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Cough is a protective reflex that expels mucus, bacteria, and other foreign substances. It is the body's defense mechanism to clean the lungs and airways.
Cough can be acute or short term which usually lasts less than 3 weeks whereas chronic or persistent cough can last from 3 to 8 weeks. There can be numerous causes for cough. You may develop cough due to upper respiratory tract infections, allergies, pneumonia, asthma or other medical conditions. Moreover, cough might also be accompanied by other symptoms such as shortness of breath, wheezing sound, hoarseness of voice, or chest pain depending on what is causing it.
Acute cases of cough are usually managed by home remedies such as steam inhalation, gargling with salt water, using a humidifier or taking cough suppressants and expectorants. Drinking warm water or avoiding foods that can aggravate cough such as oily foods can also help in improving your condition.
However, in case of chronic cough, antibiotics and other medications might be prescribed depending on the cause and duration of your cough. Treatment of the underlying cause of cough also needs to be addressed in such cases.
- All age groups
- Both men and women
- Bronchogenic carcinoma
- Chronic aspiration
- Congestive heart failure
- Foreign body of the airway
- Interstitial lung disease
- Neuromuscular disorders
- Psychogenic cough
- Chest x-ray
- Sputum examination
- CT scan
- Cough suppressants: Dextromethorphan, Levocloperastine & Codeine
- Expectorants & mucolytics: Guaifenesin
- Antibiotics: Amoxicillin clavulanate
- Bronchodilators: Salbutamol, Budesonide, Montelukast & Theophylline
- General physician
- ENT specialist
Causes of Cough
There can be numerous causes of cough. Acute or short term cough usually lasts less than 3 weeks whereas chronic or persistent cough can last from 3 to 8 weeks. The various causes are discussed below:
Causes of acute or short-term cough
1. Acute viral or bacterial upper respiratory infection
Viral infections of the upper respiratory tract which include the common cold, viral laryngitis and influenza are the most common cause of cough. In such cases, cough is usually accompanied by fever, sore throat and runny nose. Cough can also occur due to bacterial infections in certain cases.
2. Inhalation of irritants or allergens
Acute exposure to dust, smoke, toxic fumes, mold, pollen & pet fur can cause inflammation of the upper respiratory tract and initiate coughing.
3. Acute rhinosinusitis
In acute rhinosinusitis, there is an inflammation and infection of the lining of the paranasal sinuses. This infection can cause mucus to collect at the back of the throat, which may make the throat itch. Some people might frequently cough to try to clear their throats, while others might experience uncontrollable coughing.
4. Pertussis or whooping cough
Pertussis or whooping cough may cause violent coughing led by a gasp for air. Pertussis is caused by a bacteria called Bordetella pertussis that affects the respiratory tract.
5. Lower respiratory tract infections
These are more severe viral and bacterial infections which can affect the airways in case of bronchitis and even the lungs in case of pneumonia. They usually cause a deep, persistent cough along with fever.
Causes of chronic or persistent cough
The reason behind a chronic cough is more difficult to diagnose. It needs diagnosis from a cough specialist or a pulmonologist. Possible causes of chronic cough include:
1. Upper airway cough syndrome
Upper airway cough syndrome is a chronic post-nasal drip, which tends to irritate the upper airway, inducing cough.
2. Hay fever or allergic rhinitis
Allergic rhinitis is an inflammation of the nasal mucosa, which is secondary to an allergic irritation occurring due to environmental factors. This results in increased mucus secretion. The mucus may also gather in the throat, causing post-nasal drip. This, in turn, may irritate the airways and stimulate a cough. It is usually associated with dry cough, sneezing and runny nose.
3. Chronic sinusitis
After a bacterial infection, your sinus and nasal mucosa may become irritated and inflamed, resulting in cold-like symptoms and cough over time.
4. Chronic bronchitis
Excessive mucus plugging in the airways causes a cough that lasts more than 3 months. Chronic bronchitis is not always of infectious origin but may be caused by bacterial infections in the past. Smoking is also an important risk factor of chronic bronchitis, and thus, a cause of cough.
5. Post-infectious cough
While recovering from an infection, the cough receptors become hyperresponsive, thereby inducing cough.
6. Gastroesophageal reflux disease (GERD)
In GERD, acidic contents from the stomach enter into the throat. This causes the receptors in the throat to get irritated, causing cough. Cough caused due to GERD worsens on lying down because on lying down the stomach contents travel back to the throat and cause cough.
