Cough

Definition of Cough

A cough (the latin word is “tussis,” which lends its name to the suffix of some cough medicines) is a natural muscle reflex of the body attempting to remove some irritation, collection or blockage from the throat or lungs in order to allow for normal breathing and swallowing.

The normal breathing pattern occurs when air is passed through the nose and mouth down through the vocal cords (larynx) via the windpipe (trachea) and into our lungs (bronchi). Once in the lungs, the air flows into smaller air passages called “bronchioles.” At the cellular level, oxygen is added through the bloodstream, where the waste product of carbon dioxide is removed.

When an irritant bothers any section of the respiratory (breathing) system, the nerves send a message to the brain, which triggers the “cough” impulse to clear the blockage. The abdomen and diaphragm push air up past the “epiglottis,” which is a flap of elastic cartilage tissue attached to the root of the tongue that closes the throat. The force of this sudden force attempts to dislodge the foreign irritant.

There are many different cough types depending on the immediate irritant or underlying malady. Some coughs are voluntary, others are involuntary. Usually, a cough is associated with a cold or influenza (flu); but, it could also be a sign of a more serious ailment.

Symptoms

A cough is a natural process; if it is voluntary and removes any foreign irritant, then it is not a cause for concern. When there is an abnormal state of the respiratory system – nose, throat or lungs – a cough will attempt to clear the blockage. General dryness, irritation or swelling of the breathing system can trigger a cough.

Coughs can be grouped by duration, intensity and type of phlegm (also called sputum) expelled; a medical professional can determine the cause of the cough based on these characteristics. A mild cough that lasts only a couple of days is categorized as “acute.” A repetitive cough, lasting more than a month, is called “chronic,” and can be a sign of a more serious condition, like Bronchitis.

Cough? Get Remedies Fast!

Symptoms of a cough can include the following:

• Runny nose
• Sore throat
• Headache
• Muscle aches.

A doctor should be called when the following serious conditions occur with a cough:

• Blue colour in lips, tongue or face
• Coughing up blood
• Exhaustion
• Greenish-yellow or bloody sputum (phlegm)
• Heavy sweating
• High fever above 101 degrees Fahrenheit
• Hives
• Lasting for weeks
• Losing weight
• Patient is younger than three years old
• Stiff neck
• Swelling of throat, neck or face
• Violent Stridor or Whooping Cough.

Causes

Specific Irritants

Coughing is the body’s mechanism to clear the throat passage of any irritant, foreign particle or blockage. Some irritants are airborne contaminants – like dust, smoke, exhaust and smog. The most common foreign particles are food, which can get stuck in the throat, impeding air flow. The common cold or flu can lead to a build-up of mucus that blocks the throat.

Microorganisms including microbes, viruses and bacteria can infect the respiratory system. Allergic reactions to food, perfumes, chemicals or animals can lead to the swelling of throat membranes. More serious conditions can lead to psychological and physical problems with breathing.

General Categories

The following are all possible causes of a cough:

• Acute Sinusitis – Inflamed or swollen nasal passages
• Air pollution – Tobacco smoke, smog or exhaust
• Allergy – Hypersensitive reaction to some chemical, i.e. hay fever, food or pets
• Asthma (Hyperactive Airways Disease) – Bronchial tubes narrowed due to reaction
• Chronic Obstructive Pulmonary Disease (COPD) – (Bronchitis, Bronchiectasis or Bronchiolitis) – congestion, infection or inflammation of these major air tubes can be very serious
• Common cold – There is no known cure for this ailment
• Foreign body – Typically, food gets stuck in trachea (windpipe), causing swallowing difficulties
• Gastroesophageal Reflux Disease (GERD) – Stomach acid flows back into esophagus causing heartburn
• Laryngitis – Hoarseness of larynx due to overuse
• Lung (Pulmonary) problems – These ailments include cancer, edema (fluid) or embolism (blood clot)
• Medication reaction – Angiotensin-Converting Enzyme (ACE) inhibitors – Enalapril (Vasotec), Captopril (Capoten), and Lisinopril (Zestril) – are used to treat hypertension (heart disease)
• Pertussis (“Whooping cough”) – Airway infection caused by the bacteria Bordetella Pertussis
• Pleurisy – Inflammation of this lung membrane
• Pneumonia – Lung infection caused by microorganisms (viruses, fungi, parasites or bacteria)
• Post-Nasal Drip – Nose, sinuses and throat produce mucus that irritates throat
• Respiratory Synctial Virus (RSV) – Lung infection and blockage of breathing passages
• Throat Disorders (Croup, Strep, Tonsillitis or Pharyngitis) – Caused by virus or bacteria
• Tuberculosis – Serious infectious disease caused by the Tubercle Bacillus.

