Cough

COUGH

Also known as tussis, a cough is a voluntary or involuntary act that clears the throat and breathing passage of foreign particles, microbes, irritants, fluids, and mucus; it is a rapid expulsion of air from the lungs.

Coughing can be done deliberately or as a reflex action. Although coughing can be a sign of a serious illness, more often than not, it will clear up on its own without the need for medical attention.

FAST FACTS ON COUGHS

Here are some key points about coughs.

• Some types of cough only occur at night
• Home remedies can be used to soothe the most coughs.
• Certain germs use coughing to spread to new hosts.
• There is a wide array of potential causes of coughs.
• If the cough is difficult to diagnose, a chest X-ray may be necessary.

There are three phases to a cough:

• Inhalation (breathing in).
• Increased pressure in the throat and lungs with the vocal cords closed.
• An explosive release of air when the vocal cords open, which gives a cough its characteristic sound.

Coughs can be a sign of a disease. Many coughs are caused by infectious diseases, like the common cold, but there are also non-infectious causes.

TYPES OF COUGHS

Coughing occurs as a natural reaction by the body to expel fluid or foreign bodies from the lungs. It is also a reaction to irritations of the respiratory system such as a 'tickle' in the throat or post-nasal drip.

People may not easily recognize it but different causes produce different coughs. Dry cough from a dusty room is different from the cough that results from a cold or flu infection. Listed below are some different coughs, how to recognize them and what they mean:

• Dry Cough

A dry, cough is a cough that is 'non-productive.' (i.e. Does not produce any phlegm or mucus). Dry coughs can be caused by a variety of different conditions including:

Inflammation: As a result of environmental conditions, bacterial or viral infection or sometimes physical strain, the throat and lungs can become inflamed. For example, mucus production may have returned to normal after recovering from a cold or flu, but inflammation in the lungs and throat (sometimes the larynx and tonsils) may produce a dry cough. In the same way, an overuse or strain of the voice which is common in sports commentators, spectators, singers and stage performers, may cause inflammation and a dry cough. Asthma attacks which includes inflammation in the lungs could trigger a dry cough.

Irritation: A tickle in the throat may be caused by an actual foreign body in the nose, throat or lungs. (e.g. Inhaling dust, pollutants or chemical vapors in the air can trigger a cough reflex to expel the irritant from the lungs).

Dry respiratory tissues: When throat or lungs get dried out from cold air, dry air, dehydration, tobacco smoke or low mucus production, they can become irritated. This irritation may produce a dry cough.

The treatment of a dry cough will depend on the underlying cause. Sometimes a drink of water, throat lozenge or humidifier can reduce the irritation and resolve the cough.

Rest and avoidance of any triggers can help the body heal mild inflammations thus eliminating the cause for the cough. For severe inflammation such as an asthma attack, examination and treatment by doctors may be necessary to avoid complications.

• Wet Cough

Also referred to as chesty cough, these coughs are also referred to as 'productive' coughs because they produce mucus. These coughs are, in fact, attempts by the body to expel mucus from the lungs. There are many possible causes of the excess mucus. This could be chest congestion from a cold or flu, pneumonia or even allergies.

The treatment of a wet cough is actually part of treating the underlying cause for the cough. (I.e. reducing the mucus will reduce the coughing). As part of this treatment, expectorants are best to loosen and hydrate the mucus so that it is more easily coughed up.

Often times, cough suppressants are not recommended for wet coughs because they merely suppress the brain's cough reflex so the mucus remains inside the lungs rather than being coughed up. Mucus that sits in the lungs can lead to infections and in extreme cases, pneumonia.

• Whooping Cough

A whooping cough is a more violent cough which causes the lungs to expel too much oxygen that makes one gasp or 'whoop' between coughs. Whooping cough is quite characteristic of pertussis, a bacterial infection, but other conditions can also cause “whooping' cough, these could be:

• Pneumonia,
• Severe asthma attacks,
• Emphysema,
• Chronic obstructive pulmonary disease (COPD), and

Majority of the causes of a whooping cough are grave enough to justify a doctor's examination to diagnose the cause of the cough and prescribe a course of treatment.

A vaccine is available for whooping cough and is even recommended as part of a standard course of vaccinations for children.

• Barking Cough

The barking sound from this cough results from inflammation of the upper airways, particularly the airways surrounding the larynx. A barking cough is also referred to as a croup cough because it is characteristic of croup, a viral infection that causes swelling around the bronchial tubes, trachea, and larynx. Patients have difficulty breathing and develop a severe cough. The inflammation and cough may be so severe that the patient may gasp for air.

Most patients actually recover from croup at home without medical treatment. In more severe cases, doctors may recommend anti-inflammatory medicines such as steroids to reduce the swelling of the airways.

