. 2020 Jun 19;158(5):2058–2073. doi: 10.1016/j.chest.2020.06.012

Table 1.

Cough-Associated Complications

System Category	Complication
Cardiovascular	*Aortic dissection*¹⁴
	Arterial hypotension³^,¹⁵^,¹⁶^,¹⁷^,¹⁸^,¹⁹
	Arrhythmia
	• Bradyarrhythmias with or without heartblock with and without dizziness and syncope⁸^,²⁰^,²¹^,²²^,²³^,²⁴^,²⁵^,²⁶^,²⁷
	• Tachyarrhythmias, atrial, or ventricular²⁸^,²⁹^,³⁰
	*Coronary artery dissection*³¹^,³²
	*Cardiac luxation after pneumonectomy*³³
	*Stress cardiomyopathy*³⁴
	Dislodgement/malfunctioning of intravascular catheters*or other intravascular devices*³⁵^,³⁶^,³⁷^,³⁸^,³⁹^,⁴⁰
	Loss of consciousness³^,¹⁵
	*Pneumopericardium during coronary angiography*⁴¹
Constitutional symptoms	Excessive sweating, anorexia, exhaustion, temperature elevation (various combinations), vomiting⁴²
Dermatologic	Petechiae and purpura⁴³
	Disruption of surgical wounds (sternal and abdominal)⁴⁴^,⁴⁵^,⁴⁶
	*Subcutaneous hematoma not anticoagulated*⁴⁷^,⁴⁸^,⁴⁹^,⁵⁰
	*Subcutaneous hematoma receiving anticoagulation therapy*⁵¹^,⁵²
Ear, nose, and throat	*Arytenoid subluxation with or without obliteration of cricoarytenoid space*⁵³^,⁵⁴
	*Hemotympanum*⁵⁵
	*Thyroid cartilage fracture with phlegmon*⁵⁶
GI	*Esophageal rupture*⁵⁷
	*Gastroduodenal artery pseudoaneurysm rupture*⁵⁸
	Gastroesophageal reflux events⁵⁹
	Gastric hemorrhage after percutaneous endoscopic gastrostomy⁶⁰
	Gastric perforation after upper endoscopy⁶¹
	Hepatic cyst rupture⁶²
	*Laceration of stomach and spleen*⁶³
	Malfunction of gastrostomy button⁶⁴
	Mallory-Weiss tear⁶⁵^,⁶⁶
	Rectal prolapse with rupture of distal colon and evisceration of small intestine through anus and death in an infant⁶⁷
	Small bowel herniation through laparoscopic trocar site⁶⁸
	Splenic rupture⁶⁹^,⁷⁰^,⁷¹^,⁷²^,⁷³
	*Spontaneous retroperitoneal bleed with hematoma*⁷⁴
	*Inguinal or femoral or umbilical or lumbar or abdominal wall hernia*⁷⁵^,⁷⁶^,⁷⁷^,⁷⁸^,⁷⁹^,⁸⁰^,⁸¹
Genitourinary	Inversion of bladder through urethra⁸²
	Urinary incontinence⁷⁷^,⁸³^,⁸⁴^,⁸⁵^,⁸⁶^,⁸⁷
	*Vaginal cuff dehiscence with evisceration of ileal loops*⁸⁸
Musculoskeletal	*Avulsion of lesser trochanter of femur*⁸⁹
	From asymptomatic elevations of serum creatinine phosphokinase to rupture of rectus abdominus muscles with and without hematoma⁵¹^,⁹⁰^,⁹¹^,⁹²^,⁹³^,⁹⁴^,⁹⁵^,⁹⁶^,⁹⁷^,⁹⁸^,⁹⁹^,¹⁰⁰^,¹⁰¹^,¹⁰²^,¹⁰³
	*Diaphragmatic rupture with abdominal content herniation (small bowel and omentum)*¹⁰⁴^,¹⁰⁵^,¹⁰⁶
