The upper airway and chronic cough

In the beginning of the study of a patient with chronic cough (TC) should preclude the use of ACE inhibitors for hypertension, smoking, COPD or an alteration in the chest radiograph. Then please note the concept of increased sensitivity of cough reflex, which is usually linked to eosinophilic airway inflammation, gastroesophageal reflux disease (GERD) or binomial rhinitis-sinusitis as stations peripheral stimulation circuit cough. However, in the guidelines for the management of chronic cough, larynx usually probably forget because it is a field of activity of the ORL and guides are usually written by pulmonologists. But in the larynx the cough reflex coexists with the reflection of the closure of the glottis and plays an essential role in protecting the airway during swallowing; also it gives the answer to all kinds of noxious stimuli that reach the lower airway. Thus, it is necessary to consult a specialist in Pneumology so you can make an early diagnosis.

The sensory receptors closure of the glottis and cough are found not only in the larynx and trachea but large bronchi, so it is easy to diagnose cough and dyspnea in patients with larynx problems. There in the larynx is where the largest number of cough receptors, as befits host the primary reflection of the same, in defense of the aspiration to the lower airway.

It is now increasingly recognized in patients with chronic cough existence in their day to day cough triggers only minor as laughing, talking, breathing perfume etc., which directly point to a hypersensitive larynx. The current name of that state is hyperreactivity of upper airway, the consequence of which are either the sudden closure of the glottis or the source of the problem adduction of vocal cords paradoxical, ie when the closing movement of the same is It gives the inspiration, which can provoke dyspnea and chronic cough.

Causes of upper airway hyperresponsiveness

The causes most associated with the hypersensitive state of the larynx, the TC stands as the major symptom, with hoarseness, hoarseness, feeling stuck mucus etc., are allergy or viral infections in their acute stages, but especially , chronic laryngeal mucosa irritation by laryngopharyngeal reflux (LPR) reaching the area.

About the peculiarities of this reflux, acid or acid is now poured a top researcher burden as patients with RLF diagnosed by excessive acidity in the lower esophagus does not show often improving the TC when treated with omeprazole or Similar. Thus, it follows that other agents are not present in the material acid reflux as pepsin or bile acids should have a central role already glimpsed since the active uptake of pepsin on the laryngeal mucosa was discovered. This pepsin can be kept active even though an alkaline pH in the laryngeal medium as can be reactivated by lowering the surrounding pH for any reason and cause severe inflammatory changes thereby in the area.

Laryngeal dysfunction, which acts as informer CT, can trigger two types of lower airway pathologies: 

• Aspirations, to be subsensitive laryngeal mucosa to mechanical stimuli and thus decrease their watchdog role of the glottal entry. 
• Continuous or crisis, in accordance with the states of laryngospasm or paradoxical movement inherent in the laryngeal dysfunction, which can be confused vocal cords breathlessness and are recognized increasingly assiduously as associated with refractory asthmas who do not respond to usual treatment inhaled corticosteroids.

The controversy is served on the processes of lower airway and therefore it is important to study more closely the chronic cough that comes in the door (larynx) of the tracheobronchial tree.