Attacks of dry and wet cough prior to vomiting: causes, diagnosis

A painful condition in which cough comes to vomiting is known to many. Consider the causes of this symptom, the methods of diagnosis, its treatment and prevention.

Many people mistakenly perceive a cough for the disease. In fact, it acts as a protective reflex of the body to a certain pathogen - the virus, harmful microorganisms, the entry of foreign objects into the lungs and the respiratory tract.

According to the International Classification of Diseases of the 10th revision of ICD-10, cough enters the class of XVIII:

R00-R99 Symptoms, signs and abnormalities found in clinical and laboratory studies not elsewhere classified.

• R00-R09 Symptoms and signs related to circulatory and respiratory systems.
  • R05 Cough.

An unpleasant condition is one of the most common manifestations of various diseases, and not just colds. Very often this symptom is not given the necessary attention due to what the disease that provoked it, goes into a chronic form, causing various complications.

There are several types of cough that can cause vomiting:

• Dry - seizures without sputum and expectoration. Most often occurs in the early days of SARS, as well as with tracheitis, laryngitis, pleurisy. Can indicate irritation of cough centers with foreign objects. It occurs with heart defects, diseases of the central nervous system and other pathologies.
• Wet - flowing with the spitting of phlegm. Occurs only with diseases of the respiratory system. By the characteristics of the departing sputum it is possible to judge the nature of the disease.

The defect is divided according to the frequency of occurrence:

• Constant - such attacks do not allow you to breathe normally. This condition is dangerous not only vomiting, but also the risk of stopping breathing, a fainting condition.
• Paroxysmal - is most often observed with such an acute infectious disease as whooping cough.
• Periodic - single seizures, without convulsions, vomiting and convulsions.

Cough can be acute - lasts less than three months. Most often occurs after ARI, ARVI and other viral diseases. And chronic - lasts more than three months and indicates a prolonged pathological course of lung diseases. Also occurs with tumor lesions of the body, heart defects and central nervous system. In any case, the presence of vomiting indicates complications requiring medical intervention.

[1], [2], [3], [4]

Causes of the coughing up vomiting

As a rule, the appearance of coughing attacks is associated with catarrhal diseases. The causes of coughing up to vomiting largely depend on the severity of the disease state and the characteristics of its course. Such pathologies may provoke such a disorder:

• Influenza diseases, ARVI, ARD - are accompanied by a dry irritating cough. At the first stage, sputum does not go away. Gradually, the cough passes into the moist, perhaps the passage of purulent contents and the appearance of pain in the chest. There is a fever, lethargy, intoxication of the body, migraine attacks and of course vomiting.
• Bronchitis (acute, chronic) - both forms are accompanied by a strong moist cough with the withdrawal of watery mucus. Seizures often occur in a cold or dusty room, vomiting may occur in the morning.
• Inflammation of the lungs - proceeds with deep coughing attacks, fever and pain in the lungs. Convulsive attacks with a contraction of the diaphragm are so strong that vomiting appears with sputum discharge.
• Allergies - the action of the allergen provokes uncontrollable coughing attacks, in some cases with vomiting, runny nose, sneezing and fever. The painful condition is characterized by seasonal exacerbations.
• Tracheitis - a loud cough, fever, general weakness and specific pains in the chest. Attacks begin suddenly, usually after inhaling cold air or smoke. Spontaneous sputum may come off.
• Bronchial asthma - attacks of suffocation and dry cough before vomiting appear in the initial stages of the disease. Pathology can have a seasonal character and manifest allergic reactions.
• Ascariasis - this disease is associated with helminthic invasion, that is, the movement of parasites into the lungs. The patient has painful seizures, reaching for vomiting. Against this background, there is an increased body temperature and skin rashes, intestinal obstruction, painful liver symptoms.
• Tuberculosis - in the first days of the disease there is a slight cough, which quickly progresses. It is possible to not only vomit during coughing seizures, but also blood with mucus. The painful condition is aggravated at night, there is increased sweating and chills. Patients abruptly lose weight.
• Pertussis - is accompanied by severe attacks, which reach vomiting and are periodically interrupted by heavy sighs. Most often, this pathology is diagnosed in children.
• Measles is a painful dry cough with vomiting. The disease occurs with fever, rashes on the skin and mucous membranes.
• Cancer of the lungs - strong and frequent coughing attacks with vomiting, but without raising the body temperature. The patient has worsened overall health, increased weakness, headaches and other painful symptoms.
• Pharyngitis, sinusitis and rhinitis in the chronic stage - these diseases are characterized by painful symptoms in the forehead and cheeks. Also, there is discomfort in the throat and nose.
• Pleurisy is an inflammatory lesion of the serous membrane that surrounds the lungs. It flows with shortness of breath, high fever and pains in the chest.
• Cardiac insufficiency in acute stage - characterized by lack of air, paroxysmal dry cough, reaching vomiting. This symptomatology is typical for mediastinal tumors.
• Diseases of the gallbladder - attacks often occur at night, accompanied by cramps of the lower legs and thighs. Possible increased sweating and rubbing in the eyes.
• Reflux disease - the appearance of a cough is associated with irritation of the esophagus and larynx due to the pellet contents of the stomach. It flows without fever and other symptoms that are with a cold. Discomfort occurs at night, with the horizontal position of the body.

