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- What is Cough?
Cough is one of the most common distressing complaints for
which people seek medical care.
Cough is a sudden, forceful, expulsive effort of body in
response to irritation in the airways. When the airway is
exposed to any irritant such as dust, smoke or infection the
cough is automatically initiated. It serves to keep the
airway clear of irritants and phlegm (mucus).
- What are the types of
Cough?
It is possible to recognize two different types of cough on
the basis of their distinctive traits.
Dry cough
The dry, tickly and hacking cough which do not produce any
phlegm (sputum) is called Non-productive or Dry cough.
Usually, it is associated with troublesome tickly and itchy
feeling in the throat.
Common causes of Dry cough include:
- Viral
infections such as common cold and flu
- Dry air
- Smoke
- Sinusitis and
allergic rhinitis (postnasal drip)
- Allergies
- Cigarette
smoking
- Acid reflux
disease (reflux esophagitis)
- Drugs such as
ACE inhibitors (used to treat high blood pressure)
- Exposure to
industrial irritants
- Foreign body
in airways
- Psychogenic
cough
- Cough variant
Asthma
Productive cough
The cough is associated with phlegm or mucus production is
known as Productive cough. Causes of productive cough
include:
- Infection of
airways and lungs (bronchitis, sinusitis, tuberculosis,
pneumonia etc.)
- Chronic lung
diseases e.g. chronic obstructive pulmonary disease (COPD)
- Heart failure
(pink frothy sputum)
- Lung cancer
(sputum mixed with blood)
- When to consult the
doctor?
If you are suffering from severe cough, timely consultation
with the doctor can help in managing the condition better.
Immediately meet the doctor if the cough:
- persists for
more than one week
- is so severe
that it interferes with sleep and daily work
- is causing
difficulty in breathing
- is accompanied
by chest pain
- is associated
with fever or unexplained weight loss
- produces foul
smelling, rusty or greenish phlegm
- is associated
with hemoptysis (spitting of blood)
- is sudden,
violent and associated with a high pitched harsh sound (stridor).
This usually occurs if a person has inhaled a small
object.
- What will your doctor
like to know?
To understand the exact cause and to make a proper diagnosis
the doctor would like to know certain essential points
regarding your cough:
- Is the cough
acute (present for less than 3 weeks) or chronic
(present for more than 3 weeks)?
- Whether the
cough is dry or productive (i.e. associated
with production of phlegm or mucus).
- Is it
seasonal or associated with a whistling sound (wheezing)?
- What time of
the day is it more?
- Is it
associated with fever, weight loss or hemoptysis (spitting
of blood)?
- Any associated
risk factors (such as cigarette smoking or environmental
pollution)
- History of
drug intake such as ACE inhibitors (used to treat high
blood pressure e.g. Captopril, Enalapril)
- What are the
investigations to be done?
After taking a proper symptom history and performing a
physical examination your doctor may recommend the following
investigations to find out the underlying cause of cough.
These include:
- Haemogram
- Sputum
examination.
- Chest
x-ray: specially done in patients with a history of
cigarette smoking or those having symptoms such as fever,
weight loss or hemoptysis.
- X-ray PNS
(Para nasal sinuses) to confirm sinusitis.
- Pulmonary
function test shows airflow obstruction in asthma, chronic
bronchitis and emphysema.
-
Bronchoscopy to look for tumors in the bronchi (air
passage).
- Esophageal
pH monitoring for gastroesopahgeal reflux disease.
- CT scan of
lungs.
- What could be the
possible Complications?
Long, continued and severe cough can cause:
- Fatigue or
exhaustion.
- Insomnia
(disturbed sleep).
- Cough syncope
(brief unconsciousness following cough).
- Bronchospasm
(abnormal narrowing of the bronchi (airway) due to
contraction of the bronchial muscles).
- Urinary or
faecal incontinence (involuntary discharge of urine or
stool respectively).
- Rib fractures
are rare but may be seen in patients suffering from
osteoporosis, multiple myeloma.
- What is the Management?
Generally, coughs are caused by viral illness and
antibiotics usually are not required for treatment in such
cases. Besides, antibiotics may kill beneficial bacteria and
induce resistance.
Further, it is important to note that cough is
only a symptom and not a disease. Therefore, cough can
only be evaluated along with other symptoms to provide a
better picture of the disease.
Management of cough includes:
I. General measures
The best way to control cough is to avoid the triggering
factors.
- Avoid
cigarette smoking.
- Avoid dry
environment.
- Sit in a
non-smoking area.
- Avoid working
in highly polluted areas.
- Take plenty of
fluids.
- Vaporizers may
be used to loosen mucus secretions.
- If you are
taking ACE inhibitors (used to treat high blood pressure
e.g. Captopril, Enalapril), consult your doctor and change
the medication if required.
II. Treatment
Medications need to be given for relief of cough and
treatment of the associated diseases causing the cough.
- Cough
suppressant medications such as dextromethorphan
affords significant relief from irritable, hacking, dry
cough.
-
Antihistamines may be given for allergic conditions
such as allergic rhinitis.
- Cough
expectorants may be used for productive cough.
- Antibiotic
therapy for bacterial infections.
-
Bronchodilators and corticosteroid for asthma.
- Gastro
esophageal reflux disease requires certain dietary
modifications and treatment with H2 Receptors antagonists
(e.g. ranitidine, famotidine etc.) and proton pump
inhibitors (e.g. omeperazole, lanosperazole etc.).
- Surgery
may be required for bronchial tumor.
- Chest
physiotherapy to help clear the mucus in case of
bronchiectasis.
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