In asthma, the body's immune system becomes hyper-responsive to external factors. This may cause inflammation, bronchial hyperreactivity & intermittent airflow obstruction with constriction of the airways, thereby inducing cough.
8. Chronic obstructive pulmonary disease (COPD)
It is a chronic inflammatory lung disease that causes obstructed airflow from the lungs and is usually associated with smoking. A cough caused by smoking is almost chronic in nature with a distinctive sound. It’s often called a smoker’s cough.
9. Congestive heart failure (CHF)
In CHF, the heart’s ability to pump blood reduces. This results in buildup of fluid in the lung, causing cough.
10. Intolerance to angiotensin-converting enzyme (ACE) inhibitor medicine
A dry cough is one of the most bothersome side effects of ACE inhibitors taken by people for hypertension.
11. Obstructive sleep apnea
In obstructive sleep apnea, the airways get partially or completely blocked for a short period of time during your sleep. This raises airway resistance, thereby causing chest and diaphragm spasms, resulting in cough.
12. Throat disorders
Diseases such as croup in children, cause a distinctive barking cough and a harsh sound called stridor when the child breathes in.
13. Psychosomatic cough
This type of cough has psychological causes such as anxiety, stress and depression and may have been adapted with habit rather than any disease condition.
Other less common causes of cough
1. A foreign body
Accidently, food or other objects can go down the windpipe instead of the food pipe causing cough.
2. Tuberculosis (TB)
Symptoms of TB are usually coughing for three or more weeks along with coughing up blood or mucus, chest pain, or pain with breathing or coughing.
3. Lung cancer
Cancer starts when cells in the lung begin to grow out of control. It is mostly associated with chronic smokers.
4. Cystic fibrosis
This is a genetic disorder that affects the lungs and causes chronic cough.
This is a condition in which airways of the lungs are permanently damaged and widened leading to a buildup of extra mucus.
6. Pulmonary embolism
In pulmonary embolism, a blood clot or embolus travels, usually from the legs, to the lungs causing sudden shortness of breath along with a lingering dry cough.
A pneumothorax or a collapsed lung occurs when air leaks into the space between the lung and the chest wall. It can be spontaneous or due to some chest injury, certain medical procedures, or underlying lung disease. Signs of a collapsed lung include sudden chest pain, dry cough and shortness of breath.
Symptoms Of Cough
Cough, which is often mistaken as a disease condition, is a defense mechanism of the body to clear off mucus, bacteria, debris, and retained waste from your airways. The symptoms of cough may vary depending on the type of cough and the underlying pathology.
1. Whooping sound
If you have a whooping sound while coughing, you have a whooping cough. In this, there are violent bouts of cough, and it becomes hard for a person to catch a breath. This is a serious condition and should not be ignored.
2. Staccato cough
In this type of cough, you may experience repetitive cough that occurs in short outbursts. It is usually a sign of lung or bronchial infection such as pneumonia.
3. Hoarseness of voice
This is a common symptom if the cough is of either psychogenic origin or when there is the involvement of the laryngeal nerve.
4. Cough following exercise
Cough during or after exercise or intense physical activity is common in asthma patients. This is accompanied by a wheezing sound and shortness of breath.
5. Itchy and dry throat
Itchy and dry throat in cough is a symptom of bacterial or viral infection. Itchy throat is also a sign of hay fever or allergies.
6. Production of sputum
When a cough is accompanied with thick mucus, also known as phlegm, then it is a sign of infection in the lungs or upper respiratory tract.
7. Night cough
Certain conditions such as gastroesophageal reflux disease (GERD) can cause mucus to pool in the throat while lying down and result in night coughing.
8. Seasonal cough with watery eyes
Dry, cold weather or allergy season can lead to seasonal allergies, causing cough, itchy throat, and watery eyes.
Cough along with dyspnea or difficulty breathing is common in patients with asthma, COPD, and other respiratory illnesses.
Wondering why your cough is lingering on? Here are 9 top reasons why that dreaded cough may not be going.
Risk Factors For Cough
You are at a risk of cough if you have one or more of the following condition or habit such as:
Chronic obstructive pulmonary disease (COPD)
Gastroesophageal reflux disease (GERD)
Congestive heart failure
Diagnosis Of Cough
If your cough is acute, it does not require any diagnosis and can be treated symptomatically. However, if there are any suspected underlying pathologies, then your doctor may recommend going for these diagnostic procedures.