Risk Factors

Since most coughs are the result of a cold or flu, a weak immune system is the primary risk factor. Those who are overweight, smoking or experience cold-and-wet conditions for prolonged periods of time are most at-risk for conditions like GERD, lung cancer or pneumonia. Children have weaker immune systems, so they are more likely to get mild coughs.

It is very easy to transmit germs through the air or via physical contact. When someone coughs, the speed of the discharged air can reach speeds of up to 60 miles-per-hour. Sick people should cover their coughs with a handkerchief, tissue or sleeve.

Prevention Tips

“An Ounce of Prevention is Worth a Pound of Cure!”

The best way to prevent a cough is by strengthening your immune system, keeping your environment free of airborne contaminants and eating healthy meal dosages. There are germs everywhere, especially on keyboards, phones and handles that are used by different people. Wash your hands before and after meal preparation, when handling garbage, or cleaning. Using soap and sanitary alcohol cleaners can kill dangerous microorganisms before they infect you.

Other conditions that can prevent coughs include not eating within an hour before going to sleep, staying away from spicy foods, not smoking and reducing weight. Suggestions for avoiding GERD include wearing loose-fitting clothing and elevating your head while sleeping. Some ailments, like the “whooping cough” (pertussis), can be prevented with vaccines: Diptheria, Tetanus and Acellular Pertussis (DTaP).

Test and Diagnosis Considerations

Testing

Mild, acute, voluntary coughs might go away by themselves. Violent, chronic, involuntary coughs might require testing and professional medical treatment that would reveal deeper underlying problems. The following types of tests could be administered for coughs: blood and urine, imaging, scoping, or breathing.

Blood and urine tests:

These will search for common chemicals produced when different ailments are present. A common chemical produced during Asthma attacks is Immunoglobin E; thus, specialists will test to see if this chemical is present in the patient’s body.

Imaging tests:

• The Computerised Axial Tomography (CAT/CT) Scan uses a computer and x-rays to create a cross-directional map of the body for better analysis of the respiratory system.
• Medical professionals can use x-rays on the heart, lungs, or chest to search for serious maladies, like Lung Cancer.

Scoping tests:

These are performed with a small, thin, flexible, fiber-optic camera tube used to detect foreign bodies, blockages and tumours:

• Nasal endoscopy for sinuses
• Upper endoscopy for throat
• Bronchoscopy for windpipe and lungs.

Breathing tests:

These breathing tests measure lung capacity, like the “Bronchoprovocation” challenge, where the patient inhales a medication, like “Methacholine” and the pulmunologist measures the lung response.

A spirometer (peak flow meter) measures the strength of lung capacity as patients blows air into a container. A lung specialist, called a pulmunologist, might administer this test to determine possible lung problems.

Diagnosis Factors

Doctors will ask a series of questions in order to gather information that might reveal the source of a cough, including the following:

• How long has the cough lasted?
• Are there certain times that the cough is more intense?
• What type of mucus is being coughed up?
• What colour is the coughed-up mucus?
• Are you allergic to anything?
• Do you have any history of diseases in your family?
• Do you drink or smoke?
• Are you taking any medications?

A doctor would physically examine the nose, throat and lungs to see if there was any swelling. The intensity, duration and sound of the cough all help the health professionals diagnose the cough’s origins.

Since a cough can occur for so many different reasons, there are a variety of treatments that can be administered. Most physicians will advise patients to drink plenty of liquids and use some sort of cough syrup to lubricate the throat area. Therapy will be carefully conducted as the medical professional watches for how the body responds.

Cough Types

The following cough types are associated with specific ailments:

• Atopic cough could derive through genetic allergic hypersensitivity
• Psychogenic cough (Tourette’s Syndrome) is a nervous “habit” or “tic” caused by mental anxiety
• Dry cough could be Pleurisy
• Barky cough associated with Croup caused by swelling of larynx (voice box)
• Smoker’s cough due to dryness or burning of trachea
• Whooping cough (Pertussis) can be continuous without air being breathed in between coughs
• Wheezing (or Whistling) cough is usually due to swollen airways caused by asthma
• Nighttime cough is due to fluid collecting in lungs while laying down
• Mucus-filled cough could be a sign of COPD

Treatment Options

Herbal and Home Remedies

The purpose of most treatments is to control mucus expectoration, or lubricate the throat. Because coughs are such a common ailment, many families have a storage house of home cures and remedies that are affordable and easy to make. Cool or warm juice can help rejuvenate throat tissue that is becoming raw or prickly. Usually, people should stay away overly acidic orange juice that might upset the stomach. Chicken noodle soup and fibre are favourite foods. Honey and lemon offer energy and a sharp burst of citrus to bust through clogs.

