Table 2.

Cough-Associated Complications That Lead to Death

Cough-Associated Complication	Age/Sex	Comorbid Illness	Comment
Death to self and others
Cough syncope in heavy goods-vehicle drivers causing serious traffic accidents resulting in death of two drivers and two pedestrians190	UA, UA	UA	Cough syncope can lead to death for the drivers and others.
Death to self
Cough associated with spontaneous arterial gas embolism in patient with chronic necrotizing pneumonia, bullae, and brain infarct with death from complications160	78 y, M	COPD, smoker, chronic Enterobacter cloacae pneumonia, hypertension, atrial fibrillation, type 2 diabetes mellitus, hypothyroidism, dyslipidemia	Spontaneous arterial gas embolism resulted in brain infarcts and air in the cavernous sinuses, which led to death precipitated by coughing in a patient with preexisting chronic necrotizing pneumonia, blebs, and bullae. Proposed mechanism is likely weakened parenchyma that led to bleb rupture with entrainment of air into the pulmonary veins and left heart.
Paroxysms of cough followed by fainting in patients with asthma (four deaths in the series)173	UA, M (n = 281); F (n = 9) (N = 290)	Case series included patients with emphysema, bronchitis, TB, asthma, laryngitis, bronchiectasis, pneumoconiosis, sarcoidosis	Death reported as unequivocal cause after post-tussive syncope in four cases, which accounted for 1% mortality rate in the collective series included two in the literature and two personal cases
Fatal rectus sheath hematoma102	82 y, F	Polymyositis and related collagen disorders, well controlled with long-term corticosteroids (prednisone 5 mg daily), occult coronary artery disease	Rectus sheath hematoma in one of three patients reported may have been attributed to coughing associated with pneumonia. She was also on thromboprophylaxis with heparin and prednisone for polymyositis. Her course was complicated by a large hematoma, hypotension, and ultimately death.
Cough-induced lung intercostal (8th space) hernia with large abdominal hematoma in patient with COPD exacerbation and death49	73 y, M	COPD, total laryngectomy for laryngeal cancer with tracheostomy	Cough-induced intercostal muscle rupture with lung hernia associated with hematoma of the left chest and abdomen, massive subcutaneous emphysema of the left chest and lumbar region in a patient presenting with an exacerbation of COPD that was improving before the coughing insult, which ultimately resulted in death.
Fatal gas cerebral embolism after heavy coughing while using noninvasive ventilation (bilevel positive airway pressure) for fibrotic lung disease162	78 y, M	Severe restrictive lung disease due to fibrotic remodeling due to TB, MALT lymphoma	Cerebral air embolism precipitated by episodes of severe coughing that led to catastrophic stroke in a patient presenting with hemoptysis treated with left bronchial artery embolization, on noninvasive positive pressure ventilation and ultimately death due to intractable treatment of resistant cough.
Pneumomediastinum in children with cough with a death286	4 y, M	Measles and pneumonia	In a case series of five patients with severe cough, one patient had refractory cough due to measles, bronchopneumonia that resulted in extensive subcutaneous emphysema, pneumomediastinum that ultimately led to progressive decline and death.
Pneumomediastinum secondary to coughing in an elderly patient with emphysema with death due to complications288	96 y, M	Under custodial care in the geriatrics division	In this case series of three patients, the current patient experienced extensive subcutaneous emphysema and pneumomediastinum after an episode of coughing that resulted in progressive decline and death.
Prolapse of the rectum with spontaneous rupture of the distal colon and evisceration of the small intestine through the anus in an infant after a bout of coughing and death due to complications67	4 Mo, F	Low birthweight	Severe bout of coughing putatively resulted in increased abdominal pressure that caused rectal prolapse, spontaneous rupture of visceral colon, and evisceration of the small bowel.
Cough-induced syncope that resulted in death in the setting of cor pulmonale and obstructive lung disease198	61 y, M	Anthracosilicosis, COPD, cor pulmonale, right ventricle myocardial infarction	Cough exacerbated the existing pulmonary hypertension and cor pulmonale as measured by right heart catheterization which led to hypotension, syncope, and ultimately death due to cardiac arrest.

F = female; M = male; MALT = mucosal associated lymphoid tissue; UA = unavailable.