• Burning Cough

Should anyone experience burning in the throat or chest as a result of a cough, they may be coughing up stomach acid. This is a symptom of gastro esophageal reflux disease, also called GERD, acid reflux or heartburn. In this condition, the muscle at the base of the esophagus fails to seal the stomach completely, thus allowing stomach acid to flow up the esophagus.

The stomach acid irritates the esophagus. This irritation is felt as a burning sensation and can trigger a cough that can push the stomach acid up the throat and into the mouth and nose. In severe cases, this irritation and cough may even trigger regurgitation or vomiting.

There are over-the-counter medications that can be used to control GERD. Most of these medications reduce the volume of acid produced by the stomach. Antacids can also neutralize the acid in the stomach so that the acid is less irritating to the esophagus. Cases of GERD that result in regurgitation or vomiting may require a visit to the doctor.

• Phlegmy Coughs

Unknown to most people, phlegm is slightly different from mucus. Mucus is produced by the body to protect tissues from foreign particles and disease-causing microbes and to prevent tissues from drying out. Phlegm is mucus with foreign particles, microbes and immune system cells embedded in it. In other words phlegm is mucus that has completed the job it was secreted to do.

Mucus is clear because it is composed primarily of water. But phlegm can take on many colors that may be indicative of what the body is battling against:

Phlegm that is yellow or green indicates a viral or bacterial infection.

• Pink phlegm results from fresh blood.
• Brown phlegm results from old blood.
• Black phlegm usually results from substances in the lungs from smoke or coal dust.

Bronchitis remains the most common cause of phlegmy coughs. Bronchitis is caused by an infection in the lungs.

Bronchitis will often clear up on its own with proper home care, including drinking fluids and taking expectorants to loosen and hydrate phlegm so it can be coughed up.

• Serious Coughs

Some coughs may be signs of serious problems and may require medical attention from a doctor. Some signs that a cough is serious include:

• Whooping or wheezing sounds
• Gasping or breathing difficulties
• Pale or blue skin signifying lack of oxygen
• Persistent cough that interferes with sleep
• Bloody phlegm or mucus
• High or persistent fever
• Cough that lasts longer than a few weeks
• Frothy pink phlegm

While these symptoms do not necessarily mean a serious illness, they sometimes accompany life-threatening conditions such as pneumonia, congestive heart failure, lung cancer, pulmonary embolism or tuberculosis.

Visiting a doctor for examination and diagnosis would be beneficial towards helping to identify, and eliminate, the cause of the cough.

Different types of coughs can signify different illnesses and conditions as well as the seriousness of the illness or condition. Understanding and recognizing when a cough is serious can help avoid a tragic situation in which the signs of a serious illness are not recognized appropriately.

CAUSES

Some causes of short-term (acute) and persistent (chronic) coughs are listed below.

Short-term coughs

Common causes of a short-term cough include:

• Inhaled smoke or dust
• An upper respiratory tract infection (URTI) that affects the throat, windpipe or sinuses (e.g. a cold, flu, laryngitis, sinusitis or whooping cough)
• A lower respiratory tract infection (LRTI) that affects the lungs or lower airways (e.g. acute bronchitis or pneumonia)
• An allergy, (e.g. allergic rhinitis or hay fever)
• A flare-up of a long-term condition (e.g. chronic bronchitis asthma, or chronic obstructive pulmonary disease (COPD).

In rare cases, a short-term cough may be the first sign of a health condition that causes a persistent cough.

Persistent coughs

A persistent cough may be caused by:

• Smoking (a smoker's cough can also be a symptom of COPD)
• An allergy
• A long-term respiratory tract infection, (e.g. chronic bronchitis)
• Asthma (this also presents other symptoms, such as wheezing, chest tightness and shortness of breath)
• Bronchiectasis (the airways of the lungs become widened abnormally)
• Postnasal drip (mucus that drips down the throat from the back of the nose, especially if it is caused by a condition such as rhinitis or sinusitis)
• Gastro-esophageal reflux disease (GERD), (the throat becomes irritated by leaking stomach acid).

Often times, a doctor won't worry whether a cough is dry or chesty, but will need to know if the patient is producing much more or darker phlegm than usual.

It is very rare for a persistent cough to be a symptom of a more serious condition.

Coughs in children

Coughs in children often have similar causes to the ones mentioned above. For example, respiratory tract infections, asthma and GERD can all affect children.

Causes of coughs that are more common in children than adults include:

• Croup – This causes a distinctive barking cough and a harsh sound (stridor) when the child inhales.
• Bronchiolitis – A less severe respiratory tract infection that usually causes cold-like symptoms
• Whooping cough – Presents symptoms such as intense, bouts of coughing, vomiting, and a 'whoop' sound with each sharp intake of breath after coughing

Occasionally, a persistent cough in a child can be a sign of a serious long-term condition, such as cystic fibrosis.

