Cough

A cough is your body's way of responding when something irritates your throat or airways. An irritant stimulates nerves that send a message to your brain. The brain then tells muscles in your chest and abdomen to push air out of your lungs to force out the irritant.

An occasional cough is normal and healthy. A cough that persists for several weeks or one that brings up discolored or bloody mucus may indicate a condition that needs medical attention.

At times, coughing can be very forceful — the velocity of air from a vigorous cough can approach 500 miles an hour. Prolonged, vigorous coughing is exhausting and can cause sleeplessness, headaches, urinary incontinence and even broken ribs.

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A cough can be caused by several conditions, both temporary and permanent.

Clearing the throat

A cough is a standard way of clearing the throat. When your airways become clogged with mucus or foreign particles such as smoke or dust, a cough is a reflex reaction that attempts to clear the particles and make breathing easier.

Usually, this type of coughing is relatively infrequent, but coughing will increase with exposure to irritants such as smoke.

Viruses and bacteria

The most common cause of a cough is a respiratory tract infection, such as a cold or flu. Respiratory tract infections are usually caused by a virus and may last from a few days to a week. Infections caused by the flu may take a little longer to clear up and may sometimes require antibiotics.

Smoking

Smoking is another common cause of coughing. A cough caused by smoking is almost always a chronic cough with a distinctive sound. It’s often known as “smoker’s cough.”

Asthma

A common cause of coughing in young children is asthma. Typically, asthmatic coughing involves wheezing, making it easy to identify. Asthma exacerbations should receive treatment using an inhaler. It’s possible for children to grow out of asthma as they get older.

Medicines

Some medications will cause coughing, although this is generally a rare side effect. Angiotensin-converting enzyme (ACE) inhibitors, commonly used to treat high blood pressure and heart conditions, can cause coughing. Two of the more common brands are Zestril (lisinopril) and Vasotec (enalapril). The coughing stops when the medication is discontinued.

Other conditions

Other conditions that may cause a cough include:

  • damage to the vocal cords
  • postnasal drip
  • bacterial infections such as pneumonia, whooping cough, and croup
  • serious conditions such as pulmonary embolism and heart failure 

Another common condition that can cause a chronic cough is gastroesophageal reflux disease(GERD). In this condition, stomach contents flow back into the esophagus. This backflow stimulates a reflex in the trachea, causing the person to cough.

Risk factors for developing a chronic cough are:

  • Smoking: Current or former smoking is a major risk factor for chronic cough. This is caused by direct inhalation of cigarette toxins or secondhand smoking (breathing cigarette toxins in the air).
  • Allergies: People with allergies have an increased risk of developing cough when exposed to a specific allergy trigger.
  • Environmental: Some workplaces may have irritants in the air that one can breathe in and cause cough. High pollution areas or using coal for cooking or heating can also increase your risk of cough.
  • Chronic lung diseases: People with asthma, bronchiectasis (enlarged airways), COPD, and previous lung infections with scars are at increased risk of developing cough.
  • Female gender: Women have a more sensitive cough reflex, increasing their risk of developing chronic cough.

Coughing is a symptom. We can classify a cough by its duration (how long it lasts) and by other specific features:

  • Acute cough:               Sudden onset and lasts up to 3 weeks.
  • Sub-acute cough:        Lasts between 3-8 weeks.
  • Chronic cough:           Lasts for more than 8 weeks.
  • Productive cough:       Cough than brings up phlegm.
  • Dry cough:                   Cough that does not bring up phlegm.
  • Nocturnal cough:        Cough that only happens at night.
  • Hemoptysis:                 Coughing blood.

A cough can be the only sign of an illness or it can occur with symptoms of certain diseases of the lung, heart, stomach and nervous system. Some of the symptoms that commonly occur with a cough are:

  • Shortness of breath
  • Decrease in exercise tolerance (easy fatigability)
  • Wheezing or a whistling breathing
  • Runny nose
  • Sore throat
  • Heartburn
  • Weight loss
  • Fever and chills
  • Night sweats
  • Difficulty swallowing or coughing when swallowing

Your doctor will ask about your medical history and perform a physical exam. Your doctor may also order tests to look for the cause of your cough.

However, many doctors opt to start treatment for one of the common causes of cough rather than ordering expensive tests. If the treatment doesn't work, however, you may undergo testing for less common causes.

