Cough

Cough

Free Ebook Chapter on Cough

Cough is a protective response that clears the airways of secretions and mucus. It is the fifth most common reason for people to visit their doctor.

Cough is broken down into acute (less than three to four weeks) or chronic (longer than three to four weeks). The cause of cough is important to determine and can be variable depending on whether the cough is acute or chronic.

Cough is not a disease, but a symptom from another problem.

Bonus: How to Evaluate an Acute Cough

Free Cough Worksheet

What causes cough

The following is a list of causes of cough and some points about that particular cause.

Viral upper respiratory tract infections are associated with runny nose, sore throat and feeling run down.
Postnasal drip is common due to a cold, sinus infection or allergies.
Bronchitis is an acute inflammation of the breathing passages.
Chronic bronchitis exacerbation is similar in presentation to acute bronchitis but it occurs in a patient with known chronic bronchitis.
Pneumonia will usually present with a fever and productive cough. A virus or bacterium most commonly causes pneumonia. It is uncommonly caused by a fungus or food/drink going into the lung in a condition called aspiration pneumonia.
Pulmonary embolism is a blood clot in the lung and is a rare cause of cough. It may present with chest pain, cough and shortness of breath.
Congestive heart failure is another uncommon cause of cough in the adult. Heart failure is a condition where the heart does not pump out enough blood and fluid backs up into the lungs. This extra fluid in the lungs will sometimes make a person cough.
Foreign body, though not common in the adult, will result in a cough

Chronic cough common occurs due to:

Postnasal drip from allergies or a chronic sinus infection may cause of chronic cough.

Pneumonia can cause chronic cough. This is most typical with a type of pneumonia called atypical pneumonia. Atypical pneumonias (commonly known as walking pneumonia) are caused by certain types of bacteria that can go undetected (or misdiagnosed as a viral illness) for an extended period of time.

Chronic bronchitis can cause cough and it is diagnosed when an individual has a cough that persists more than 3 months in two consecutive years when no other cause has been found. This is common in those who have a long history of smoking.

Post upper respiratory tract infection often leads to a chronic cough that may persist for weeks to months after an infection.

Acid reflux can irritate the respiratory tract and cause coughing. A natural solution to heart burn can be found at: Heartburn No More. It is a holistic system to naturally cure heartburn and improve quality of life.
Medications have the potential to cause cough. A class of blood pressure medications called angiotensin converting enzyme inhibitors is a common culprit of cough. The cough can occur form days to months after the medication is started.

Asthma is usually associated with wheezing, but a cough variant asthma presents with only coughing.

Tumors are an uncommon cause of cough, but should be suspected if there is fever, weight loss and night sweats.

Tuberculosis is another rare cause of cough and should be suspected when there is fever, weight loss, night sweats and blood in the mucus.

Fungal infections rarely cause chronic cough, but should be considered in those who have recently traveled to a place that is known for their fungal infections such as the southwest United States.

Excessive earwax or a foreign body in the ear can irritate a nerve in the ear that can lead to cough.

Psychogenic cough is basically a cough that is in your head.

The reason that all of these causes were discussed was because, determining the cause of the cough is more important than trying to stop the cough.

The most common cause of an acute cough in a child is an viral upper respiratory tract infection. Other common causes of acute cough include: pneumonia and foreign body. The younger child may be afflicted with bronchiolitis (better know as RSV) and croup.

Chronic cough is most commonly caused by asthma. Other common causes of chronic cough in the child include: acid reflux and post-nasal drip – often from allergies. Other less common causes of chronic cough include walking pneumonia, tuberculosis, foreign body and pertussis (whooping cough).

Who needs to see a doctor

Things to be concerned about

Shortness of breath with cough
Coughing up blood
Weight loss
Risk factors for tuberculosis or HIV (HIV: multiple sexual partners, men who have sex with men, intravenous drug use. Tuberculosis: living in a country where it is common such as Africa, living in close quarters, those in jail or those with HIV).

Red flags

Red flags are things that need to be watched for closely. They indicate that immediate medical intervention is necessary.

Bluish discoloration of the lips or hands
Difficulty breathing or shortness of breath
Looking very sick
Stridor – a high pitched inspiration sound
Cough with drooling or severe anxiety

Treatment

Most cases of cough do not need any fancy treatments. As mentioned most coughs are related to viral upper respiratory infections. Some of the features that indicate more serious infection are highlighted above.

Chest x-ray is often used when there is a red flag above. Chest x-ray is also indicated if pneumonia, tuberculosis, cystic fibrosis or foreign body aspiration is suspected.

Based on the suspected cause of the cough, the patient embarks on a treatment course. If there is no improvement based on the likely cause of the cough, more extensive test may be indicated. For example, if the doctor thinks that post-nasal drip from allergies is he cause of the cough and he prescribes a treatment that does not stop the cough, then diagnostic testing may be indicated

As mentioned earlier, it is important to determine what is causing the cough. Treating a cough is not helpful in most cases.

