PAPER

COUGH AND SPUTUM

Supervisior: Samsul Arifin

By:
Syamsiah Chandrawati
(14201.06.14040)

COLLEGE OF HEALTH SCIENCES

HASHAWATY ZAINUL HASAN GENGGONG
PAJARAKAN PROBOLINGGO
ACADEMIC YEAR 2015-2016

CONFIRMATION PAGE
PAPER
COUGH AND SPUTUM
Prepared to Meet Task English.

Witness,
Lecturer

Samsul Arifin, S. Pd

ii

FOREWORD

Thank God we pray worship and praise Allah SWT. Above all his mercy and
blessing. So that we can complete the preparation of this paper, and sholawat and greetings
may always gushing adoration bestowed on the great Prophet Muhammad SAW. The purpose
of this paper is to fulfill the task in STIKES Hafshawaty, we put in the form of a scientific
study entitled "Cough and Sputum and with the completion of the preparation of this paper,
we also do not forget to thank to :
1. KH. Moh. Hasan Mutawakkil Alallah, SH.MM as caretakers boarding Zainul Hasan
Genggong.
2. Ns. Iin Isnawaty Aini, S.Kep., M. Kes. as chairwoman STIKES Hafshawaty Zainul
Hasan Genggong.
3. Ns. Khusyairi, M.Kep. as Chairman of the Prodi S1 Nursing.
4. Samsul Arifin, S. Pd as lecturer teaching English.
5. Ns. Nafolion Nur Rahmat S.Kep. as Lecturer Guardian S1 Nursing Level 2.
There is no hope at all of us except this paper can be useful, make a positive
contribution to all readers, and increase knowledge and insight about the food processing to
the body.
Along with it all, then by all the capabilities we have, we try various ways in
preparing this paper to be easily understood and accepted by the nursing students. We realize
this paper is far from perfect. As a man who has limitations, as the authors of this paper we
apologize if there are errors.

Probolinggo, November 2015

Author

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TABLE OF CONTENTS
Cover.................................................................................................................
Confirmation Page............................................................................................
Foreword...........................................................................................................
Table Of Content...............................................................................................

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CHAPTER 1 PRELIMINARY
1.1 Background.................................................................................................

1.2 Problem Formulation..................................................................................

1.3 Purpose.......................................................................................................

1.4 Benefit.........................................................................................................

CHAPTER 2 DISCUSSION
2.1 Definition of Cough adn Sputum................................................................

2.2 Causes of Cough.........................................................................................

2.3 Effect of Cough...........................................................................................

3.4 Resolving Cough........................................................................................

3.5 Prevention...................................................................................................

CHAPTER 3 CLOSING
3.1 Conclusion..................................................................................................

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3.2 Suggestion...................................................................................................

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BIBLIOGRAPHY

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CHAPTER 1
PRELIMINARY
1.1 Background
While people can generally cough voluntarily, a true cough is usually a reflex
triggered when an irritant stimulates one or more of the cough receptors found at different
points in the respiratory system. These receptors then send a message to the cough center
in the brain, which in turn tells the body to cough. A cough begins with a deep breath in,
at which point the opening between the vocal cords at the upper part of the larynx
(glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved
in breathing press against the lungs, the glottis suddenly opens, producing an explosive
outflow of air at speeds greater than 100 miles (160 km) per hour.
In normal situations, most people cough once or twice an hour during the day to
clear the airway of irritants. However, when the level of irritants in the air is high or when
the respiratory system becomes infected, coughing may become frequent and prolonged.
It may interfere with exercise or sleep , and it may also cause distress if accompanied by
dizziness , chest pain , or breathlessness. In the majority of cases, frequent coughing lasts
one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more
than three weeks it is considered a chronic cough, and physicians try to determine a cause
beyond an acute infection or irritant.
Coughs are generally described as either dry or productive. A dry cough does not
bring up a mixture of mucus, irritants, and other substances from the lungs (sputum),
while a productive cough does. In the case of a bacterial infection, the sputum brought up
in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral
infection it may be clear or white. In the most serious conditions, the sputum may contain
blood.
Formal statistics on coughs are not maintained. Virtually all persons will
experience coughs several times each year throughout their lives. In the majority of cases,
coughs are caused by respiratory infections, including the following: colds or influenza,
bronchitis, a viral inflammation of the larynx, windpipe, and bronchial passages that
produces a bark-like cough in children whooping cough, a bacterial infection
accompanied by the high-pitched cough for which it is named pneumonia, a potentially
serious bacterial infection that produces discolored or bloody mucus, tuberculosis
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(another serious bacterial infection that produces bloody sputumfungal infections, such as
aspergillosis, histoplasmosis, and cryptococcosis).

