Cough

Cough, often mistaken as a disease condition, is a defense mechanism of the body to clear mucus, bacteria, debris, and retained waste from the airways. The symptoms of cough may vary depending on the type of cough and the underlying pathology.

• Whooping sound: If you have a whooping sound while coughing, you may have whooping cough. This condition involves violent bouts of coughing, making it difficult for a person to catch their breath. It is serious and should not be ignored.
• Staccato cough: This type of cough is characterized by repetitive coughs that occur in short outbursts. It is usually a sign of lung or bronchial infection, such as pneumonia.
• Hoarseness of voice: This is a common symptom if the cough has a psychogenic origin or if there is involvement of the laryngeal nerve.
• Cough following exercise: Coughing during or after exercise or intense physical activity is common in asthma patients, often accompanied by wheezing and shortness of breath.
• Itchy and dry throat: An itchy and dry throat during a cough may indicate a bacterial or viral infection. Itchy throat can also be a sign of hay fever or allergies.
• Production of sputum: A cough that produces thick mucus, known as phlegm, may indicate an infection in the lungs or upper respiratory tract.
• Night cough: Conditions such as gastroesophageal reflux disease (GERD) can cause mucus to pool in the throat while lying down, resulting in night coughing.
• Seasonal cough with watery eyes: Dry, cold weather or allergy season can lead to seasonal allergies, causing cough, itchy throat, and watery eyes.
• Dyspnea: Coughing accompanied by dyspnea, or difficulty breathing, is common in patients with asthma, COPD, and other respiratory illnesses.

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There can be numerous causes of cough. Acute or short-term cough usually lasts less than 3 weeks, whereas chronic or persistent cough can last from 3 to 8 weeks. The various causes are discussed below:

I. Causes of Acute or Short-Term Cough

• Acute viral or bacterial upper respiratory infection: Viral infections of the upper respiratory tract, including the common cold, viral laryngitis, and influenza, are the most common cause of cough. In such cases, cough is usually accompanied by fever, sore throat, and runny nose. Cough can also occur due to bacterial infections in certain cases.
• Inhalation of irritants or allergens: Acute exposure to dust, smoke, toxic fumes, mold, pollen, and pet fur can cause inflammation of the upper respiratory tract and initiate coughing.
• Acute rhinosinusitis: In acute rhinosinusitis, there is inflammation and infection of the lining of the paranasal sinuses. This infection can cause mucus to collect at the back of the throat, which may make the throat itch. Some people might frequently cough to try to clear their throats, while others might experience uncontrollable coughing.
• Pertussis or whooping cough: Pertussis, or whooping cough, may cause violent coughing followed by a gasp for air. Pertussis is caused by the bacteria Bordetella pertussis that affects the respiratory tract.
• Lower respiratory tract infections: These are more severe viral and bacterial infections that can affect the airways in cases of bronchitis and even the lungs in cases of pneumonia. They usually cause a deep, persistent cough along with fever.

II. Causes of Chronic or Persistent Cough

The reason behind a chronic cough is more difficult to diagnose and requires evaluation by a cough specialist or a pulmonologist. Possible causes of chronic cough include:

• Upper airway cough syndrome: This is a chronic post-nasal drip that irritates the upper airway, inducing cough.
• Hay fever or allergic rhinitis: Allergic rhinitis is an inflammation of the nasal mucosa secondary to allergic irritation from environmental factors. This results in increased mucus secretion, which may gather in the throat, causing post-nasal drip and subsequent cough. It is usually associated with dry cough, sneezing, and runny nose.
• Chronic sinusitis: Following a bacterial infection, the sinus and nasal mucosa may become irritated and inflamed, resulting in cold-like symptoms and cough over time.
• Chronic bronchitis: Excessive mucus plugging in the airways leads to a cough lasting more than 3 months. Chronic bronchitis is not always of infectious origin but may be caused by past bacterial infections. Smoking is also a significant risk factor for chronic bronchitis.
• Post-infectious cough: During recovery from an infection, cough receptors may become hyperresponsive, inducing cough.
• Gastroesophageal reflux disease (GERD): In GERD, acidic contents from the stomach enter the throat, irritating receptors and causing cough. Cough due to GERD worsens when lying down, as stomach contents travel back to the throat.
• Asthma: In asthma, the immune system becomes hyper-responsive to external factors, leading to inflammation, bronchial hyperreactivity, and intermittent airflow obstruction, resulting in cough.
• Chronic obstructive pulmonary disease (COPD): This chronic inflammatory lung disease causes obstructed airflow from the lungs and is usually associated with smoking. A cough caused by smoking is often chronic in nature, referred to as a smoker's cough.
• Congestive heart failure (CHF): In CHF, the heart's ability to pump blood decreases, resulting in fluid buildup in the lungs and causing cough.
• Intolerance to angiotensin-converting enzyme (ACE) inhibitor medication: A dry cough is a common side effect of ACE inhibitors taken for hypertension.
• Obstructive sleep apnea: In obstructive sleep apnea, the airways become partially or completely blocked for short periods during sleep, raising airway resistance and causing chest and diaphragm spasms, resulting in cough.
• Throat disorders: Conditions such as croup in children cause a distinctive barking cough and a harsh sound called stridor during inhalation.
• Psychosomatic cough: This type of cough has psychological causes, such as anxiety, stress, and depression, and may develop as a habit rather than due to a disease condition.