	*False-positive PET scan uptake in muscle related to cough*¹⁰⁷
	*Intercostal muscle rupture with lung herniation*¹⁰⁸^,¹⁰⁹^,¹¹⁰
	*Lung herniation through rib separations*⁴⁹^,¹¹¹
	*Lung herniation through previous incision*¹¹²
	*Liver, colon, small bowel, omentum, and lung herniation through transdiaphragmatic intercostal separation*¹¹³
	*Intercostal artery rupture and hematoma with or without hemothorax with or without rib fracture*⁴⁷^,¹¹⁴^,¹¹⁵^,¹¹⁶
	*Internal oblique muscle tear with hematoma*¹¹⁷^,¹¹⁸
	*Osteophytes of the ribs*¹¹⁹
	Rib fractures⁴⁷^,⁷⁸^,¹²⁰^,¹²¹^,¹²²^,¹²³^,¹²⁴^,¹²⁵^,¹²⁶^,¹²⁷^,¹²⁸^,¹²⁹^,¹³⁰^,¹³¹^,¹³²^,¹³³^,¹³⁴^,¹³⁵^,¹³⁶^,¹³⁷^,¹³⁸^,¹³⁹^,¹⁴⁰
	*• Costal margin separation with or without rib fracture and diaphragmatic rupture with abdominal visceral herniation into thoracic cavity or abdomen and/or subcutaneously*¹⁴¹^,¹⁴²^,¹⁴³^,¹⁴⁴^,¹⁴⁵^,¹⁴⁶^,¹⁴⁷^,¹⁴⁸
	*• Rib fracture with pseudohernia of abdominal contents*¹⁴⁹
	*• Rib fracture with lung herniation with or without pleural effusion*¹⁵⁰^,¹⁵¹^,¹⁵²^,¹⁵³^,¹⁵⁴
	*Scapula fracture*¹⁵⁵
Neurologic	Acute cervical radiculopathy and disc herniation¹⁵⁶
	*Carotid artery dissection and pseudoaneurysm¹⁵⁷***
	*Carotid artery dissection with stroke¹⁵⁸***
	*Cerebral air embolism causing stroke with and without death*¹⁵⁹^,¹⁶⁰^,¹⁶¹^,¹⁶²
	Cerebral spinal fluid rhinorrhea¹⁶³^,¹⁶⁴
	*Cervicobrachial pain¹⁶⁵***
	Cervical epidural hematoma associated with oral anticoagulation¹⁶⁶
	Cough syncope¹⁷^,¹⁶⁷^,¹⁶⁸^,¹⁶⁹^,¹⁷⁰^,¹⁷¹^,¹⁷²^,¹⁷³^,¹⁷⁴^,¹⁷⁵^,¹⁷⁶^,¹⁷⁷^,¹⁷⁸^,¹⁷⁹^,¹⁸⁰^,¹⁸¹^,¹⁸²^,¹⁸³^,¹⁸⁴^,¹⁸⁵^,¹⁸⁶^,¹⁸⁷^,¹⁸⁸^,¹⁸⁹^,¹⁹⁰^,¹⁹¹^,¹⁹²^,¹⁹³^,¹⁹⁴^,¹⁹⁵^,¹⁹⁶^,¹⁹⁷^,¹⁹⁸^,¹⁹⁹^,²⁰⁰^,²⁰¹^,²⁰²^,²⁰³^,²⁰⁴^,²⁰⁵^,²⁰⁶
	*Cough syncope causing car crash with injuries*¹⁸⁷
	*Cough syncope causing traffic accident*¹⁹¹
	*Cough syncope causing traffic accident with death of pedestrians*¹⁹⁰
	*Cough-induced anoxic cerebral injury in child*²⁰⁷
	*Cough-induced cluster headache*²⁰⁸
	*Cough-induced transient ischemic attack*²⁰⁹
	*Cough-induced nystagmus*²¹⁰
	*Cough-induced recurrence of spinal anesthesia*²¹¹
	*Cough-induced vertigo*¹⁹²
	Cough headache⁷⁷^,²¹²^,²¹³^,²¹⁴^,²¹⁵^,²¹⁶^,²¹⁷^,²¹⁸^,²¹⁹^,²²⁰^,²²¹^,²²²^,²²³^,²²⁴^,²²⁵
	*Cough headache presenting as toothache*²²⁶
	*Cough-induced hemiparesis*²²⁷
	*Cough-induced hemiplegic migraine*²²⁸
	*Cough-induced myxoma embolism causing paraplegia*²²⁹
	Dizziness²³⁰
	Cough-induced seizures¹⁷²^,¹⁷⁶^,¹⁸⁵^,²⁰¹^,²³¹
