The primer on cough
March 27 2014 11:04 PM
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Acute cough has a sudden onset and is present for less than three weeks, chronic cough lasts longer
Acute cough has a sudden onset and is present for less than three weeks, chronic cough lasts longer than eight weeks.


By Dr Jacob Neil

All of us cough occasionally to clear our throat. If your cough lasts for more than three weeks, or if you cough up blood or experience other unexplained problems such as weight loss or fever, seek medical help immediately.

What is cough?
A cough is a reflex action to clear your airways of mucus and irritants such as dust or smoke. Coughs can be productive (sputum/phlegm producing) or non-productive (dry). Acute cough has a sudden onset and is present for less than three weeks, chronic cough lasts longer than eight weeks.
Dry cough is usually felt in the throat as a tickle that sets off the coughing. It is experienced when your throat and upper airways are inflamed (swollen). Dry cough does not produce thick mucus. Common cold or flu can also cause dry cough. That is because your brain considers inflammation in your throat or airways as a foreign object and tries to remove it through cough. A chesty cough/wet cough usually produce phlegm (thick mucus). Cough helps to clear the phlegm from your lung passages. Based on the duration of the cough, it can be categorised in one of the following:
» Acute coughs usually begin suddenly and are often due to a cold, flu, or sinus infection. They usually go away after three weeks.
» Sub-acute coughs last three to eight weeks.
» Chronic coughs last longer than eight weeks.

Causes
Recent upper airway infections, such as common cold and flu, can cause coughs. Other common causes include:
» ACE inhibitors (medications used to control blood pressure).
» Allergic rhinosinusitis (inflammation of the nose or sinuses).
» Asthma.
» Chronic obstructive pulmonary disease (emphysema or chronic bronchitis).
» Gastroesophageal reflux disease (GERD).
» Lung disease such as bronchiectasis, interstitial lung disease, or tumours.
» Lung infections such as pneumonia or acute bronchitis.
» Sinusitis leading to postnasal drip.
Another major cause of cough, particularly common in the Middle East, is smoking. According to a national study on smokers, the annual smoking rate is 12,000 cigarettes per person in Qatar. The same report revealed that smokers in Qatar purchased at least 1bn cigarettes per year.  
Even exposure to second-hand smoking (passive smoking) can equally harm a human body. Smoking is the main cause of lung cancer. Look out for the ‘red flag’ symptoms often accompanied by cough, which could suggest a serious medical condition. The economic impact of this is proof — $150mn is spent per year in Qatar on hospital fees to cover care for patients with smoking-related diseases.

Shisha
Shisha is a socially accepted pastime here in Qatar.  Unfortunately, it is even more dangerous and harmful than cigarette smoke, in fact several hundred times more. While cigarettes have filters to moderate the smoke, shisha smoke passes directly into the mouth, throat and lungs. Shisha is a major cause for smoking-related diseases.

When to see your doctor?
A history of heart disease, swelling in your legs, or a cough that gets worse when you lie down (may be signs of congestive heart failure).
If you are exposed to someone with tuberculosis.
Cough in an infant younger than 3 months old.
Cough that lasts longer than 10-14 days.
Cough that produces blood.
Fever (may be a sign of a bacterial infection that requires antibiotics).
High-pitched sound (called stridor) when breathing in.
Thick, foul-smelling, yellowish-green phlegm (could be a bacterial infection).
Unintentional weight loss or night sweats (could be tuberculosis).
Violent cough that begins suddenly.

When to call for emergency care …
Shortness of breath or difficulty in breathing.
Hives or a swollen face or throat with difficulty in swallowing.
Cough that produces blood.

Diagnosis
In order to diagnose the cause of cough and to understand the medical conditions, doctors will examine your ears, nose, throat and chest. Tests that may be performed include:
Bronchoscopy.
CBC/ESR/CRP.
Chest X-ray/ X-ray of the paranasalsinus.
Chest CT scan.
Lung scan.
Pulmonary function tests (including oximetry).
Sputum analysis (if the cough produces sputum) and culture.

Treatment
Treatment will depend on the likely cause of your cough. Doctors will recommend you to quit cigarette and shisha smoking, if you are a smoker. For asthma patients, inhalers are offered. If the cough is due to tablets given for high blood pressure, you can switch to another type. If bacterial infection is likely, you may be prescribed antibiotics. Doctors will not prescribe antibiotics for viral infections like cold or flu which leads to cough. This is because antibiotics do not work on viruses.
Antibiotics will not work for coughs caused due to any allergic reactions. A steroid nasal spray may help postnasal drip. Losing weight, cutting out acid foods and alcohol, and taking medicine to stop acid in the stomach may all help acid reflux. You may be referred to a lung (respiratory) specialist for further tests.

Home care
Although coughing can be a troubling symptom, it is usually your body’s way of healing. Here are some tips to help ease your cough …
If you have a dry, tickling cough, try cough drops or hard candy. Never give these to a child under age of three, because they can cause choking.
Use a vaporiser or take a steamy shower. Both these things increase the moisture in the air and can help soothe a dry throat.
Drink plenty of fluids. Liquids help thin the mucus in your throat and make it easier to cough it up.
Home remedy containing honey and lemon may help ease a short-term cough.

Medications
Guaifenesin helps break up mucus. Drink lots of fluids if you take this medicine.
Decongestants help clear a runny nose and relieve postnasal drip. Do not give children under age of six an over-the-counter decongestant unless specifically told to do so by your doctor. You should check with your doctor before taking decongestants if you have high blood pressure.
If cough still persists contact your doctor for treatment.

- Dr Jacob Neil is a general practitioner at Aster Medical Centre in Al Hilal




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