1.2 Problem Formulation

1.2.1 What is cough?
1.2.2 What is causes cough?
1.2.3 What is effect from cough?
1.2.4 How is resolving cough?
1.3 Purpose
1.3.1

General Purpose
Knowing about cough and sputum.

1.3.2

Spesific Purpose
a. Knowing about causes of cough.
b. Knowing about effect of cough.
c. Explaining how to resolving cough.

1.4 Benefit
1.4.1

For Educational Institutions

a. The creation of the students who know about causes, effect, and resolving of
cough.
b. The creation of the theoretical basis of observation.

1.4.2

For the Nursing Profession

a. The creation of professional health workers.
b. The creation of a sense of comfort in every patient treated.
c. The creation of high intellectual human resources.

1.4.3

For Student
a. Can understand the definition of cough.
b. More knowing the skills and knowledge to analyze information that is not in
the know.
c. Can understand about how to resolving cough.

CHAPTER 2
DISCUSSION

2.1 Definition Of Cough and Sputum

A cough is a forceful release of

air from the lungs that can be heard.
Coughing

protects

the

respiratory

system by clearing it of irritants and

secretions (Thomas F. Boat, 2003).
A cough is a sudden, usually
involuntary, expulsion of air from the
lungs with a characteristic and easily
recognizable sound. Although it is known as the most common symptom of respiratory
disorders, it serves the functions of defending the respiratory tract against noxious
substances and maintaining airway patency by removing excessive secretions from the air
passages. Expectoration or sputum production is the act of coughing up and spitting out
the material produced in the respiratory tract (Coulter DM, 1987).
Sputum is the liquid substance that comes from the respiratory tract when cough.
In addition to mucus, sputum contains many materials that are not visible to the naked
eye. It often consists of bacteria, cellular fragments, blood, ans pus.
2.2 Causes Of Cough
In the majority of cases, coughs are caused by respiratory infections, including the
following:
a. Colds or influenza, the most common causes of
coughs.

b.

Bronchitis,
an
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inflammation of the mucous membranes of the bronchial tubes croup, a viral

inflammation of the larynx, windpipe, and bronchial passages that produces a barklike cough in children whooping cough.

c.

A bacterial infection accompanied by the highpitched cough for which it is named pneumonia.

d.

A potentially serious bacterial infection

that produces discolored or bloody mucus
tuberculosis,

another

serious

bacterial

infection that produces bloody sputum

fungal infections, such as aspergillosis,
histoplasmosis, and cryptococcosis.
e. Allergies: Something in the environment (i.e. dust, smoke, ragweed, pollen, etc) or to a
food or a medicine. In response to the allergy-causing agent, people get drainage
(usually clear drainage) or a "runny nose." Red, itchy eyes may accompany this cough
too. This drainage can run down the back of your throat and cause a "tickle" in your
throat and can produce a chronic cough.
f. Infection: Many people cough when they get a cold, a viral or bacterial infection (i.e.
pneumonia, tuberculosis), or the flu. This cough is usually accompanied by feeling
tired, achy, running a fever, and/or having a runny/stuffy nose with clear or
yellow/green mucous.
g. Irritants: Such as smoking, second hand smoke, chemical irritants.
h. Disease: Tumors in the lung or lymph node involvement in the chest (called the
mediastinum) can cause cough spells.

