Figure 1 Schematic representation of the anatomy of the cough reflex. This sketch was derived

During vigorous coughing, intrathoracic pressures up to 300 mmHg, expiratory ve­ locities up to 28,000 cm/s or 500 mph (i.e., 85% of the speed of sound), and energies from 1 to 25 J may be generated. While the pressures, velocities, and energies of these magnitudes allow coughing to be an effective means of clearing the airways and providing cardiopulmonary resuscitation, they can also cause a variety of cardiovascular, central nervous system, gastrointestinal, genitourinary, and respiratory complications. While such physical complications have been significantly associated with health-related dysfunction in patients with chronic cough, the health-related dysfunction has been shown to be more commonly psychosocial in nature.