Clearing the air around coughing

A cough is the body’s attempt to clear out the airways. It can be a one-off to expel a physical obstruction (such as accidentally inhaling dust), or it can be a more common occurrence in response to respiratory agitation, infection or illness. In this article, consultant in respiratory medicine Dr John Chinegwundoh describes the common causes of cough, and how patients can know If they need to seek medical intervention.

 

 

What are the types of cough?

Coughing is a helpful reflex, but it can be indicative of an issue, and constant coughing can be painful and bothersome. There are many types of coughs, and they are categorised by how long they last:

• Acute cough begins suddenly and lasts up to three weeks
• Subacute cough follows an infection and lasts between three to eight weeks
• Chronic cough lasts longer than eight weeks
• Refractory cough is a treatment-resistant chronic cough.

Coughs can be further delineated by sensations invoked, such as sound and texture:

• A wet cough comes with mucus or phlegm, and a dry cough brings up neither
• A cough can sound like a ‘whoop’, like a bark, or a wheeze

 

What causes a cough?

Coughing can, and has, inflicted everyone. It is unlikely to encounter someone who has never coughed at least once in their life. However, those who are most likely to experience more frequent bouts or periods of coughing are smokers and vapers, people with chronic illnesses and allergies, and children as their immune systems are still developing.

Coughing can be triggered by environmental factors like smoke, strong smells, dust, sprays, and pollen. Certain medications are also linked with increased coughing, such as ACE inhibitors. However, coughing may occur to conditions such as:

• Colds
• Flu
• Bronchitis
• Sinusitis
• Pneumonia
• Whooping cough
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Tuberculosis
• Lung cancer
• COVID-19
• Postnasal drip

 

How is cough treated?

For acute coughs, they tend to be viral infections that are treatable at home with over-the-counter remedies; however, more persistent coughing with a lot of discoloured mucus, blood, strong wheezing, fever, pain, or discomfort may be more serious and will require thorough diagnosis so that appropriate treatment can be administered to address the root cause of coughing.

The cause of a cough can be determined through examinations and tests. Doctors will typically ask about a patient’s medical history and conduct a physical exam, before progressing to more thorough tests like an X-ray or a CT scan to check the physical condition of the lungs and sinuses and see if there are any abnormalities or infections.

Non-invasive tests for lung function can be used in the diagnosis of asthma or COPD. These include spirometry, which is a simple test that measures how much air can be exhaled in one go, or a cardiopulmonary exercises test to assess how the lungs (in conjunction with the heart and muscles) react under strain.

In the interim, pharmacists can recommend decongestants, lozenges, cough syrups, and nasal sprays to ease discomfort from the symptoms. Some medicines will have paracetamol or ibuprofen for any pain or headaches, which can help if patients are struggling to sleep whilst ill. Pneumonia and more grave infections are treated with antibiotics and other medications that can only be diagnosed by a doctor, such as

• Antihistamines, corticosteroids and decongestants. These medicines are standard treatment for allergies and postnasal drip.
• Inhaled asthma medicines. The most effective treatments for asthma-related cough are corticosteroids and bronchodilators. They reduce inflammation and open up the airways.
• Antibiotics. If a bacterial, fungal or mycobacterial infection is causing your chronic cough, doctors may prescribe antibiotic medicines for the infection.

There are lifestyle adaptations that can be made to relieve coughing. Keeping hydrated by drinking fluids, as well as trying to stay in humid or moist environments (with the assistance of a steamy shower or an air humidifier) can help to soothe and lubricate the throat. Smokers are always encouraged to cease as the smoke irritates the lungs and strains blood vessels in the body.