	Malfunctioning ventriculoartrial shunts²³²
	*Pneumocephalus*²³³
	*Pneumorrhachis*²³³^,²³⁴^,²³⁵^,²³⁶
	*Spontaneous dissection of cerebral arteries*²³⁷
	Stroke due to vertebral artery dissection²³⁸^,²³⁹^,²⁴⁰
	*Stroke due to bilateral carotid artery thrombus formation*²⁴¹
Ophthalmologic	*Extrusion of ocular contents during surgery*²⁴²
	Spontaneous compressive orbital emphysema of rhinogenic origin²⁴³
	*Orbital emphysema compressing the eyeball and the optic nerve*²⁴³
	*Periorbital ecchymosis (Panda sign)*²⁴⁴^,²⁴⁵
	*Subconjunctival hemorrhages*⁷⁷^,¹⁸⁰^,²⁴⁵^,²⁴⁶
	*Retinal detachment*²⁴⁷
	*Subhyaloid hemorrhage*²⁴⁸
	*Suprachoroidal hemorrhage*²⁴⁹^,²⁵⁰
	*Transient blindness*²⁵¹
	*Postoperative Trabeculectomy bleb leak*²⁵²
Psychosocial/quality of life	Fear of serious disease²³⁰^,²⁵³^,²⁵⁴
	Lifestyle changes²³⁰^,²⁵⁴^,²⁵⁵
	Self-consciousness²³⁰^,²⁵⁴^,²⁵⁵
	*Adverse effects on quality of life*⁸⁷^,²⁵⁴^,²⁵⁵^,²⁵⁶^,²⁵⁷^,²⁵⁸^,²⁵⁹^,²⁶⁰^,²⁶¹^,²⁶²^,²⁶³^,²⁶⁴
Respiratory	*Apical lung herniation with tracheal displacement*²⁶⁵
	*Chylothorax*²⁶⁶
	Diaphragmatic rupture with herniation of small intestine or stomach into chest⁶³^,²⁶⁷
	Exacerbation of asthma²⁶⁸
	*Hemothorax*¹¹⁶^,¹⁴⁴
	Herniations of the lung (eg, intercostal and supraclavicular) with and without incarceration²⁶⁹^,²⁷⁰^,²⁷¹^,²⁷²^,²⁷³
	Hydrothorax in peritoneal dialysis²⁷⁴
	*Hydropneumothorax and tension pneumothorax*⁵⁷
	Laryngeal trauma (eg, laryngeal edema and hoarseness)²³⁰^,²⁵⁴^,²⁵⁵^,²⁷⁵^,²⁷⁶
	Pulmonary interstitial emphysema, with one or more of pneumatosis intestinalis, pneumomediastinum, pneumoperitoneum, pneumopericardium, pneumoretroperitoneum, pneumorrhacis, pneumothorax, subcutaneous emphysema, retropharyngeal, paraesophageal air⁴⁹^,¹¹¹^,¹⁶¹^,²³³^,²³⁴^,²³⁵^,²⁷¹^,²⁷⁷^,²⁷⁸^,²⁷⁹^,²⁸⁰^,²⁸¹^,²⁸²^,²⁸³^,²⁸⁴^,²⁸⁵^,²⁸⁶^,²⁸⁷^,²⁸⁸^,²⁸⁹^,²⁹⁰^,²⁹¹^,²⁹²^,²⁹³
	*Rupture of bronchus during bronchoscopy with or without pneumothorax*²⁹⁴^,²⁹⁵
	*Rupture of trachea*²⁸⁷^,²⁹⁶
	Tracheobronchial trauma (eg, bronchitis and bronchial rupture)²³³^,²⁹⁷
	*Transmission of infectious disease*²⁹⁸^,²⁹⁹
Disease transmission	*Transmission of infectious disease*²⁹⁸^,²⁹⁹
Laboratory testing	*False-positive PET scan uptake in muscle related to cough*¹⁰⁷

Modified from Table 1 in Irwin RS. Complications of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(suppl1):54S-58S.¹ Complications that are new since 2006 are given in bold italic type.