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Coughs

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Coughs
Summary
  • Coughs fall broadly into two categories: productive (mucus producing), chesty and non-productive (dry).
  • Dry Coughs are usually caused by a viral illness.
  • Productive Coughs usually indicate a bacterial infection, or allergic reaction.
Description

Coughs are sudden and explosive movements which remove particles and excess mucus from the airways. Coughing is a protective response which prevents foreign material from entering and damaging the lungs. Coughs are a common symptom of respiratory illnesses 1.

Coughs may be acute (lasting less than 3 weeks) or chronic (lasting longer than 3 weeks). Coughs fall broadly into two categories: productive (mucus producing), chesty and non-productive (dry).

Dry Coughs are usually caused by a viral illness. The cough is triggered by a tickling sensation in the throat. The upper airways may be inflamed and a post nasal drip may be present. A viral Cough usually resolves within 2-3 weeks. 2

Productive Coughs usually indicate a bacterial infection, or allergic reaction. When the airways are irritated, excess mucus is produced to trap foreign particles. Coughing then helps the body to remove this extra mucus from the airways. Non-infected mucus, produced during allergic reactions, appears white or clear. Mucus with a green or yellow colour is a sign of infection. Streaks of blood in the mucus may be a sign of mild trauma due to violent coughing. Heart failure may cause a cough with frothy pink mucus, while bright red mucus is a sign of fresh bleeding in the upper airways. If any blood appears in the mucus, your Doctor should be consulted. 3 Productive Coughs are also referred to as 'chesty' coughs, with the related symptoms of 'chestiness' and 'congestion'.


Cause

An acute cough is usually caused by a viral infection such as the common cold and is commonly associated with a sore throat 4. A dry cough can be early symptom of pneumonia along with fever, coloured mucus and breathlessness. Tuberculosis may present as a chesty cough and is more likely to occur in high-risk people such as the elderly, alcoholics, those with a suppressed immune system and immigrants from Africa, south-east Asia and Eastern Europe 5. Initial symptoms of whooping cough are similar to the common cold. The cough then develops a characteristic 'whooping' sound.

Post-nasal Drip (PND) often develops in people as a result of allergies or the common cold. Nasal secretions entering and irritating the lining of the throat cause the PND cough.

Asthma may present as a chronic cough with wheezing, breathlessness or tightness of the chest 6.

Gastric reflux occurs when acidic stomach contents move upwards into the oesophagus. This can cause a burning sensation in the chest and a chronic cough may develop. A cough caused by reflux is usually worse at night or on bending and straining.

Bronchitis refers to inflammation of the bronchial tree (the breathing tubes within the lungs) 7. Chronic bronchitis is characterised by a long-term, productive cough. 8

Bronchiectasis is an abnormal enlargement of the main airways (bronchi) that carry air into the lungs 9. This condition can cause a chronic, chesty cough with large amounts of coloured, foul-smelling mucus.

Medication such as ACE inhibitors cause a dry cough in 15% of people 10. The cough usually resolves within weeks of withdrawal of the drug 11.

Psychogenic cough, habit or nervous cough usually present as a barking or honking sound or as a repeated dry cough. This type of cough usually begins as part of a viral infection and continues voluntarily due to the attention the person receives or as a result of anxiety. Symptoms are absent during sleep with this type of cough.

Heart Failure may cause a type of cough. Left-ventricular heart failure may produce the symptom of a night-time cough, 12 therefore it is important to seek medical advice for any type of unexplained or persistent coughing.

  • Management

    As with all conditions your Doctor should be consulted. Your Doctor will diagnose and treat this condition. A specific diagnosis by your Doctor can usually be made with a thorough history, physical examination and simple laboratory investigations. 13 Your Doctor might suggest a chest X-ray and other tests to diagnose the cause of the cough.


    Lifestyle

    Diet Hints
    • Try to avoid all foods that aggravate the cough reflex. Food allergies or intolerances may promote coughing.
    • Dry foods e.g., biscuits or crispbread and spicy or very sweet foods may promote coughing, while liquids tend to have a soothing action.
    • Foods high in vitamins A, C, E and zinc may help the body to combat any infections which may be present. Citrus fruits as well as red, orange and yellow fruits and vegetables are high in these vitamins 14
    • Garlic and onions should be eaten regularly to help shift mucus out of the lungs and help combat infections. Garlic has natural antibiotic properties which is thought to be useful in combating infections 15.
    • Try to drink plenty of fruit and vegetable juices at room temperature. These may help expel mucus and sooth the throat. Ginger, added to juices and cooking, is an effective herb for coughing.  


    Vitamins/Minerals/Herbs
    • Vitamin A may help heal inflamed mucous membranes and to strengthen the immune system. 16 - Vitamin C may help fight infections. 17 - Zinc may assist in boosting the immune system 18.
    • Garlic may be useful due to its natural antibiotic and immune system enhancing properties 19.
    • Lungwort, borage, angelica, peppermint, mullein, lobelia or hyssop may be useful herbs for loosening phlegm and relieving coughs 20.
    • Liquorice herb is effective for soothing coughs and inflammation.
  • Pharmacist's Advice

    Ask your Pharmacist for advice.