Chest X-ray: A chest X-ray is done when a cough is determined to be severe or if the patient appears extremely ill. A chronic cough may also require diagnostic measures that include a chest x-ray and complete pulmonary function testing.
Bronchoscopy: Bronchoscopy provides direct visualization of vocal cords, trachea, and the airway passage. This is helpful in ruling out the presence of any mass in the vocal cord or throat.
Blood and skin tests: To diagnose if your cough is caused by an allergy, your doctor may recommend blood & skin tests for allergies.
Phlegm or mucus analysis: To diagnose the presence of any bacteria or tuberculosis, phlegm or mucus analysis is recommended.
Biopsy: A biopsy or a bronchoalveolar lavage is required to obtain samples for cytological analysis and presence of any microbes.
Echocardiogram: An echocardiogram may be indicated to look for any problem with the heart’s functioning that may be causing your cough.
CT scan: CT scan of the chest may be indicated for anatomical analysis of the chest region to look out for any abnormalities.
Gastroesophageal studies: Gastroesophageal studies evaluate speech and swallowing activities. This helps analyze aspiration and gastroesophageal reflux.
Prevention Of Cough
By knowing what triggers cough, you can easily prevent it. Here are some of the preventive measures to cough:
Get vaccination for flu: If you have seasonal allergies, it is advised to get a flu shot. You also need to ensure you've had the pneumococcal vaccine if you're 65 or older.
Wash your hands: Washing your hands is non-negotiable if you want to prevent common ailments like a cough or a cold. It is advised to wash your hands thoroughly before eating or touching your eyes, nose, or mouth. If you do not have access to clean water, carry a hand sanitizer when you travel.
Avoid contact with people who are sick: Just like all other common illnesses, you must wait for at least two weeks after the person got infected. The reason is, during this time, the person may be infectious, putting you at high risk of catching the infection.
Do not share belongings: Sharing stuff such as towels, utensils, etc. with the infected person can make you ill. Therefore, it is advised that to avoid contracting the disease, you must not share your personal stuff.
Dietary changes: A diet rich in fruits, fiber, and vegetables can help you prevent cough and other respiratory conditions and stay healthy in general.
Quit smoking: People who smoke tend to develop chronic cough, which is generally very hard to treat. To quit smoking there are various anti-smoking products available in the market that can assist you in smoking cessation.
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Treatment Of Cough
Most cases of cough are symptomatically relieved with the help of cold & cough medicines. Some of the common treatment measures for cough include:
Cough suppressants are used to decrease the intensity of cough by suppressing the cough reflexes. Examples include:
Expectorants & mucolytics
These are used in case of excessive mucus secretions where the main aim is to increase mucus clearance. These are usually prescribed for a wet or productive cough. They work by thinning the mucus in the air passages to make it easier to cough up the mucus and clear the airways. The most commonly used expectorant is guaifenesin.
If your cough is caused by chronic infectious upper respiratory infections, your doctor may prescribe antibiotic therapy. Amoxicillin clavulanate is the common antibiotic prescribed for cough.
The treatment of a chronic cough should focus on the underlying etiology whenever possible. The treatment should be aimed at reducing coughing rather than suppressing the cough. If you suffer from asthma or other bronchoconstriction conditions, bronchodilators may be used for the bronchodilatory effect for symptomatic relief in emergency situations. Examples of drugs that belong to this class are:
If there are any additional symptoms with cough, like an allergic reaction or pain on coughing, your doctor may prescribe:
Antiallergic medications (antihistamines)
Pain medications (analgesics)
Home-care For Cough
Along with medicines, you can also try certain tips or some simple home remedies to get rid of cough.
1. Keep yourself hydrated by drinking lots of fluids like coconut water, fruit juices, or infused waters. Fluids help to thin the mucus whereas lukewarm liquids like tea or soup can soothe the throat.
2. Honey is an excellent remedy when it comes to the treatment of cough. For a sore throat, you can mix honey in warm water or simply eat a spoonful of it. Never give honey to children younger 1-year-old as it might contain bacteria harmful for them.
3. Gargling with salt or povidone-iodine mixed in water is a simple but effective remedy that is of great help to remove mucus and soothe your throat.
4. Elevate your head with extra pillows while sleeping.
5. Use a cool mist humidifier in your room or work area or take a steamy shower to moisten the air. This will help in breaking the mucus buildup.
Ayurvedic herbs not only protect the airways and expel mucus but also boost your immune system. These are some of the ingredients that make up an all-natural, herbal cough syrup and are good for both dry and wet cough.
