntary discharge of urine, feces. Moderate catarrhal symptoms and intoxication are noted. Similar manifestations are less pronounced in paracoccus.
Tuberculosis of the lungs
The occurrence of a deep dry cough that persists for more than three weeks, accompanied by a temperature of up to 37.5-38 ° C and sweating, increases in the second half of the night, disturbing sleep— is a serious reason for excluding tuberculosis. Unproductive cough is one of the symptoms of focal and infiltrative variants of pulmonary tuberculosis infection, it is noted in the initial period of acute disseminated pulmonary tuberculosis and out of exacerbation in the cirrhotic form of the disease. With tumorous tuberculosis, the symptom is manifested by bitonal attacks.
Tracheitis and bronchitis
Attacks of deep unproductive cough, which eventually turns into a wet one, combined with soreness, pain behind the sternum or in the chest area, often indicate an inflammatory lesion of the tracheobroncheal tree. In the acute process, cough is accompanied by malaise, catarrhal symptoms, fever. Frequent intense coughing attacks provoke overstrain of the respiratory muscles and abdominal muscles, causing noticeable muscle discomfort.
With laryngotracheitis, hoarseness of the voice and discomfort in the larynx are additionally noted, a reactive increase in cervical lymph nodes is possible. The spread of inflammation to the bronchi (tracheobronchitis, bronchitis) is evidenced by shortness of breath and wheezing, characteristic of bronchial obstruction. Dry deep cough is quickly replaced by unproductive, and then moist with mucous or mucopurulent sputum. Recurrent or persistent unproductive coughing attacks with pain during deep breathing, episodes of hemoptysis are typical for atrophic bronchitis.
Other diseases of the bronchi and trachea
Dry tracheobronchial or bronchial cough can be caused by non-inflammatory causes. In these cases, its occurrence is due to irritation of the bronchial receptor apparatus and tracheal bifurcation due to impaired drainage function or obstruction of the respiratory tract. The symptom is revealed in the clinical picture of such diseases as:
- Williams-Campbell syndrome. Underdevelopment of cartilage tissue contributes to a decrease in tone and dyskinesia of the bronchial wall. Insufficiency of drainage function predisposes to frequent bronchitis, pneumonia. Cough is accompanied by noisy whistling (stridorous) breathing, pronounced shortness of breath, blue nasolabial triangle. Pathology is usually detected in early childhood.
- Bronchoobstructive syndrome. Organic or functional impairment of bronchial patency, in addition to deep unproductive or unproductive cough, is manifested by noisy breathing with prolonged exhalation, attacks of suffocation. Auxiliary muscles participate in breathing: the sternocleidomastoid muscles of the neck are strained, intercostal spaces are drawn in. Children may have apnea attacks.
- Stenosis of the trachea and bronchi. For congenital and acquired narrowing of the trachea, cough-fainting syndrome is typical, in which at the height of an attack of dry barking cough, suffocation with dizziness, loss of consciousness, and the discharge of viscous mucus after an attack is observed. Cough with stenosis of large bronchi is painful, paroxysmal, combined with stridorous breathing with difficulty exhaling.
- A foreign body of the bronchus. If foreign objects accidentally enter the respiratory tract, a protective reflex is triggered, triggering a paroxysmal whooping cough. The patient experiences suffocation, the face turns blue, the voice disappears, vomiting and hemoptysis are possible. A similar mechanism of dry cough development is typical for bronchial adenoma, but the symptoms are not so acute, shortness of breath and stridorous breathing prevail.
An unproductive cough is characteristic of some atypical pneumonia (chlamydial inflammation, respiratory mycoplasmosis, legionellosis), fungal and protozoal processes (candidiasis, cryptococcosis, pneumocystosis), the period of abscess formation in lung abscess. The intensity of a deep cough, the presence and severity of concomitant symptoms (shortness of breath, suffocation, fever, intoxication) depend on the factor that caused the inflammation. From non – inflammatory pathologies with cough attacks occur:
- Diffuse pneumosclerosis. The compaction of the parenchyma due to the proliferation of connective tissue disrupts the normal gas exchange in the lungs. Therefore, in addition to dry cough and thoracic pain, shortness of breath, cyanosis of the skin, rapid fatigue are detected in pneumosclerosis.
- Malignant lung tumors. Cough with hemoptysis and shortness of breath is an early symptom of central lung cancer. In Pancost’s disease, a rough cough occurs against the background of hoarseness of the voice, Gorner’s syndrome, pain in the arm and shoulder, paresthesia in the hand on the side of the lesion, compression of the superior vena cava.