    1. Suppressants are effective in relieving a dry cough. Common ingredients in cough suppressants include pholcodine, codeine and dextromethorphan. 21 It is important that a cough suppressant is not used for a productive cough as this can worsen the condition.
    2. Demulcents such as lemon, glycerin, honey and eucalyptus are soothing and have few side effects. They are particularly suitable for children due to their pleasant flavour. 22
    3. Expectorants are used to treat productive coughs. They help loosen the mucus to make it more easily coughed up. The active ingredient is called guiphenesin. 23
    4. Sympathomimetics are used when a combination of suppressants and expectorants is desired. They may cause sleeplessness and are not suitable for children, or patients taking certain medications. Active ingredients include pseudoephedrine and phenylpropanolamine. 24
    5. Smoking is a common cause of coughing. It causes extreme irritation to the airways and increases the risk of infections 25. Ask your Pharmacist about the range of products available to help you stop smoking.
    6. A steam vaporiser can help by humidifying the air and reducing irritation to the upper airways.
  • Notes

    References

    1. Cough. Mosby's Medical, Nursing and Allied Health Dictionary. 4th edition. 1994. USA.
    2. Bleckinsopp A et al. Symptoms in the Pharmacy (3rd ed). Oxford: Blackwell Science; 1998.
    3. Bleckinsopp A et al. Symptoms in the Pharmacy (3rd ed). Oxford: Blackwell Science; 1998.
    4. Managing Coughs. Continuing Pharmacy Education. Australian Pharmacist. Pharmaceutical Society of Australia. Vol 22. No 11. Nov 2003.
    5. Tuberculosis Fact Sheet no.104 World Health Organisation. www.who.int/mediacentre/factsheets. Sept 2003.
    6. Managing Coughs. Continuing Pharmacy Education. Australian Pharmacist. Pharmaceutical Society of Australia. Vol 22. No 11. Nov 2003.
    7. Beers M et al (eds). The Merck manual of diagnosis and therapy (17th ed). New Jersey: Merck Research laboratories; 1999
    8. Beers M et al (eds). The Merck manual of diagnosis and therapy (17th ed). New Jersey: Merck Research laboratories; 1999
    9. Stevens A, et al. Pathology. London: Mosby; 1995.
    10. Managing Coughs. Continuing Pharmacy Education. Australian Pharmacist. Pharmaceutical Society of Australia. Vol 22. No 11. Nov 2003.
    11. Inwin RS et al. Managing Cough as a Defence Mechanism and as a Symptom. A consensus panel report of the American College of Chest Physicians. Chest; 1998; 114, 2:133S-181S.
    12. Managing Coughs. Continuing Pharmacy Education. Australian Pharmacist. Pharmaceutical Society of Australia. Vol 22. No 11. Nov 2003.
    13. Leung-AK; Robson-WL; Tay-Uyboco-J; Chronic cough in children. Can-Fam-Physician. 1994 Mar; 40: 531-7.
    14. Sies-H; Stahl-W.Vit E and C, beta-carotene, and other antioxidants.Institut fur Phys Chemie I, Heinrich-Heine Uni Dusseldorf, Germany.Am-J-Clin-Nutr.1995 Dec.62(6 Suppl).
    15. Tchernychev-B; Rabinkov-A; Natural antibodies to dietary proteins; garlic (Allium sativum) in human serum.Immunol-Lett. 1995 Jul-Aug; 47(1-2): 53-7.
    16. Balch-JF,MD; Balch-PA. Prescription for Nutritional Healing, second edition, Avery Publishing Group, New York, 1997, p209.
    17. Balch-JF,MD; Balch-PA. Prescription for Nutritional Healing, second edition, Avery Publishing Group, New York, 1997, p209.
    18. Balch-JF,MD; Balch-PA. Prescription for Nutritional Healing, second edition, Avery Publishing Group, New York, 1997, p209.
    19. Balch-JF,MD; Balch-PA. Prescription for Nutritional Healing, second edition, Avery Publishing Group, New York, 1997, p209.
    20. Gursche-S. Encyclopedia of Natural Healing, Alive Publishing Inc, Canada, 1997, p625-626.
    21. Bleckinsopp A et al. Symptoms in the Pharmacy (3rd ed). Oxford: Blackwell Science; 1998
    22. Bleckinsopp A et al. Symptoms in the Pharmacy (3rd ed). Oxford: Blackwell Science; 1998
    23. Bleckinsopp A et al. Symptoms in the Pharmacy (3rd ed). Oxford: Blackwell Science; 1998 
    24. Bleckinsopp A et al. Symptoms in the Pharmacy (3rd ed). Oxford: Blackwell Science; 1998
    25. Freund-KM; Belanger-AJ; D'Agostino-RB; Kannel-WB; The health risks of smoking. The Framingham Study: 34 years of follow-up. Ann-Epidemiol. 1993 Jul; 3(4): 417-24.
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