Metallic or barking cough in adults

Specialty: Respiratory.

• brass coughs
• resonant tracheal cough
• ringing cough in adults

Why it occurs

• Severe acute bacterial tracheitis (invasive bacterial infection of the trachea by Staphylococcus aureus or Streptococcus pyogenes that causes the formation of purulent crusts and produces a harsh, strident cough with a metallic resonance)
• Intrathoracic tracheal compression due to mediastinal tumor mass (lymphoma, thymoma or metastases that deform the lumen of the trachea and alter its acoustic resonant properties)
• Vocal fold paralysis associated with glottal asynchrony (failure in complete coaptation of the vocal folds that produces a metallic ringing vibration)
• Inhalation of corrosive toxic vapors with direct damage to the upper tracheal epithelium.

Initial workup

Laryngoscopy and flexible bronchoscopy (direct tracheal inspection); Computed tomography (CT) of the neck and chest with three-dimensional virtual reconstruction; Chest x-ray; Culture of direct respiratory secretions; Spirometry (evaluate upper central airway obstruction pattern).

Standard management

• Dexamethasone — 4-8 mg intravenously every 12 hours to reduce edema of the mucosa of the trachea and larynx
• Ceftriaxone — 2 g intravenously every 24 hours in case of suspected bacterial tracheitis
• Inhalation of warm humid air or nebulization with warm physiological saline to humidify and facilitate the expulsion of dense tracheal crusts.