A cough is one of the commonest, yet one of the most annoying symptoms if not treated timely. A cough is also one of the body’s natural defence mechanisms to clear the airways and protect the respiratory tract against infections and foreign bodies.
Cough, although seemingly harmless, is one of the most neglected symptoms considering that it will subside by itself. Cough is not a disease in itself, but it can be a presentation of minor illnesses like common cold to some major, complicated illnesses.
Cough is a multi-faceted symptom making it difficult to understand and treat it accurately. So what is it that makes it so difficult understanding a simple symptom of a cough?
- Cough may be mild and transient, lasting for a few days or it may be persistent and significantly troublesome enough to interfere with regular daily activities of a person like sleep, breathing and other social activities.
- Persistent and chronic cough can also become embarrassing especially at an office setting or during a meeting.
- Cough may be a basic symptom for respiratory tract diseases like bronchial asthma, bronchitis and emphysema. Almost all respiratory tract affections have a basic presentation of cough.
- Cough can be acute and self-limiting or chronic.
- Cough can have some serious effects on the body like syncope from excessive coughing, urinary incontinence, disturbed sleep and fatigue, to name a few.
With so much being said, there is certainly no measure as to how much cough is normal?
As per statistics, a lot of money is spent on medications for a cough and cold more than any other disease.
Studies Done on The Prevalence of A Cough Showed That
- Nocturnal and productive cough was seen more in females than in males.
- A higher incidence of nocturnal non-productive was again seen more in females due to winter, cigarette smoking, asthma, environmental smoke and obesity.
- Among children, environmental smoke, air pollution and inhalation of particulate matter were some of the leading causes for a dry or productive cough.
- Exposure to particulate matter also caused cough with soreness of throat without any evidence of asthma.
- Living in an area of heavy traffic was associated with higher incidences of a persistent cough as compared to living in an area having lighter or no traffic.
- While evaluating the causes of a chronic cough in any community, nearly 25-30% population is found to be cigarette smokers. Nearly 13% individuals had sputum production with a cough every day or half the days in a year.
- Cigarette smokers did not seek treatment for their cough unless the pattern of their cough changed.
Types and Causes of Cough
For the ease of understanding, cough has been divided into
- Acute Cough
- Self Limiting Cough
- Chronic Cough
An acute onset cough which does not resolve for up to 8 weeks is considered as chronic.
Causes For Acute Cough
1. Viral Infections
- Maximum cases of acute onset cough are due to viral infection of the respiratory tract.
- Multiple strains of viral pathogens are responsible for respiratory tract infections. Yet, they all share a common incubation period of 1-4 days.
- Most common viruses affecting the respiratory tract are influenza, para-influenza, rhinovirus, syncytial virus, adenovirus and respiratory coronavirus.
- Since these viruses undergo antigenic shift constantly, there is no specific treatment or vaccine for the ever-changing strains.
- People often do not take treatment for a viral cough and wait for it to subside or resort to self medication.
|Para-influenza||Antigenically more stable as compared to other viruses.
Can cause trachea-bronchitis, croup and severe lower respiratory tract infections among children and infants.
|Respiratory syncytial virus||Responsible for cough in infants.
Infection with this virus usually occurs in epidemics during autumn and early spring.
|Adenovirus||There are more than 1000 serotypes causing syndrome of severe acute cough.|
|Rhinovirus||The virus has more than 100 serotypes.
It causes common cold and is a leading cause for mild upper respiratory tract illness in both children and adults.
|Corona virus||Infection with this virus has a similar presentation to that of rhinovirus.
About 5-10% cases of cough and cold are due to this virus.
Irritation of the respiratory tract due to smoke, chemicals, and animal dander, pollen or air pollutants can produce an acute cough. Cough subsides when the offending agent is withdrawn and adequate treatment is provided for the same.
Infection of a part of the lung or an entire lung can occur due to bacteria, viruses, fungi and even protozoa. Pneumonia can be mild and be resolving to fatal. H. influenza virus and the bacteria Streptococcus pneumonia are the commonest organisms causing pneumonia.
Klebsiella pneumonia, E.coli and Staphyloccocus aureus cause hospital-acquired infections.
Causes For Chronic Cough
- Smoking – Cigarette smoking is the most common identified cause among people having a chronic cough. Cessation of smoking resolves or reduces cough in about 90% of cases.
- Chronic Bronchitis – This condition is defined as having cough with expectoration for 3 consecutive months for more than 3 years.
- Post Infectious Cough – Post viral cough is dry and seldom productive. This cough takes several weeks to even months to subside. Virus induced hypersensitivity of the vagus nerve is the probable cause for post-viral cough.
- Bronchial Asthma – Cough-predominant asthma is a term used to describe the clinical condition of asthmatic airway inflammation along with the symptom of cough. In these patients, the major symptom is of cough with some or all features of bronchial asthma.
- Gastro Esophageal Reflux – In Gastro Esophageal Reflux Disease (GERD), refluxed content irritate the air passages producing cough. Abnormal lower esophageal sphincter tone and high doses of proton pump inhibitors to control this reflux are responsible for chronic cough.
Laryngoscopy reveals a cobblestone appearance of the larynx and pharynx.
- Rhinitis and Sinusitis – Post-nasal drip is reported in about 50% cases of rhinitis and sinusitis.
- ACE inhibitor cough – This type ofa cough is seen in patients who are on ACE inhibitor medications. Cough usually resolves within a week after stopping the medications. Cough is typically dry and tickly.
Other causes for cough are left heart failure, acute exacerbations of Chronic Obstructive Lung Diseases (COPD) and foreign body inhalation.
Habitual cough syndrome is identified in children and young adults. Habitual cough is associated with about 10% of patents having Tourette’s syndrome. Quality of cough in those with a habitual cough can be described as barking.
Some Selfcare Methods Can Help You Treat Cough at Home
- Ginger tea or chewing pieces of ginger.
- Apple cider vinegar with warm water and honey.
- Drink warm fluids like soups, tea, broths to soothe the throat.
- A spoonful of plain honey can be had. It creates a smooth layer in the throat and relives cough and throat irritation.
- Warm water with lemon and honey is known to cleanse the lymphatics.
- Warm milk with turmeric is a well known antiseptic.
- Gargle with warm saltwater to get rid of and to prevent build up of infection.
When To Go to The Doctor for Cough?
Although it is not possible to define a “normal cough”, the medical science has come up with few parameters to measure the severity, frequency and intensity of a cough. So if you are wondering when to go to the doctor for cough, the following parameters may help you to assess yourself and understand the need of seeking medical help
- Frequent coughing interfering with daily activities
- Distressing cough most of the days
- Frequent waking at night due to cough
- Distressing cough at night now allowing sleep.
- If you have fever with cough
- If you notice wheezing while coughing
- If you notice symptoms of breathlessness with or without cough
- If you notice bluish discoloration of nails and lips from cough
- If you notice yellowish-greenish expectoration – indicates infection
- If you notice blood with sputum when you cough
- If bouts of cough are severe enough to make you dizzy and lose consciousness.
It is mandatory to go to the doctor for immediate treatment of a cough if you notice any of these above signs and symptoms. These symptoms mentioned above indicate complicated cases of cough and therefore are not to be ignored.
Cough can indicate a wide spectrum of disorders. Untreated cough can interfere with daily routine activities. There can be over 100 causes for cough. It is important to not underestimate any kind of cough and seek medical help at the earliest to avoid any complications.