Another possible cause of emetic cough is the accumulation of mucus in the nasopharyngeal cavity. Attacks occur due to the flow of phlegm through the walls of the pharynx. This condition is most often associated with neglected catarrhal diseases.

The disorder occurs in smokers, with occupational diseases and after the use of certain medications. If cough comes to vomiting, you should seek medical help. After a comprehensive diagnosis, the doctor will diagnose and prescribe the appropriate treatment.

[5], [6]

Risk factors

Many pathological processes occurring in the body, can cause attacks of coughing, reaching vomiting. Risk factors for the emetic reflex are most often associated with a decrease in the protective properties of the immune system and the emergence of respiratory / catarrhal diseases:

• OZZ
• ARVI
• Tracheitis
• Bronchitis
• Pneumonia
• Bronchial asthma
• Tuberculosis
• Oncological lesions of the lungs and respiratory system

The factor provoking a painful condition may be insufficient functioning of the cardiovascular system. Frustration is accompanied by a lack of air and a desire to breathe it as much as possible. Another possible risk factor is allergic reactions. When the stimulus is eliminated, the state is normalized.

[7], [8]

Pathogenesis

Coughing with vomiting is a common symptom that indicates cardiopulmonary disorders. Pathogenesis can be arbitrary and reflexive. Attacks have afferent and efferent ways of origin:

• Afferent factors - cough reflex activates the receptors of sensitive endings of the upper laryngeal, glossopharyngeal, trigeminal and vagus nerves.
• Efferent factors - include the recurrent nerve, which regulates the closure of the glottis and spinal nerve endings, responsible for contraction of the abdominal and pectoral muscles.

The mechanism of origin of the cough is directly related to the action of the stimulus followed by a deep breath. After that, the vocal chasm closes, the skeletal muscles contract and the diaphragm relaxes. A high intrathoracic pressure and positive airway pressure are created, which is countered by the voice gap. The pressure causes the narrowing of the trachea and creates a rapid air flow, which helps to remove mucus, sputum, foreign bodies.

Due to dry and violent attacks, a vomiting reflex is activated, provoking a cough with vomiting. Also, rupture of emphysematous areas is possible. If the patient has lesions of bone tissue, convulsive and jerky contractions of the diaphragm can cause a fracture of the ribs. Increased intrathoracic pressure and decreasing venous return to the heart can cause fainting. In this case, the patient is diagnosed with a paroxysmal cough.

[9], [10], [11]

Epidemiology

Irritation of irrational receptors by inflammatory, chemical, thermal or mechanical stimuli leads to the appearance of coughing attacks. Epidemiology indicates that in 90% of cases, inflammatory irritation is associated with viruses and 10% with bacteria. Under certain factors, viral pathology can cause a secondary bacterial infection. Most often, patients detect influenza viruses, entero- and adenoviruses. As for bacterial infections, it is pneumococci, mycoplasma, hemophilic rod.