WHEN TO SEE A DOCTOR

Call a doctor if the cough (or the child's cough) doesn't go away after a few weeks or if it also involves any one of these:

• Experiencing fainting
• Coughing up thick, greenish-yellow phlegm
• Experiencing a fever
• Experiencing shortness of breath
• Wheezing while breathing
• Experiencing ankle swelling or weight loss

Seek emergency care if you or the child:

• Experiences chest pain
• Chokes or vomits
• Has difficulty breathing or swallowing
• Coughs up bloody or pink-tinged phlegm

RISK FACTORS

Any inhaled substance that irritates or obstructs the airways can trigger the cough reflex. Persistent exposure to these substances can lead to cough hypersensitivity in which one become abnormally sensitive to inhaled substances.

Smoking the most common cause and a lifestyle that one can readily change⁠. However, there are other irritants that are just as impactful.

Studies have established that secondhand smoke triggers the cough reflex inappropriately.

There are certain risk factors that can increase one's risk of cough hypersensitivity and, subsequently, the duration and/or severity of a cough.

They include:

• Air pollution
• Uncontrolled asthma
• Smoking (including second-hand smoke)
• Allergies (especially seasonal allergies)
• Industrial fumes, smoke, dust, and aerosolized chemicals

Avoidance can go a long way toward reducing the incidence, frequency, and, severity of a cough.

DIAGNOSIS

The doctor will begin by asking for a detailed medical history and asking about the nature of the cough; times when it gets worse, times when it gets better and if there may be additional symptoms. If the cough presents other symptoms such as fever, chest pains, headaches, drowsiness, confusion, coughing up blood or having difficulty breathing it will likely require further tests.

To help the doctor get a proper diagnosis, it may be a good idea to prepare the following information in advance:

• Whether he/she smokes cigarettes or marijuana?
• Whether he/she inhales vapor created by an electronic cigarette?
• Whether patient is aware of any allergies or cough triggers?
• When did the cough begin?
• Whether or not the cough brings up mucus?
• If there is mucus, what's the consistency and color? If there Is any blood?
• Whether patient has been in close contact with people with any respiratory infections.
• What medical illnesses does the patient have?
• Whether he/she uses drugs?

TREATMENT

Coughs can be treated in many ways, depending on the cause. For healthy adults, most treatments will involve self-care.

At-home treatments

A cough that results from a virus for instance cannot be treated with antibiotics. The symptoms can however be soothed in the following ways:

• Use extra pillows to elevate the head when sleeping.
• Remain hydrated by drinking plenty of water.
• Gargle with warm salt water at short intervals to remove mucus and soothe the throat.
• Avoid irritants like smoke and dust.
• Add honey or ginger to hot tea to relieve the cough and clear the airway.
• Use cough drops to soothe the throat.
• Use decongestant sprays to ease breathing by unblocking the nose.

Medical care

Typically, medical care will involve the doctor looking down the throat, listening to the cough, and asking about any other symptoms.

If the doctor thinks the cough is due to bacteria, he will prescribe oral antibiotics, which will usually be taken for a week to fully cure the cough.

If the doctor finds it difficult to diagnose a cause for the cough, they may order additional tests which can include:

• A chest X-ray to assess whether the lungs are clear
• Blood and skin tests if they suspect an allergic response
• Analysis of phlegm or mucus for signs of bacteria or tuberculosis

It's not common for a cough to be the only symptom of a heart problem, but a doctor may request an echocardiogram to ensure that the heart is functioning correctly.

Complications

Having a persistent cough can be exhausting. Coughing can cause a variety of problems, including:

• Fractured ribs
• Excessive sweating
• Sleep disruption
• Headache
• Dizziness
• Vomiting
• Loss of bladder control
• Passing out

LIFESTYLE AND HOME REMEDIES

Follow the doctor's plan for treating the cause of the cough. In the meantime however, these tips can be useful at home to ease the cough:

• Drink fluids. Liquid will thin out the mucus in the throat. Warm liquids, such as broth, tea or juice, can soothe the throat.
• Suck on cough drops or hard candies - They surely will ease dry coughs and soothe irritated throats.
• Consider using honey - A teaspoon of honey may help loosen a cough. Do not give honey to children age 1 or below because honey can contain bacteria harmful to infants.
• Moisturize the air - Use a cool-mist humidifier or take a steamy shower.
• Avoid tobacco smoke - Smoking or breathing secondhand smoke irritates the lungs and can worsen coughs caused by other factors.