Imaging tests

  • X-rays. Although a routine chest X-ray won't reveal the most common reasons for a cough — postnasal drip, acid reflux or asthma — it may be used to check for lung cancer, pneumonia and other lung diseases. An X-ray of your sinuses may reveal evidence of a sinus infection.
  • Computerized tomography (CT) scans. CT scans also may be used to check your lungs for conditions that may produce cough or your sinus cavities for pockets of infection.

Lung function tests

These simple, noninvasive tests are used to diagnose asthma and COPD. They measure how much air your lungs can hold and how fast you can exhale.

Your doctor may request an asthma challenge test, which checks how well you can breathe before and after inhaling the drug methacholine (Provocholine).

Lab tests

If the mucus that you cough up is colored, your doctor may want to test a sample of it for bacteria.

Scope tests

If your doctor isn't able to find an explanation for your cough, special scope tests may be considered to look for possible causes.

These tests use a thin, flexible tube equipped with a light and camera. With a bronchoscope, your doctor can look at your lungs and air passages. A biopsy can also be taken from the inside lining of your airway (mucosa) to look for abnormalities.

With a rhinoscope, your doctor can view your nasal passages to look for upper airway causes of cough.

Children

A chest X-ray and spirometry, at a minimum, are typically ordered to find the cause of a cough in a child.

A cough can be treated in a variety of ways, depending on the cause. For healthy adults, most treatments will involve self-care.

Self-treatment

A cough that results from a virus can’t be treated with antibiotics. You can, however, soothe it in the following ways:

  • Keep hydrated by drinking plenty of water.
  • Elevate your head with extra pillows when sleeping.
  • Use cough drops to soothe your throat.
  • Gargle hot salt water regularly to remove mucus and soothe your throat.
  • Avoid irritants, including smoke and dust.
  • Add honey or ginger to hot tea to relieve your cough and clear your airway.
  • Use decongestant sprays to unblock your nose and ease breathing.

Medical care

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

If your cough is likely due to bacteria, your doctor will prescribe oral antibiotics. You’ll usually need to take the medication for a week to fully cure the cough. They may also prescribe either expectorant cough syrups, or cough suppressants that contain codeine.

If your doctor can’t find a cause for your cough, they may order additional tests. This could include a chest X-ray to assess whether your lungs are clear, along with blood and skin tests if they suspect an allergic response. In some cases, phlegm or mucus may be analyzed for signs of bacteria or tuberculosis.

It’s very rare for a cough to be the only symptom of heart problems, but a doctor may request an echocardiogram to ensure that your heart is functioning correctly and isn’t causing the cough.

Difficult cases may require additional testing. A CT scan offers a more in-depth view of the airways and chest, and it can be useful when determining the cause of the cough. If the CT scan doesn’t show the cause, your doctor may refer you to a gastrointestinal (GI) specialist or a pulmonary (lung) specialist. One of the tests these specialists may use is esophageal pH monitoring, which looks for evidence of GERD.

In cases where the previous treatments are either not possible or extremely unlikely to be successful, or the cough is expected to resolve without intervention, doctors may prescribe cough suppressants.

While infrequent coughing is necessary to clear the airways, there are ways you can prevent catching other coughs.

Quit smoking

Smoking is a common contributor to a chronic cough. It can be very difficult to cure a “smoker’s cough.” There are a wide variety of methods available to help you stop smoking, from gadgets such as electronic cigarettes to advice groups and support networks. After you stop smoking, you will be much less likely to catch colds or suffer from a chronic cough.

Dietary changes

A study in the American Journal of Respiratory and Critical Care Medicine found that people who eat diets high in fruit, fiber, and flavonoids are less likely to suffer from chronic coughs. If you need help adjusting your diet, your doctor may be able to advise you or refer you to a dietitian.

Medical conditions

It’s advisable to stay away from anyone suffering from contagious illnesses, such as bronchitis, to avoid coming into contact with germs. You should wash your hands frequently, and you shouldn’t share cutlery, towels, or pillows.

If you have existing medical conditions that increase your chances of developing a cough, such as GERD or asthma, consult your doctor about different management strategies. Once the condition is correctly managed, you may find that your cough disappears, or it may become much less frequent.

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