Patients with cough frequently present to clinicians working in both primary and secondary care. An acute cough, which often follows an upper respiratory tract infection, may be initially disruptive but is usually self‐limiting and rarely needs significant medical intervention. A chronic cough often points towards some underlying lung pathology but many a time it presents as the sole manifestation of some throat pathology as well. Even with a clear diagnosis, cough can be difficult to control and, for the patient, can be associated with impaired quality of life. Any surgery may have some implications on the course of cough for any cause, whatsoever. On the other hand, surgery, per say, may create some situations which lead to a distressing cough.
Acute Cough before surgery
May occur as an exacerbation of chronic underlying lung disease eg. Asthma, COPD or lung fibrosis or an acute viral illness, commonly. The chronic disease should be evaluated in terms of lung function to predict post-operative risk for prolonged ventilation.Any acute viral illness causing distressing cough may entail delaying the surgery for 6 weeks, depending on the assessment of concerned Anaesthesiologist. This is due to the fact that an acute viral infection may make the person more susceptible to the ill effects of anesthetic agents. Another issue regarding the effect of a violent cough in some specific form of surgery like Cataract extraction is the adverse operative outcome due to raised pressure in eyes with every bout. So, the cough needs to get controlled by applying vigorous measures, depending on the cause and extent of cough, in such special cases.
Post- Operative Cough
There could be several causes occurring not very rare in many post-operative cases. The causes may be:
- Effect of Anaesthetic gases
- Laryngeal swelling due to the placement of a plastic tube in airways during any prolonged surgery
- Segmental Lung collapse due to lack of chest wall movement
- Infection in lower airways due to any compromised immune status or pre-existing illness
- Partial damage of a nerve named phrenic nerve in any upper abdominal surgery, causing partial immobility to the diaphragm
Most of the conditions deserve separate attention, but common post-operative measures taken to mitigate cough, are :
- Post-operative deep breathing exercises
- Incentive spirometry
- Chest physiotherapy
- Steam inhalation, mostly for tracheal problems regarding intubation
- Inhaled bronchodilators as and when necessary
- Suitable antibiotics, as needed
Good effect of Cough, post-operatively
Mainly after thoracic and upper abdominal surgeries, Cough-reflex is very important. The natural defence mechanism to clear the airways, is utterly needed in these cases to prevent post-operative pneumonia. The only precaution to be taught is, the patient has to immobilise the operative site with a clinching pillow ,while coughing, to prevent wound dehiscence and other complications.
To summarise, cough as a reflex to clear the airways, is welcome proposition to prevent stasis of secretions and subsequent infection. But, distressing and uncontrolled cough is a real worrisome phenomenon, needing meticulous prevention and control before and after surgery ,to avoid untoward complications.