LECTURE 4 COUGHING

1. LECTURE 4COUGHING The normal cough pump may be reflexive or voluntary. When a person coughs, a series of actions occur:- 1-deep inspiration occurs. 2-glottis closes and vocal cords tighten. 3-abdominal muscles contract and diaphragm elevates, causing an increase in intra thorasic and intra_ abdominal pressures. 4-glottis opens. 5-explosive expiration of air occurs.

2. Under normal condition, the cough pump is effective to the 7ͭ ͪͭͪ generation of bronchi. (There are total of 23 generation of bronchi in the tracheobroncial tree). Ciliated epithelial cells are present up to the terminal bronchiole and raise secretions from the smaller to the larger airways in the absence of pathology. An effective cough is necessary to eliminate respiratory obstructions and keep the lungs clear. Airway clearance is an important part of management of patients with acute or chronic respiratory conditions.

3. Factors that decrease the effectiveness ofthe coughmechanism and cough pump: Decreased inispiratory capacity because of pain: - As in case of acute lung diseases, rib fractures, trauma to the chest and recent thoracic or abdominal surgery. -Specific muscles weakness that affects the diaphragm or accessory muscles of inspiration as: In cases of high spinal cord injuries and anterior horn cell diseases .

4. - Inability of the patient to forcibly expel air as the result of: - -Spinal cord injury above T ˡ². -Myopathic diseases and weakness such as muscular dystrophy. -Tracheotomy. -Critical illness causes excessive fatigue. -Chest wall or abdominal incisions. -Decreased action of cilia in the bronchial tree secondary to: - -General Anesthesia and intubations. -C O L D. -Smoking.

5. -Increase in the amount or thickness of mucus caused by:- -Cystic fibrosis. -Chronic bronchitis. -Pulmonary infections such as pneumonia. -Dehydration. -Intubations. Teaching an effective cough.- Additional means of facilitating a cough.-