When discussing cough medicine to treat cough there are two options: suppressing the cough and helping expel the mucus. Expectorants are used to help rid the body of mucus. The OTC expectorants are outlined in table 6. The main OTC product that does this is guaifenesin. While OTC expectorants are very commonly used, their effectiveness is questionable.

Expectorants are most helpful when you are affected with a cough that is accompanied by thick mucus that you are not able to expel. In addition to trying these products when you have thick mucus, make sure you drink plenty of fluid – which will also help thin mucus.

Cough suppression is not generally recommended for children (and usually not adults) with cough. The cough is a built in protective mechanism that serves some very important services. First, it helps clear mucus from the airway. Second, it protects the airway from aspiration of a foreign body. In addition, the cough may help your doctor determine if there is an underlying disease.

The use of cough suppression is not recommended in children as they have proven not beneficial and may even be harmful. Expectorants have also not proven to be effective in children.

In adults the use of over-the-counter cough medicine is mildly effective at best. Products like Robitussin DM and Delsym can be tried, but do not expect dramatic results.

Instead of treating the cough itself, treat the cause. Common causes of cough and their treatment include:

Viral infections of the respiratory tract are treated with nasal saline, rest, increased fluids and cool mist vaporizers.

Allergies are treated with antihistamines and sometimes, nasal steroids.
Asthma is treated with inhaled medications that open op the airway.

Pneumonia is treated with antibiotics.

Most cases of bronchitis are viral and are not related and do not respond to treatment with antibiotics, cough suppression may be tried if there is significant cough that is causing pain or interfering with sleep.

To purchase products discussed in this chapter visit The Drug Store.

Free Cough Worksheet

Cough Medications

Table 6: Expectorants

Mucinex – Mucinex comes in a variety of formulations. Mucinex is guaifenesin, which can be taken 600 mg to 1200 mg every 12 hours. Plain Mucinex is purely an expectorant, which means that it helps remove mucus from the respiratory tract. The pill formulation of this mediation is meant for those over the age of 12 and not recommended for those under 12. It should be taken with a full glass of water. The medication is an extended release tablet that should not be broken, chewed or crushed. It comes in a regular formulation and a maximum strength formulation. The regular formulation allows you to take one or two pills (600 mg per pill), whereas the maximum strength is the same medication but each pill is 1200 mg and you take one pill every 12 hours.

Mucinex DM is a combination production that combines guaifenesin with dextromethorphan. Dextromethorphan is a cough suppressant. Likewise, this medication should not be used in those under that age of 12. It also comes in a regular formulation and a maximum strength formulation.

Mucinex D is another combination product that combines guaifenesin with pseudoephedrine. This mediation provides the expectorant along with a nasal decongestant. It can help not only rid the body of mucus but reduce nasal congestion.

Robitussin syrup is a shorter acting formulation of guaifenesin as it is dosed every 4 hours.

Robitussin DM syrup is a combination of guaifenesin and dextromethorphan. It is a combination expectorant and cough suppressant.

Robitussin CF is a combination of guaifenesin, dextromethorphan and a nasal decongestant.

Guaifenesin comes as a generic formulation 400 mg - which is taken every 4 hours in the adult. A child between the ages of 6 and 11-years-old can take one-half of a tablet every 4 hours and it is not recommended for those under the age of 6.

Mucinex comes in other formulations that are appropriate for children.

Mucinex oral solution comes as guaifenesin 100 mg per 5 ml. It is used in those over the age of 4-years-old and is dosed 50-100 mg every four hours in the child 4-5-years-old; and in children 6-11-years-old it is given 100-200 mg every four hours. It comes in a variety of flavors including grape and berry. The Mucinex oral solution comes combined with a nasal decongestant in Mucinex Cold.

Mucinex mini-melts come in packages that contain 100 mg of guaifenesin.

Table 7: Cough Suppression

Robitussin DM is a product already discussed above. The DM component of the medication is dextromethorphan, which is the cough suppressant.

Dextromethorphan polistirex (Delsym) is an extended release suspension that provides cough suppression for 12 hours. It is dosed for those 12-years-old and older, 2 teaspoons every 12 hours; in those 6-11-years old, one teaspoon every 12 hours; and for those 4-6-years-old, ½ teaspoon every 12 hours. Make sure you read the labeling – some of the Delsym products are not indicated for children.

To purchase products discussed in this chapter visit The Drug Store.

What to do

When affected by a cough, evaluate your symptoms using the worksheet below. The worksheet will help you evaluate your symptoms and help you determine the cause of your cough. Try to treat the cause of the cough. Cough suppression may be tried if there is significant cough that is causing pain or interfering with sleep. The use of an expectorant can be considered if you are affected by thick mucus that you cannot expel. In addition, increase your intake of clear fluids

Bonus: How to Evaluate a Chronic Cough