i. Gastric reflux or heartburn: This kind of cough is usually aggravated by certain foods
(i.e. chocolate, mints, alcohol, and coffee) or by smoking. The cough can also be
worse when one lays down, especially lying down shortly after eating a meal. Lastly,
being overweight can also aggravate these symptoms. Therefore, by losing some
weight you may be able to lessen your heartburn.
j. Environmental pollutants, such as cigarette smoke, dust, or smog, can also cause a
cough. In the case of cigarette smokers, the nicotine present in the smoke paralyzes the
hairs (cilia) that regularly flush mucus from the respiratory system. The mucus then
builds up, forcing the body to remove it by coughing. Post-nasal drip, the irritating
trickle of mucus from the nasal passages into the throat caused by allergies or
sinusitis , can also result in a cough. Some chronic conditions, such as asthma ,
chronic bronchitis, emphysema, and cystic fibrosis , are characterized in part by a
cough. A condition in which stomach acid backs up into the esophagus
(gastroesophageal reflux) can cause coughing, especially when a person is lying down.
A cough can also be a side-effect of medications that are administered via an inhaler. It
can be a side-effect of beta-blockers and ACE inhibitors, which are drugs used for
treating high blood pressure.
2.3 Effect Of Cough
The dynamic effect of a cough is the creation of an airflow velocity, within a
certain portion of the airway, intense enough to shear and dislodge the secretions
accumulated on the mucosal surface. Although coughing may be entirely voluntary, it is
usually a physiologic reflex. As such, it is mediated through a reflex arc made of sensory
receptors, afferent nerve fibers, a center, efferent nerve fibers, and effector muscles.
Cough receptors are considered to be the rapidly adapting nerve endings, which
are also known as irritant receptors. These nerve endings are more plentiful in the mucosa
of the larynx, carina, trachea, and large bronchi, which are readily stimulated by
mechanical or chemical irritants. These are the portions of the airways in which the cough
is most effective in clearing the secretions. The cough receptors have also been
demonstrated or suspected in other sites, including the pharynx, peripheral airways, and
other intra- or extrathoracic sites such as pleura, ear canals, tympanic membrane, and
even the stomach. The vagus is the most important afferent nerve, although the
glossopharyngeal and trigeminal nerves may operate, depending on the receptors
involved. A medullary cough center has been postulated with no proof of its precise
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anatomic location. This "center" is under the influence of the higher voluntary nerve
centers, which may initiate or modify the cough. The efferent nerves are the vagi
(recurrent laryngeals), the phrenic nerves, and the spinal motor nerves of the expiratory
muscles.
The mechanical events involved in a typical cough are rapid successions of:
a) a fairly deep initial inspiration;
b) the tight closure of the glottis, reinforced by the supraglottic structures;
c) the quick and forceful contraction of the expiratory muscles; and
d) the sudden opening of the glottis while the contraction of the expiratory muscles
continues.
The very high intrapulmonary pressure generated during the last two phases results in
a very rapid airflow from the lungs once the glottis is open. In addition, the pressure
difference between the outside and the inside of the intrathoracic airways during phase 4
causes their dynamic compression and narrowing. The combination of a high airflow and
airway narrowing results in the expulsion of an airstream with a linear velocity
sometimes nearing the speed of sound. The blast of air thus produced is capable of
expelling the secretions with a great force. The site and the extent of the dynamic
compression are determined by the lung volumes. With large lung volumes, only the
trachea and large bronchi are compressed; with smaller lung volumes, more distal
airways are also narrowed. With each successive cough without an intervening
inspiration, as seen in patients with chronic bronchitis, lung volumes become smaller, and
the cough becomes effective also in removing secretions from more distal airways. With
the ensuing deep inspiration, the cough restarts with larger lung volumes, and the cycle
repeats itself.
The characteristic explosive sound of coughing results from the vibrations of the
vocal cords, mucosal folds above and below the glottis, and the accumulated secretions.
Variation in sounds of coughing is due to several factors, including the nature and
quantity of secretions, anatomic differences and pathologic change of the larynx and
other air passages, and the force of the cough. Vibrations of coughing also help in
dislodging secretions from the airway walls.
The small amounts of tracheobronchial secretions normally produced are very
effectively handled by the mucociliary clearance mechanism. These secretions are made
up of water, dialyzable substances such as electrolytes and glucose, mucus glycoprotein,