A small amount of brandy can help patients sleep, moistening the throat and killing bacteria. Patients must be careful to continue to drink large amounts of water, since alcohol will tend to dry the body out. Herbal remedies include menthol, camphor, eucalyptus and tea to soothe air passages. Most cough sweets (drops) include a combination of these herbs.

Pharmaceutical

Cough medications aim at reducing the mucus in the throat passages, acid in the stomach or body pains. Cough syrups usually have a combination of medicines for treating coughs.

• A cough suppressant – like Codeine, Dextromethorphan or Quaifenesin – will directly reduce any throat muscle irritation that causes the cough.
• Antihistimines, like Diphenhydramine (Benadryl), stop runny noses, sneezing and the Upper Airway Cough Syndrome (UACS) by freeing up mucus that clogs airways.
• Nasal decongestants, like Pseudoephedrine (Sudafed) clean out sinus conditions (post-nasal drip or a stuffy nose), so that people can breathe more easily.
• Pain relievers, like Aspirin, reduce the headaches and body aches that sap the strength of the cougher. Don’t give Aspirin or adult cough medicine to children.
• GERD can be treated by anti-acid, proton-pump inhibitors (PPIs) – Famotidine (Pepcid), Cimetidine (Tagamet), Esomeprazole (Nexium), Lansoprazole (Prevacid), Omeprazole (Prilosec), Pantoprazole (Protonix), Rabeprazole (Aciphex), or Ranitidine (Zantac).
• Antibiotics can help treat more serious ailments, killing bacteria that can cause the conditions that lead to a cough. Antibiotics don’t help treat the common cold.
• Nasal inhalers, like Ipratropium Bromide (Atrovent), can also be used to relieve congestion.
• Bacterial Pneumonia and Bronchitis can be treated with Azithromycin (Zithromax).
• Corticosteroids can treat Eosinophil Granulocytes.
• Inhaled steroids or a bronchodilator can treat Asthma.
• Analgesics will help fight Pleurisy.

Surgeries

Surgery is the final treatment if a cough is chronic and severe. A sequence of tests should be conducted to verify the source of the cough. Extreme ailments, like a hiatic hernia, might require surgery. Major surgery can require extensive time for the body to recover.

Air Cleaning Systems

Better air cleaning technology has permitted people to purchase a number of systems that can improve their immediate living environment. There are a variety of different air purifier systems – High-Efficiency Particulate Air (HEPA), Ionic and Ultraviolet – that usually work with air conditioning and heating furnace systems to remove dust, mold and allergens from the air. Those who suffer from severe asthma are turning to these air cleaning systems to prevent coughs.

Hot steam via a humidifier can help relieve dry throat conditions that cause coughing. A dehumidifer can clear out air that is so full of water vapour that it is difficult to breathe.

Side effects

Risks

When coughs fail to remove a foreign blockage from the space where air, liquid and food travel, the results can be very serious.

A continual cough can lead to any of the following side effects:

• Back muscle strain
• Dizziness
• Fainting
• Fractured ribs
• Headache
• Insomnia
• Leg swelling
• Lightheadedness
• Lung discomfort or pain
• Pneumonia
• Shortness of breath
• Swallowing difficulties.

When the patient is coughing up blood (hemoptysis), get immediate medical attention. There could be blood in the stomach or lungs. This could be caused by COPD, a lung abscess, mitral valve stenosis, pneumonia, tuberculosis, or Wegener’s granulomatosis.

Efficacy

The efficacy of different treatments depends upon the person, strength of dosage and severity of any underlying ailment.

Costs

Home remedies are the most affordable, cough sweets are very cheap.

Surgery can be very expensive.

Remedies from other cultures

Many African cultures use hot peppers, especially in pepper soup to burn through the microorganisms and mucus that may cause a cough. The herb, “Pelargonium Sidoides,” is found in South Africa; it has natural immune system boosters and anti-inflammatory agents.

The Chinese herb, “Radix Platycodi” is used for clearing phlegm from lungs. “Biao Men Dong” is used for coughs. “Bai He Gu Jin Tang,” “Er Chen Tang,” “Ding Chuan Tang,” and “Chuan Bei Pi Pa Gao” are other natural remedies for coughs.