The mechanical irritants are inhaled tiny dust particles and allergens. Their action leads to an increase in the tone of smooth muscles and the development of bronchial asthma. If there is a squeezing of the respiratory tract, then this indicates a pulmonary neoplasm, a lesion of the bronchi, aorta, mediastinum.

A chemical irritant is the inhalation of gases with a strong odor, for example cigarette smoke, chemical emissions. Thermal irritation is associated with the inhalation of hot or cold air, which burns the airways, causes vomiting.

[12], [13], [14], [15], [16]

Symptoms

The symptoms of coughing up to vomiting depend on the underlying disease and the severity of its course. Most often, this disorder occurs with a dry cough, that is, in the absence of sputum production. In this case, the patient feels tight in the chest, a sore throat, shortness of breath.

Consider the main signs of pathologies that cause vomiting coughing urges:

• Viral infections - fever, dizziness, general weakness.
• Oncology is a long and persistent cough.
• Pertussis - protracted and dry seizures caused by a small aerobic gram-negative cocci Bordetella pertussis.
• Infectious lesions - dry expectoration, which gradually gives way to wet.
• Sinusitis, inflammation of adenoids, rhinitis - protracted seizures with stuffy nose, snoring and suffocation.

The symptomatology of a morbid state depends on the time of day:

• Early morning - coughing seizures occur in smokers, with chronic obstructive pulmonary disease, bronchial asthma, infectious inflammatory lesions and bronchiectasis.
• Evening time - pneumonia, bronchitis.
• Night - bronchial asthma, tuberculosis, tumor lesions.

A loud cough in combination with vomiting attacks is typical for whooping cough. Quiet appears with inflammation, and the soundless is the ulceration of the vocal cords.

[17]

Cough to vomiting in an adult

If a cough is diagnosed before vomiting in an adult, this may indicate such pathologies:

• Influenza and colds.
• Infectious and viral pathologies.
• Disorders from the cardiovascular system.
• Allergy.
• Tuberculosis.
• Cancer of the lungs.

Complaints most often occur in smokers, people working in dusty premises. If the appearance of a cough is associated with an exacerbation of colds, the gag reflex is produced due to irritation of the receptors in the throat wall. Painful symptoms occur mainly in the evening and at night, creating problems with sleep. A muffled cough with vomiting in the morning or on the street indicates an exacerbation of chronic bronchitis.

[18],

Severe coughing before vomiting

Such a symptom as a strong cough before vomiting can occur in both adults and children. But most often it is diagnosed in children, since their centers responsible for cough and vomitive reflexes are very closely located, that is, they have a close connection. At an early age, the immune system does not have time to recover and form, so the body is more susceptible to various diseases.

The main causes of severe coughing with vomiting:

• Perch.
• Acute respiratory viral infections.
• Flu.
• Bronchitis (acute, chronic).
• Pneumonia is chronic.
• Bronchial asthma.
• Pathology of the cardiovascular system.
• Allergic reactions.
• Oncological pathologies (vomiting with blood impurities).

All of the above diseases, in addition to a strong emetic cough, may be accompanied by an increase in body temperature, stools, runny nose and deterioration in overall well-being. The color of sputum and vomiting indicates the nature of the pathology. If there are bloody veins in the vomit, then this condition is typical for tuberculosis, bronchoectatic disease, pulmonary embolism. The presence of high temperature often occurs with exacerbation of bronchitis.

Treatment depends on the severity of the disease, which caused unpleasant symptoms. In particularly neglected cases, patients are shown therapy in a hospital. Patients are prescribed antibiotics and medications that suppress cough reflexes. Also shown is a complex of vitamin preparations and physiotherapy.

Dry cough before vomiting

Reflex response of the body with a sharp contraction of the muscles of the respiratory system is a cough. It can proceed as with the departure of sputum and inflammatory purulent contents, and without. A dry cough before vomiting indicates an attempt by the body to clear the respiratory system of irritants on its surface.