III. Other Less Common Causes of Cough

• A foreign body: Accidentally inhaled food or other objects can enter the windpipe instead of the esophagus, causing cough.
• Tuberculosis (TB): Symptoms of TB typically include coughing for three or more weeks, along with coughing up blood or mucus, chest pain, or pain with breathing or coughing.
• Lung cancer: Cancer begins when cells in the lung grow uncontrollably and is mostly associated with chronic smokers.
• Cystic fibrosis: This genetic disorder affects the lungs and causes chronic cough.
• Bronchiectasis: This condition involves permanent damage and widening of the airways, leading to excess mucus buildup.
• Pulmonary embolism: In pulmonary embolism, a blood clot travels, usually from the legs, to the lungs, causing sudden shortness of breath along with a lingering dry cough.
• Pneumothorax: A pneumothorax, or collapsed lung, occurs when air leaks into the space between the lung and chest wall, which can be spontaneous or due to injury, medical procedures, or underlying lung disease. Signs include sudden chest pain, dry cough, and shortness of breath.

• Smoking
• Allergies
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Gastroesophageal reflux disease (GERD)
• Congestive heart failure

If your cough is acute, it does not require any diagnosis and can be treated symptomatically. However, if there are any suspected underlying pathologies, then your doctor may recommend the following diagnostic procedures:

• Chest X-ray: A chest X-ray is performed when a cough is severe or if the patient appears extremely ill. A chronic cough may also require diagnostic measures, including a chest X-ray and complete pulmonary function testing.
• Bronchoscopy: Bronchoscopy provides direct visualization of the vocal cords, trachea, and airway passage. This procedure helps rule out the presence of any mass in the vocal cord or throat.
• Blood and skin tests: To determine if your cough is caused by an allergy, your doctor may recommend blood and skin tests for allergies.
• Phlegm or mucus analysis: To diagnose the presence of any bacteria or tuberculosis, phlegm or mucus analysis is recommended.
• Biopsy: A biopsy or bronchoalveolar lavage is required to obtain samples for cytological analysis and to check for the presence of any microbes.
• Echocardiogram: An echocardiogram may be indicated to assess any problems with the heart's functioning that may be causing your cough.
• CT scan: A CT scan of the chest may be indicated for anatomical analysis of the chest region to identify any abnormalities.
• Gastroesophageal studies: Gastroesophageal studies evaluate speech and swallowing activities, aiding in the analysis of aspiration and gastroesophageal reflux.

By knowing what triggers cough, you can easily prevent it. Here are some preventive measures:

• Get vaccinated for flu: If you have seasonal allergies, it is recommended to get a flu shot. Ensure you have received the pneumococcal vaccine if you are 65 or older.
• Wash your hands: Washing your hands is essential to prevent common ailments like cough or cold. It is advised to wash your hands thoroughly before eating or touching your eyes, nose, or mouth. If you do not have access to clean water, carry hand sanitizer while traveling.
• Avoid contact with people who are sick: Just like other common illnesses, wait for at least two weeks after a person has been infected, as they may still be infectious during this time.
• Do not share belongings: Sharing items such as towels or utensils with an infected person can increase the risk of illness. To avoid contracting the disease, do not share personal items.
• Dietary changes: A diet rich in fruits, fiber, and vegetables can help prevent cough and other respiratory conditions while promoting overall health.
• Quit smoking: Smokers are more likely to develop chronic cough, which is often difficult to treat. Various anti-smoking products are available to assist with smoking cessation.

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Most cases of cough are symptomatically relieved with the help of cold and cough medicines. Some of the common treatment measures for cough include:

1. Cough suppressants
   Cough suppressants are used to decrease the intensity of cough by suppressing the cough reflexes. Examples include:
   • Dextromethorphan
   • Levocloperastine
   • Codeine
2. Expectorants and mucolytics
   These are used in cases of excessive mucus secretions, where the main aim is to increase mucus clearance. These are usually prescribed for a wet or productive cough. They work by thinning the mucus in the air passages to make it easier to cough up the mucus and clear the airways. The most commonly used expectorant is guaifenesin.
3. Antibiotics
   If your cough is caused by chronic infectious upper respiratory infections, your doctor may prescribe antibiotic therapy. Amoxicillin clavulanate is the common antibiotic prescribed for cough.
4. Bronchodilators
   The treatment of a chronic cough should focus on the underlying etiology whenever possible. The treatment should be aimed at reducing coughing rather than suppressing the cough. If you suffer from asthma or other bronchoconstriction conditions, bronchodilators may be used for symptomatic relief in emergency situations. Examples of drugs that belong to this class are:
   • Salbutamol
   • Budesonide
   • Doxofylline
   • Montelukast
   • Theophylline

