What is a cough? A cough is a sudden, often involuntary, forceful
release of air from the lungs. The cough reflex is one of the
body's best defence mechanisms. Irritation or obstruction in the
airways activates this reflex, and the strong rush of air helps
clear material from the breathing passages. Coughs are generally
described as either dry or productive. A cough is more helpful if
it is producing and expelling something, such as yellowish pus.
This kind of cough is termed ‘productive’ and usually should not
be suppressed by drugs. Minor irritations in the throat can start
the cough reflex, even though normal mucous/spittle are the only
material to be expelled. This is called a ‘dry’ cough. Mucous from
the nasal passages can drain into the throat and lungs (post-nasal
drip) and trigger the cough reflex. Such coughs are not helpful
and may be treated with cough suppressants. In diagnosing the
cause of a cough, it is important to notice details about the
cough, such as the type of cough, does it bring up mucous or pus,
and so on. A cough that is caused by bronchitis or similar
infection commonly lasts for up to 2 weeks. However, a cough that
persists longer than this should be evaluated by a doctor.
A cough may indicate a serious condition
if:
* blood is accompanied with cough
* it is accompanied by chest pain
* there is difficulty breathing or shortness of breath
* there is also unintentional weight loss
* there is a cough in an infant less than 3 months old
* coughing is accompanied by other symptoms such as fever or
abdominal swelling.
* the cough is producing thick, foul-smelling, rusty or greenish
mucous.
What are the causes?
Smoking (smoke destroys the cells in the lining of the breathing
tubes so that mucous cannot be expelled normally, leading to a
chronic cough). This also includes passive smoking
Common cold, influenza and other viral infections (with yellow or
white mucous) are the most common causes
Drugs (such as ACE inhibitors or expectorants) cause persistent,
dry, non-productive coughs
Stress (if the cough disappears during sleep, then stress may be
the cause)
Allergies
Aspiration
Bacterial infectionsuch as bronchitis, pneumonia, sinusitis or
tracheitis
Viral infection such as bronchiolitis, pneumonia, upper
respiratory infection
Congestive heart failure
Environmental pollution
Gastroesophagul reflux
Postnasal drip
Asthma
Lung cancer
What is the diagnosis?
To determine the cause of a cough, a physician takes the medical
history and performs an exam. Information regarding the duration
of the cough, what other symptoms may accompany it, and what
environmental factors may influence it aid the doctor in his or
her diagnosis. The appearance of the sputum will also help
determine what type of infection, if any, may be involved. The
doctor may even observe the sputum microscopically for the
presence of bacteria and white blood cells. Chest X-rays may help
indicate the presence and extent of such infections as pneumonia
or tuberculosis. If these actions are not enough to determine the
cause of the cough, a bronchoscopy or laryngoscopy may be done.
These tests use slender tubular telescopic instruments to inspect
the interior of the bronchi and larynx.
How can cough be taken care of at home? 1.Increasing
humidity in the air helps relieve coughing. A vapourizer and a
steamy shower are two ways to increase the humidity.
2. Drink extra fluids to help thin secretions and make them easier
to cough up.
3. Glyceryl guaiacolate (guaifenesin) is available without
prescription and may help liquefy the mucous. Drink lots of fluids
if taking this medication.
4. When a cold and a stuffy, runny nose accompany the cough, it is
often caused by mucous dripping down the back of the throat. A
decongestant that opens the nasal passages will relieve this
postnasal drip, and is the best treatment for that type of cough.
5. Decongestants such as phenylephrine, pseudoephedrine or
combinations of these two decongestants are available as
over-the-counter cold medications. Don't give decongestants to a
child under six years of age unless prescribed by the doctor. It
is important to talk to your physician before using any cough
medications for children under two.
6. If you have high blood pressure (hypertension), consult the
doctor before taking decongestants.
7. Coughs due to chronic postnasal drip are probably caused by
either sinus infection or allergy. If allergy is the cause, it is
typically treated by avoiding the trigger (allergen) that is
causing the allergy. In addition, anti-histamines and a steroid
nasal spray are sometimes used to suppress the allergic
inflammation.
8. Dry, tickling coughs can be relieved by sucking on cough
lozenges or hard candy. (However, never give a lozenge or hard
candy to a child under 3 years old because it is a choking
hazard.)
8. Codeine is a very effective cough suppressant, but has some
side effects, can lead to physical dependence and addiction and
requires a prescription.
9. Dextromethorphan (such as in Vick's Formula 44 of Robitussin
DM) is an effective cough suppressant that is available without
prescription.
What is the treatment? Treatment of a cough generally involves addressing the
condition causing it. An acute infection such as pneumonia may
require antibiotics, an asthma-induced cough may be treated with
the use of bronchodilators, or an antihistamine may be
administered in the case of an allergy. Physicians prefer not to
suppress a productive cough, since it aids the body in clearing
respiratory system of infective agents and irritants. However,
cough medicines may be given if the patient cannot rest because of
the cough or if the cough is not productive, as is the case with
most coughs associated with colds or flu. The two types of drugs
used to treat coughs are antitussives (drugs that suppress a
cough) and expectorants (drugs that make mucous easier to cough up
by thinning it).
What is the prognosis? Since the majority of coughs are related to the common
cold or influenza, most will end in seven to 21 days. The outcome
of coughs due to a more serious underlying disease depends on the
pathology of that disease.
What is the prevention?
It is important to identify and treat the underlying disease and
origin of the cough. Avoid smoking and coming in direct contact
with people experiencing cold or flu symptoms. Wash hands
frequently during episodes of upper-respiratory illnesses.
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