More often the pathological process is caused by such reasons:

• Bronchial asthma - spasmodic attacks that occur in the evening and night. Cough is allergic and may occur with suffocation, pain in the chest and stomach. In especially severe cases, sputum is seen to leave a thick consistency and dark color.
• Pertussis - the disease begins as an ordinary cold, but soon a runny nose and fever go to coughing seizures with vomiting urges. The violation lasts for more than a month, and treatment can take place in a hospital.
• ARVI - a painful condition occurs with inflammatory lesions of the ENT organs (nasopharynx, larynx, pharynx). With the progression of the disorder, it is possible to develop tracheitis, bronchitis, and pneumonia. When bronchitis attacks occur during the day and night, the patient is very difficult to clear his throat.
• The ingress of a foreign object into the respiratory tract is a paroxysmal, painful, vomiting cough that does not go away after taking medications. The state is normalized only after the removal of foreign objects or particles.

In addition to the above factors, dry cough before vomiting occurs with bronchoectatic disease, lung abscesses, bronchial and pulmonary tumors, mediastinal syndrome. Cough with vomiting, runny nose and diarrhea appears with rotavirus, that is, intestinal flu. In this case, painful symptoms last 3-4 days. With proper treatment, the patient's condition quickly normalizes. In any case, if the painful condition persists for an extended period of time, you should seek medical help.

[19], [20]

Cough at night before vomiting

Many diseases with airway damage occur with coughing attacks, which are intensified at night. Cough at night before vomiting often occurs in the horizontal position of the body. The blood supply slows down, and because of the blocked airways, mucus / phlegm penetrates into the pharynx and provokes vomiting.

• Emetic attacks with night coughing are characteristic of dry cough. At the same time, the neck and face are tense, and tears can flow from the eyes. The amount of vomit is small, and vomiting is stopped after cough subsiding.
• If the urge to vomit occurs between coughing, it indicates a wet cough. The disorder is associated with the sputum accumulated in the body, which is not excreted during the night rest. Respiratory tracts are embedded and swollen. Vomiting is due to the fact that the stomach is trying to remove the mucus that got into it and prevents it from functioning normally.

A painful condition can be associated with throwing the contents of the stomach into the esophagus, with dry air in the room or breathing in the mouth, which overdries the mucous membranes.

[21]

Coughing attacks before vomiting

A fairly common symptom, indicating the pathological processes in the body - is a coughing attack before vomiting. The most painful condition is associated with such causes:

• Bronchitis (acute, chronic).
• Inflammation of the lungs.
• Bronchial asthma.
• Helminthiasis.
• Tracheitis.
• Perch.

A strong cough, reaching vomiting, can be observed with colds. So, in ARVI and ARI, there is an increased body temperature, deterioration of general health, headaches. The pathological condition occurs with various types of bronchitis, as well as in contaminated rooms.

If cough comes to vomiting, it causes discomfort and additional pathological symptoms. Especially active sputum is collected at night, when the body is in a horizontal position and normal cleansing of the airways is impossible. The patient may develop fainting and dizziness.

Eliminate attacks of vomiting when coughing can be through abundant warm drinking, proper nutrition and proper rest. Also for treatment, inhalations and additional air humidification are recommended.

[22]

Cough until vomiting in the baby

Such a symptom as a cough before vomiting in a child is associated with the characteristics of the child's body. Pediatricians explain this condition by the fact that children have cough and vomiting centers located side by side and are interconnected. If such symptoms occur, exclude pertussis in the first place. During seizures, the baby tries to clear his throat, but it does not work, his face becomes purple and there are signs of suffocation. In some cases, there is a complication, such as swelling of the vocal cords.

If pertussis as the cause of coughing with vomiting is excluded, then other conditions should be differentiated:

• ARVI
• ENT pathology
• OZZ
• Flu

If the disorder occurs in a neglected form, then this may indicate the development of bronchitis. In this case, the accumulation of thick mucus in the bronchi provokes coughing urges due to the fact that the sputum is not separated and not displayed on the surface of the respiratory tract. With ENT diseases and allergic reactions, mucus accumulates in the nasal cavity, draining along the back wall of the pharynx causes attacks of dry cough and regurgitation.

