Post-tussive emesis is vomiting that occurs immediately after a coughing episode. This phenomenon is frequently observed in individuals experiencing intense or prolonged coughing spells. The force and nature of the cough trigger the body’s emetic response, leading to the expulsion of stomach contents.
Understanding the Phenomenon
When an individual coughs intensely, physiological events can lead to vomiting. The forceful contraction of muscles in the chest and abdomen during a strong cough significantly increases intra-abdominal pressure. This elevated pressure can compress the stomach, potentially pushing its contents upward.
Furthermore, intense coughing can stimulate the gag reflex, an involuntary contraction of the throat muscles. This reflex is closely linked to the brain’s vomiting center. Stimulation of this center, from the cough’s intensity or indirectly, can initiate the vomiting process. The body’s reflexes are interconnected, meaning the same muscles and neural pathways involved in coughing also play a role in vomiting.
Common Underlying Causes
Post-tussive emesis is a symptom, often pointing to an underlying cause of the cough. Respiratory infections are frequent culprits, including acute bronchitis, pneumonia, and pertussis (whooping cough). Pertussis is characterized by violent coughing fits often followed by vomiting.
Chronic respiratory conditions also frequently contribute to this symptom. Asthma, including cough variant asthma where coughing is the primary symptom, can cause intense coughing spells that trigger emesis.
Gastroesophageal reflux disease (GERD), where stomach acid flows back into the esophagus, can irritate the airways and lead to a persistent cough. Post-nasal drip, caused by mucus running down the back of the throat, is another common cause of chronic cough that can be severe enough to induce emesis.
Other factors can also cause coughing intense enough to lead to vomiting. These include chronic obstructive pulmonary disease (COPD), certain medications like angiotensin-converting enzyme (ACE) inhibitors, and smoking.
When to Seek Medical Advice
Occasional post-tussive emesis is usually not serious, but certain signs warrant medical attention. Persistent vomiting, especially if it continues for more than two days in adults, 24 hours in children under two, or 12 hours in infants, is concerning. Signs of dehydration, such as excessive thirst, dry mouth, infrequent urination, or dizziness, also require medical evaluation.
Other warning signs include unexplained weight loss. If the vomit contains blood, resembles coffee grounds, or appears green, immediate medical attention is needed. A high fever, severe chest pain, difficulty breathing, or any confusion alongside post-tussive emesis are serious.
Medical advice should be sought if post-tussive emesis occurs in very young infants, individuals with compromised immune systems, or if there is a history of underlying chronic health conditions. These populations may be at higher risk for complications from persistent vomiting or the underlying cause of the cough.
Diagnosis and Management
Diagnosing the underlying cause of post-tussive emesis involves a medical evaluation. A healthcare professional will take a detailed medical history, inquiring about the nature and duration of the cough, associated symptoms, and any existing medical conditions. A thorough physical examination will also be performed to assess respiratory and other bodily systems.
Depending on the suspected cause, various diagnostic tests may be ordered. These can include a chest X-ray to check for pneumonia or other lung abnormalities, laboratory tests to identify infections, or allergy tests if asthma or allergies are suspected. In cases where GERD is considered, an endoscopy might be performed to examine the esophagus and stomach.
Management focuses on treating the specific underlying condition causing the cough, which is the most effective way to resolve the vomiting. For bacterial infections like pneumonia or pertussis, antibiotics are prescribed. If asthma is the cause, bronchodilators or anti-inflammatory medications are used to manage airway inflammation and reduce coughing.
For GERD, antacids or other medications that reduce stomach acid production can help alleviate the cough and subsequent vomiting. Supportive care, such as adequate hydration and managing electrolyte imbalances, is also important, especially if vomiting has been frequent.