indigenous and transudated proteins, and lipids (surfactant). The mucous glands and
goblet cells are the primary sources of the tracheobronchial mucus. By forming a thin
blanket, the airway mucus covers the ciliated epithelium. Rhythmic vibrations of cilia
propel it toward the pharynx from where it is swallowed, usually unnoticed. A proper
balance between its formation and its clearance maintains a thin protective layer of mucus
for trapping and removing the impurities of the inspired air while preventing the
excessive accumulation of secretions. With an adequate function of the mucociliary
escalator, the cough has no additional benefit in removing the amount of secretions
formed under normal conditions. In pathologic states, however, when the mucociliary
function is ineffective or insufficient because of the quantity or alteration of the physical
properties of secretions, the cough becomes essential for airway clearance.
Although coughing is most effective when the excessive secretions are
accumulated in the large, centrally located airways, it also plays an important role in
clearing the peripheral airways in situations in which there is impaired mucociliary
clearance, as in chronic bronchitis, cystic fibrosis, or primary ciliary dyskinesia (immotile
cilia syndrome). A "milking" effect of coughing on peripheral airways has been suggested
as a mechanism of its action in removing secretions from these sites. This requires
coughing at low lung volumes when the secretions are squeezed out of the small airways
toward more centrally located bronchi.
In addition to the mucus, the expectorated sputum may contain other endogenous
or exogenous materials, including transudated or exudated fluids, various local or
migrated cells, microorganisms, necrotic tissues or cells, aspirated vomitus, or other
foreign particles. Gross appearance and other physical characteristics of the sputum are
the result of its content of these and other materials. Mucous sputum is clear or
translucent and viscous, containing only small numbers of microscopic elements.
Purulent sputum is off-white, yellow or green, and opaque. It indicates the presence of
large numbers of white blood cells, especially neutrophilic granulocytes. In asthmatics,
the sputum may look purulent from the eosinophilic cells. Red coloration, uniform or
streaky, is usually due to its mixture with blood. Carbon particles discolor the sputum
gray (as in cigarette smokers) or black (as in coal miners or with smoke inhalation)
(McCool FD, 1987).
2.4 Resolving Cough

Treatment of a cough generally involves addressing the condition causing it. An

acute infection such as pneumonia may require antibiotics , an asthma-induced cough
may be treated with the use of bronchodilators, or an antihistamine may be administered
in the case of an allergy. Physicians prefer not to suppress a productive cough, since it
aids the body in clearing respiratory system of infective agents and irritants. However,
cough medicines may be given if the person cannot rest because of the cough or if the
cough is not productive, as is the case with most coughs associated with colds or flu. The
two types of drugs used to treat coughs are antitussives and expectorants .
a. Antitussives: Antitussives are drugs that suppress a cough. Narcoticsp rimarily
codeine are used as antitussives and work by depressing the cough center in the brain.
However, they can cause such side effects as drowsiness, nausea, and constipation.
Dextromethorphan, the primary ingredient in many over-the-counter cough remedies,
also depresses the brain's cough center but without the side effects associated with
narcotics. Demulcents relieve coughing by coating irritated passageways.
b. Expectorants: Expectorants are drugs that thin mucus in order to make it easier to
cough up. Guaifenesin and terpin hydrate are the primary ingredients in most overthe-counter expectorants. However, some studies have shown that in acute infections,
simply increasing fluid intake has the same thinning effect as taking expectorants.
c. Decongestant / Alpha/Beta agonist: (acts on certain receptors of the lining of the lungs
and airways causing constriction, and relaxation thus relieving congestion).
Pseudoephedrine - a generic ingredient of various cough preparations.
d. Antihistamines: (Competes with histamine for receptor sites on cells in the lining of
the gastrointestinal tract, blood vessels, and nose, lung and airways, this helps to
decrease symptoms of excessive secretions (ie. runny nose) particularly related to
allergies).