[23],

Diagnostics of the coughing up vomiting

Cough is a symptom of many diseases, therefore it is very important to establish its etiology. Diagnosis of coughing before vomiting begins with an anamnesis. The doctor asks the patients about:

• Duration of attacks.
• The ratio of the appearance of the disorder and time of day.
• Character and timbre of the defect.
• The presence of fever, rales and other symptoms.

During the examination, the presence of adverse factors that are characteristic of occupational asthma, as well as for such a harmful habit as smoking, is taken into account. At physical examination the doctor estimates a condition of the top and bottom respiratory ways, parenchyma of lungs. Whistling and noisy breathing indicates obstruction of the upper respiratory tract. Whistling wheezing is bronchospasm, and wet wheezing when inhaled in combination with vomiting is bronchitis.

The laboratory diagnostics is compulsory, which consists of the analysis of blood, urine and sputum. Another important stage of the survey is instrumental diagnostics. The patient is given X-rays and CT of chest organs and a number of other procedures. Particular attention is paid to the differentiation of the disease state with similar pathologies. On the basis of a comprehensive examination, the doctor diagnoses and prescribes treatment.

[24], [25], [26]

Analyzes

Cough seizures that go to vomiting are a sign of many diseases, so when they appear, doctors should exclude many diagnoses. Analyzes make it easier to identify the root cause of the disorder, since it allows you to assess the general condition of the body, each organ or system separately.

The main tests for an emetic cough:

• A general blood test - allows you to draw conclusions about the nature of the disease, that is, its viral, bacterial or inflammatory nature. This analysis makes it possible to exclude allergic pathologies and the presence of parasites.
• A blood test for mycoplasmosis and chlamydia. Mycoplasmosis is an infectious disease that occurs according to the type of infection of the upper or lower respiratory tract. Pulmonary chlamydia is a respiratory infection due to the Chlamydia psittaci virus.
• The study of the gas composition of blood - an estimate of the oxygen saturation of blood, the level of carbon dioxide.
• A general urine test is necessary to exclude specific disorders from the kidneys and gallbladder. And also used to compare the results with blood tests.
• Stool analysis - this study is conducted to exclude helminthic invasion, which can provoke a painful condition with coughing and vomiting. Diagnosis is aimed at detecting antibodies to a specific type of helminths.
• Sputum analysis on the microflora - allows you to assess the condition of the lungs and bronchi. With the help of this study, bronchial asthma, bronchitis, pulmonary edema, the presence of foreign bodies in the airways and other pathologies can be identified. It also allows you to determine the sensitivity of the secretions to antibacterial drugs.

Based on the results of the tests, the doctor can draw conclusions about the possible cause of the disease state and, if necessary, assign additional studies.

[27], [28]

Instrumental diagnostics

All patients with coughing attacks are assigned instrumental diagnostics. The survey complex includes such procedures:

• Chest X-ray - allows to confirm or exclude tumor lesions, infections, pathology from the interstitial tissue, basal lymphadenitis.
• Computed tomography - used for suspected bronchiectasis or interstitial lung diseases.
• Spirometry - an estimation of air passableness of respiratory ways and ability of lungs to straightening.
• Fibrobronchoscopy - examination of the bronchial mucosa and evaluation of its cellular composition. This study is prescribed for suspected cancers of the lung and sarcoidosis.
• Bodipletizmografiya - is an evaluation of the function of external respiration. It allows to determine the volume and capacity of the lungs, which is not always detected by spirography.
• Angiopulmonography is the study of pulmonary vessels.
• A biopsy of the lungs is performed when a granule is found in the trachea or bronchi.
• Broncho-provocative test is a spirometry before and after inhalation of a medicinal product that dilates the bronchi. Used to assess the reversibility of constriction of the bronchus.

Instrumental diagnostics is carried out during and after treatment to assess the patient's condition.