Complications Of Cough
A little bit of cough every now and then is normal, however, persistent cough can indicate a health condition. Acute cough that lasts less than 2-3 weeks may be a sign of acute illnesses such as cold. Whereas, chronic cough which is persistent may be the result of:
Dust fumes or occupational pollutants
Gastro-esophageal reflux disease (GERD)
You should not ignore persistent coughs (that have been there for more than four weeks) and seek medical advice, particularly if it disturbs your sleep or affects your work.
Alternative Therapies Of Cough
Here are few of the remedies for cough other than your conventional medicines.
1. Thyme leaves contain flavonoids that help in relieving sore throat. You can boil a few thyme leaves in water and consume the mixture after straining to get relief from the sore throat.
2. Peppermint (Pudina) helps in providing relief from the sore throat. You can either consume it in the form of tea or inhale it by adding a few drops of peppermint oil in boiling water
3.Clove (Lavanga) can be fried in ghee and should be kept in mouth for sucking. This preparation is quite useful for relieving cough.
4. Take 60 mg powdered fruit of long pepper (pippali) and 120 mg of rock salt (saindhava lavana) mix it with hot water & take it two times in a day.
5. Take 3-6 gm of fruit and root of long pepper (pippali) and dried ginger (shunthi) in equal proportion. Mix this with honey and take this mixture two times in a day.
6. Prepare ghrta also called ‘ghee’ from equal part of fruit of black pepper (maricha), adrak (ginger) and raw sugar (sharkara). It is to be taken twice a day in a dose of around 12-24 gm.
7. Taking 1-3gm of sitopaladi churna with 4 to 6 gm of honey twice a day may also help.
8. You can also take 300mg of karpooradi churna along with equal parts of sugar candy, twice a day.
9. You may take a juice of ginger (adrak) 14 ml with equal quantity of honey, twice a day.
10. The decoction of tamarind (imli) leaves (14 to 28 ml) is to be taken with 2 g of rock salt (saindhava lavana) and 500 mg of asafoetida (hing) fried in ghee. This preparation can be taken twice a day.
Living With Cough
If you are dealing with chronic cough, here are few simple tips which could help you deal better with your condition, without affecting your sleep and work.
Stay away from allergic triggers: Identify what you’re allergic to and keep away from the allergen. Avoid polluted areas. Dust mites are one of the most common causes of allergies.
Keep your clean and dust-free: Wash pillows, curtains and other upholstery regularly to eliminate the accumulation of dust.
Consult a doctor: Any cough that lasts more than 3 weeks is associated with fever or other unusual symptoms needs proper evaluation by a registered medical practitioner.
Avoid codeine containing cough preparations: This is because they can be habit forming in the long run. Also, avoid anti-allergy medicines in children and elderly as they can cause drowsiness.
Do not self-medicate: Many over-the-counter (OTC) syrups contain a combination of multiple drugs like suppressants, expectorants & analgesics. They should be avoided as they may contain drugs which you may not even need.
Use a humidifier: Dry air can aggravate your cough problems. You can use a humidifier in your room to keep the humidity. You can even try steam inhalation at home.
Gargle with salt water: Take half teaspoon of salt and mix with a cup of water. You can gargle with this solution 2-3 times a day to get relief from cough.
Use a thicker pillow: It is advised to use a thick pillow or use two pillows. This helps in elevating the trunk region, thus opening up the airways.
Hydrate well: Drinking enough water before bedtime helps in clearing the throat and loosening the mucus.
Sleep the right way: Sleeping on your back or stomach can aggravate the stomach. The best position to sleep while you have a cough is to sleep on your side.
Frequently Asked Questions
- Louella B. Amos.Cough.Nelson Pediatric Symptom-Based Diagnosis. 2018 : 15–38.e1.
- Sharma Sandeep, Hashmi Muhammad F, Alhajjaj Mohamed S. Treasure Island (FL): StatPearls Publishing; 2021 Jan
- Arinze Johnmary T, Roos Emmely W. de, Karimi Leila, Verhamme Katia M.C.Prevalence and incidence of, and risk factors for chronic cough in the adult population: the Rotterdam Study.ERJ Open Res. 2020 Apr; 6(2): 00300-2019.
- Li Jun, and Ye Ling. Effect of pregabalin for the treatment of chronic refractory cough.Medicine (Baltimore). 2019 Jun; 98(23): e15916.
- Janardan Pandey.Shushka-Kasa(Sukhi khansi)Dry cough.National health portal. 2016 Jun <