- Acute atelectasis of the lung. The appearance of a deep cough is preceded by a sharp pain in the affected half of the chest. There is increasing shortness of breath, cutaneous cyanosis. The patient’s pulse quickens and blood pressure drops. Typically, the lag of half of the chest in breathing.
- Lung damage. A deep cough with weakness, fever, expiratory dyspnea develops with radiation pneumonitis, complicating radiotherapy of oncopathology. The symptom first bothers episodically during exercise, then constantly and at rest.
- Antisynthetic syndrome. The main pulmonary manifestations of fibrosing alveolitis in dermatomyositis are deep cough and shortness of breath. Most patients are characterized by a combination of symptoms with fever and Raynaud’s phenomenon (pallor and cyanotic fingers).
- Histiocytosis X . The peculiarity of dry cough in people suffering from pulmonary eosinophilic granuloma is its persistent, persistent nature. The patient is also concerned about thoracic pain, difficulty breathing. Possible damage to the skin, liver, spleen, lymphadenopathy.
Cough without sputum can precede acute conditions and serve as an initial sign of some lung diseases. The symptom is observed in the prodrome of pulmonary edema, combined with rapid breathing, a feeling of tightness in the chest, dizziness. The periodic appearance of a deep dry cough, shortness of breath under stress is characteristic of the first stage of pulmonary cystic fibrosis, which can last up to 10 years.
Some of the receptors that initiate the cough reflex are located in the pleura. Therefore, pathological processes involving the serous lining of the lungs, as a rule, occur with an unproductive cough. The symptom is often combined with chest pains that increase during breathing, shortness of breath, cyanotic skin and mucous membranes, fever, intoxication. The appearance of a deep cough without sputum is typical for dry and serous pleurisy, including tuberculosis origin. The appearance of the symptom is also facilitated by:
- Benign tumors of the pleura. The growth of volumetric neoplasms is accompanied by dry cough, shortness of breath, thoracic pain, subfebrile fever, exudation into the pleural cavity. Intercostal neuralgia is possible.
- Malignant pleural neoplasia. More quickly, such symptoms progress with pleural metastases and pleural cancer. The pain is excruciating, radiating into the shoulder blade, the upper arm. Gorner’s syndrome is detected early, the superior vena cava is compressed.
- Pneumothorax. Activation of the cough reflex occurs with traumatic excitation of pleural receptors in patients with pneumothorax. In addition to a cough attack, there is a sharp thoracic pain, shortness of breath, cyanosis or pallor of the face, panic fear of death.
Sometimes the cause of an unproductive deep cough is the reactive excitation of pleural receptors during inflammatory and volumetric processes that occur in the abdominal organs adjacent to the diaphragm. The symptom is described in the clinic of a subdiaphragmatic abscess, spleen cysts, although other signs of these pathologies are leading in such cases.
Diseases of the esophagus
Excitation of tracheobronchial tree receptors is observed due to their compression in patients suffering from epibronchial diverticula of the esophagus. With large protrusions, night coughing is supplemented by dysphagia, belching undigested food and air, nausea, bad breath. Esophageal cancer is characterized by a combination of progressive dysphagia, dry cough, a feeling of pain and a “lump” behind the sternum, exhaustion due to malnutrition.
Volumetric formations of the mediastinum
Compression of the bronchi, provoking coughing, occurs with lymphoma and other mediastinal tumors, mediastinal cysts, aortic aneurysm. After the stage of asymptomatic course, such diseases are manifested by thoracic pain of varying intensity, signs of compression of other organs of the chest – attacks of deep coughing, dysphagia, shortness of breath. Headaches and dizziness are possible due to a violation of the venous outflow from the head with the pressure of the volume formation on the superior vena cava.
In dilated cardiomyopathy and coelomic cysts of the pericardium, the leading cause of dry chest cough is the reaction of compressed bronchi. Diseases occur with the presence of discomfort, pain in the precardial region, palpitations, interruptions, shortness of breath, against which a dry cough periodically appears. In pericarditis and postinfarction syndrome, the pleural reaction plays a key role in the implementation of the cough reflex. Coughing appears against the background of shortness of breath, moderate or severe chest or thoracic pain.