Brompheniramine,

cetirizine,

chlorpheniramine,

diphenhydramine,

fexofenadine, loratadine are generic ingredients of various cough preparations.

Coughs due to bacterial or viral upper respiratory infections may be effectively
treated with botanical and homeopathic therapies. The choice of remedy will vary and be
specific to the type of cough the person has. Some combination over-the-counter herbal
and homeopathic cough formulas can be very effective for cough relief. Lingering coughs
or coughing up blood should be treated by a trained practitioner.

Many health practitioners advise increasing fluids and breathing in warm,

humidified air as ways of loosening chest congestion. Others recommend hot tea flavored
with honey as a temporary home remedy for coughs caused by colds or flu. Various
vitamins , such as vitamin C, or minerals , such as zinc, may be helpful in preventing or
treating conditions (including colds and flu) that lead to coughs. Avoiding of mucusproducing foods can be effective in healing a cough condition. These mucus-producing
foods can vary, based on individual intolerance, but dairy products are a major mucusproducing food for most people.
2.5 Prevention
It is important to identify and treat the underlying disease and origin of the cough.
It is helpful to avoid cigarette smoke and coming in direct contact with people
experiencing cold or flu symptoms. Hands should be washed frequently during episodes
of upper-respiratory illnesses.
a. Nutritional concerns
Persons with coughs should be sure to maintain balanced and healthy diets.
b. Parental concerns
Parents of children under the age of five should closely monitor their children
when they have a cough. Parents of children over five years of age must accept the
fact that their children are likely to acquire coughs and related illnesses from
schoolmates. They should remain vigilant and consider having their children seen by a
physician if the cough does not resolve after five to seven days.

CHAPTER 3
CLOSING

3.1 Conclusion
A cough is a forceful release of air from the lungs that can be heard. Coughing
protects the respiratory system by clearing it of irritants and secretions (Thomas F. Boat,
2003). Coughs are caused by respiratory infections, likes influenza, bronchitis,
pneumonia, tuberculosis, etc. The dynamic effect of a cough is the creation of an airflow
velocity, within a certain portion of the airway, intense enough to shear and dislodge the
secretions accumulated on the mucosal surface.
Cough can be treated with drugs, likes antitussives, and expectorants. Coughing
can also be prevented by cigarrete smoke and coming in direct contact with people
experiencing cold or flu symptoms. Hands should be washed frequently during episodes
of upper-respiratory illnesses. Persons with coughs should be sure to maintain balanced
and healthy diets.Parents of children under the age of five should closely monitor their
children when they have a cough. Parents of children over five years of age must accept
the ,fact that their children are likely to acquire coughs and related illnesses from
schoolmates.

3.2 Suggestion
We must always maintain our health. Including the health of our respiratory system.
Because if the respiratory system have a problem or disease, it can causes cough and
produce the sputum.

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BIBLIOGRAPHY

Boat, Thomas F. 2003. Talipes Chronic or Recurrent Respiratory Symptoms. Philadelphia:

Saunders, pp. 140144.
Coulter DM, Edwards IR.1987. Cough associated with captopril and enalapril. Br Med J.
1987;294:152123. [PMC free article] [PubMed]
Godfrey RC. 1980. Diseases causing cough. Eur J Respir Dis.;61(Suppl 110):5764.
[PubMed]
McCool FD, Leith DE. 1987. Pathophysiology of cough. Clin Chest Med. [PubMed]
http://chemocare.com/chemotherapy/side-effects/cough-and-chemotherapy.aspx
http://www.ncbi.nlm.nih.gov/books/NBK359/
www.healthofchildren.com

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