Differential diagnosis

Such a symptom as a cough with vomiting is inherent in many diseases. Differential diagnosis can reveal the true causes of the disorder. Differentiation is carried out with such pathologies:

• ARI - coughing attacks have different intensity. At the beginning of the disease, they are dry, that is, without sputum, but as they progress, they become wet. There are catarrhal symptoms.
• Bronchitis - the disease is caused by viral or bacterial pathogens. A couple of days after the onset of the disease, there is abundant phlegm and scattered wet rales. Paroxysmal cough persists for several days, breathing and pulse are frequent.
• Bronchial asthma is a coughing attack caused by contact with an allergen and suffocation. At the end of the attack, there is a discharge of vitreous sputum.
• Influenza pneumonia - occurs on the 5-7th day of the flu, but in patients of childhood can be observed earlier. Characterized by a sharp deterioration in overall health, pronounced intoxication of the body, severe pain in the chest and fever. In the analysis of blood, there is an increased content of leukocytes and a shift of the formula to the left.
• Croupous pneumonia - cough dry and very painful. There is a discharge of sputum rusty color. The temperature is raised, febrile condition, severe pain in the chest, rapid breathing and pulse.
• Tuberculosis of the lung - for this disease is characterized by a morning cough with sputum discharge and painful attacks with the accumulation of fluid.
• Pulmonary edema is a severe shortness of breath, but cough and vomiting temporarily improve well-being.
• Pleurisy is dry - a paroxysmal cough at the beginning of the disease with stabbing pain in the chest. With restraining seizures, severe pain occurs.
• Laryngitis is a strong barking cough that causes irritation of the larynx. It flows with hoarseness and rude voice. Most often it develops due to inflammatory nasopharyngeal lesions.

Pathologies from the cardiovascular system and other internal organs are also taken into account. When differential diagnosis in children, pay attention to the symptoms of whooping cough, stenosis of the larynx, croup and anomaly in the development of the respiratory system.

[29], [30], [31]

Treatment of the coughing up vomiting

The treatment of an emetic cough should be dealt with only by a doctor, self-medication is not permissible. Without timely therapy, the disease can go into a chronic form, cause serious consequences and complications

Complications and consequences

If cough persists for an extended period of time and no medications help to eliminate it, it can cause serious consequences and complications.

Most often, patients face such problems:

• Sleep disturbances.
• Vomiting.
• Fainting and short-term loss of consciousness.
• Pneumothorax.
• Involuntary defecation and urination.
• The formation of the abdominal and pelvic hernia due to a severe cough.
• Suffocation.

This condition requires serious diagnosis and medical care. The most serious consequences and complications occur in pregnant women, especially in the first trimester. Strong tension in the muscles of the abdominal cavity can lead to bleeding and premature birth.

[32], [33], [34], [35]

Prevention

An effective way to prevent the appearance of a severe cough that comes to vomiting to date does not exist. Prevention is aimed at reducing the risk factors for the development of a morbid condition:

• Avoid mass congestion, especially in the period of viral and infectious diseases.
• Refuse from smoking, including passive. Tobacco smoke significantly increases the risk of chronic pathologies from the bronchopulmonary system.
• In time, treat any disease, preventing their transition to a chronic form.
• Follow the rules of hygiene, wash your hands with disinfectants to reduce the risk of infectious diseases.
• Adhere to a full-fledged healthy diet. Eat fruits and vegetables that provide the body with vitamins and minerals necessary for its normal functioning.
• Dress in the weather, especially in the cold season. Try to close your throat, as the common cold is one of the factors in the development of bronchitis and other pathologies with coughing attacks.

In addition to the above preventive methods, it is recommended to undergo an annual vaccination. This is especially true for people of child and retirement age, pregnant women. It will not be superfluous to temper the body to strengthen the immune system.

[36], [37], [38], [39], [40]

Forecast

The condition in which coughing comes to vomiting requires complex diagnosis and treatment. The forecast depends on the reasons that provoked it. The earlier treatment is prescribed, the higher the chances of avoiding all sorts of consequences. If the disorder occurs in chronic form, the prognosis worsens, since there is a high risk of serious complications from many organs and systems.