If there are any additional symptoms with cough, such as an allergic reaction or pain on coughing, your doctor may prescribe:

• Antiallergic medications (antihistamines)
• Pain medications (analgesics)

Along with medicines, you can also try certain tips or some simple home remedies to get rid of cough.

• Keep yourself hydrated by drinking lots of fluids like coconut water, fruit juices, or infused waters. Fluids help to thin the mucus, whereas lukewarm liquids like tea or soup can soothe the throat.
• Honey is an excellent remedy for the treatment of cough. For a sore throat, you can mix honey in warm water or simply eat a spoonful of it. Never give honey to children younger than 1 year old as it might contain bacteria harmful to them.
• Gargling with salt or povidone-iodine mixed in water is a simple but effective remedy that helps remove mucus and soothe your throat.
• Elevate your head with extra pillows while sleeping.
• Use a cool mist humidifier in your room or work area, or take a steamy shower to moisten the air. This will help break the mucus buildup.

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A little bit of cough every now and then is normal; however, a persistent cough can indicate a health condition. Acute cough that lasts less than 2-3 weeks may be a sign of acute illnesses such as a cold. In contrast, a chronic cough, which is persistent, may be the result of:

• Asthma
• Bronchitis
• Sinus issues
• Allergies
• Dust, fumes, or occupational pollutants
• Gastroesophageal reflux disease (GERD)

You should not ignore persistent coughs that have lasted more than four weeks and seek medical advice, particularly if it disturbs your sleep or affects your work.

Here are a few remedies for cough other than conventional medicines:

• Thyme leaves contain flavonoids that help relieve sore throat. Boil a few thyme leaves in water and consume the mixture after straining to get relief.
• Peppermint (Pudina) provides relief from sore throat. You can consume it as tea or inhale it by adding a few drops of peppermint oil to boiling water.
• Clove (Lavanga) can be fried in ghee and kept in the mouth for sucking. This preparation is useful for relieving cough.
• Take 60 mg of powdered long pepper (pippali) and 120 mg of rock salt (saindhava lavana), mix it with hot water, and take it twice a day.
• Take 3-6 gm of fruit and root of long pepper (pippali) and dried ginger (shunthi) in equal proportions. Mix this with honey and take twice a day.
• Prepare ghrta, also called ‘ghee,’ from equal parts of black pepper (maricha), ginger (adrak), and raw sugar (sharkara). Take this twice a day in a dose of around 12-24 gm.
• Take 1-3 gm of sitopaladi churna with 4 to 6 gm of honey twice a day.
• Take 300 mg of karpooradi churna along with equal parts of sugar candy, twice a day.
• Consume 14 ml of ginger (adrak) juice with an equal quantity of honey, twice a day.
• The decoction of tamarind (imli) leaves (14 to 28 ml) should be taken with 2 g of rock salt (saindhava lavana) and 500 mg of asafoetida (hing) fried in ghee, twice a day.

If you are dealing with chronic cough, here are a few simple tips that could help you manage your condition without affecting your sleep and work.

• Stay away from allergic triggers: Identify your allergens and avoid them. Stay clear of polluted areas. Dust mites are common allergens.
• Keep your environment clean and dust-free: Wash pillows, curtains, and other upholstery regularly to eliminate dust accumulation.
• Consult a doctor: Any cough lasting more than 3 weeks, especially if associated with fever or other unusual symptoms, requires evaluation by a registered medical practitioner.
• Avoid codeine-containing cough preparations: These can be habit-forming over time. Also, avoid anti-allergy medications in children and the elderly, as they may cause drowsiness.
• Do not self-medicate: Many over-the-counter (OTC) syrups contain a combination of multiple drugs like suppressants, expectorants, and analgesics, which may not be necessary.
• Use a humidifier: Dry air can aggravate cough issues. A humidifier can help maintain humidity in your room. Steam inhalation at home can also be beneficial.
• Gargle with salt water: Mix half a teaspoon of salt with a cup of water. Gargle with this solution 2-3 times a day for relief from cough.
• Use a thicker pillow: It is advisable to use a thick pillow or two pillows to elevate the trunk region, helping to open up the airways.
• Hydrate well: Drinking enough water before bedtime helps clear the throat and loosen mucus.
• Sleep the right way: Sleeping on your back or stomach can worsen symptoms. The best position is to sleep on your side.