An unproductive cough manifests a number of occupational diseases in which the bronchi and lungs are affected — silicosis, silicatoses, berylliosis. At the beginning of the disease, dry coughing is usually noted, which is gradually replaced by an increasing cough and is aggravated by shortness of breath, chest pain, fatigue, signs of respiratory failure. Occupational pathology develops in patients who inhale dust with silicon dioxide and silicates, beryllium vapors, smoke with its compounds for a long time. In the latter case, severe acute course with conjunctivitis and hyperthermia is possible.
The causes of a deep paroxysmal cough with allergic lesions of the bronchi and lungs are bronchospasm, swelling and hypersecretion of the mucosa when ingested by allergens to which the body is sensitized. A distinctive feature of a cough episode is the occurrence against the background of suffocation or shortness of breath. Often, at the end of the attack, the patient expectorates a small amount of viscous mucosal sputum. The development of a deep allergic cough is noted in such pathological conditions as:
- Asthmatic bronchitis. Obstruction of the medium and large bronchi due to an allergic reaction of an immediate or delayed type causes attacks of dry cough with noisy labored exhalation and expiratory shortness of breath. The disease is provoked by inhalation of dust, fluff, pet hair, plant pollen, in a number of patients it serves as a manifestation of food, vaccine, drug allergies or is a consequence of respiratory infections.
- Bronchial asthma. Cough of asthmatic origin usually proceeds paroxysmally and is combined with other signs of bronchial obstruction — wheezing audible at a distance, expiratory shortness of breath, occasional suffocation. Dry cough, along with nasal congestion, itching, anxiety and sleep disorders, serves as a harbinger of an attack. Asthmatic suffocation itself is accompanied by an unproductive cough with scanty viscous sputum.
- Allergic alveolitis. Atopic lesion of the alveoli and interstitial lung tissue is characterized by a clinical picture of inflammation. Allergic alveolitis is often preceded by prolonged massive contact with the allergen. The appearance of increasing shortness of breath and dry cough is typical for the acute and subacute course of the disease. The symptom manifests against the background of fever, chills, headaches, general malaise, reminiscent of the symptoms of SARS.
- Schistosomatid dermatitis. The allergic component is leading in the development of unproductive deep cough with repeated parasitic skin lesions as a result of the introduction of schistosome larvae living in natural reservoirs. The appearance of cough attacks with fever and headaches contributes to the sensitization of the body after the previous invasion. The symptom is observed against the background of typical skin lesions — urticaria, itching, red spots and nodules, edema.
Diagnosis of the causes of deep dry cough is usually handled by a therapist or family doctor. According to the indications, consultations of specialized specialists are appointed. The initial examination is aimed at assessing the condition of the lower respiratory tract, with the defeat of which the symptom is most often determined. The primary recommended methods of examination are:
- X-ray examinations. Usually, fluorography or an overview radiography of the lungs is performed as a screening. X-ray diagnostics allows you to detect inflammatory changes, malformations, signs of systemic processes, volumetric formations in the mediastinum, chest.
- Express diagnosis of tuberculosis. It is prescribed for prolonged causeless cough, the presence of information about contacts with patients with tuberculosis infection, the patient’s belonging to risk contingents. A tuberculin test or a molecular genetic test is indicated.
- Serological studies. Due to the absence or scanty volume of expectorated sputum, microbiological seeding is usually ineffective. Therefore, in order to exclude a possible infectious process, RIF, ELISA, and PCR diagnostics are more often performed.
A general blood test is performed to detect acute bacterial inflammation, in which ESR increases, leukocytosis is noted, the leukocyte formula shifts to the left, as well as allergic processes occurring with eosinophilia. At the next stages of diagnosis, additional pulmonological examination methods are often prescribed (bronchography, bronchoscopy, examination of the function of external respiration, ultrasound of the pleura and mediastinum, tomography of organs located in the chest, etc.), allergy tests.
The periodic occurrence of attacks of deep dry cough or its persistence for 5-7 days, especially in combination with subfebrile or high fever, other respiratory disorders (shortness of breath, suffocation), thoracic pain is a serious reason to seek qualified medical help. Self-medication in such cases is unacceptable. The patient is recommended to limit motor activity, and in case of fever and poor health, observe bed rest.
It is important to ensure regular ventilation and sufficient humidification of the air in the room. Before identifying the causes of a deep cough, to alleviate the symptom and relieve intoxication, it is recommended to drink copious compotes from dried fruits, fruit drinks from fresh berries, juices, warm tea. It is effective to use warm alkaline drinks — non-carbonated mineral water, warmed milk with a small amount of soda. If there is a reasonable suspicion of whooping cough, a sick child or adult should be protected from bright light, noise, and other irritants.