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Cough (Adults)

 


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Condition
Cough (Adults)
Class
Respiratory system
Description
A cough is a protective mechanism that the body uses to clear the airways of an obstruction such as foreign objects, dust, smoke, irritants or mucus. A cough may also be due to inflammation of the upper airway caused by a viral infection such as a cold or influenza, or a symptom of other diseases that affect the lungs such as asthma, bronchitis or whooping cough.
Causes
Coughing occurs when the body wants to clear something from the airways. Foreign objects, dust, smoke, irritants, mucus or particles of food stimulate receptors in the airways that send signals to the brain that start the coughing reflex. When there is a viral infection such as cold, it is the inflammation of the airways and the presence of mucus running down the back of the nose onto the throat, which causes the cough. When the airways are inflamed, they become swollen and make breathing more difficult. The receptors in the airways react as if there is an obstruction, signalling a cough reflex. Some medicines, such as ACE inhibitors used for the treatment of hypertension and heart failure, can also cause a cough as a side effect. In rare cases, a cough may be a symptom of more serious diseases such as lung cancer, tuberculosis or pneumonia.
Symptoms
There are three types of cough - productive cough, congested non-productive cough and a dry cough.

A productive cough, sometimes called a chesty cough makes a person feel that they want to clear mucus or phlegm that has been produced as a result of a chest infection. The mucus is thin and clear and is removed by coughing.

A congested non-productive cough also makes a person feel that there is mucus in the airways that needs to be cleared, but because the mucus is thick and clinging it is difficult to be dislodged by coughing.

A dry cough, sometimes called a non-productive cough, is called dry as there is no mucus to clear. The dry cough is produced by a persistent tickling in the throat or chest that is often worse at night.
Treatment
The treatment of cough depends upon the type of cough and the nature of the symptoms.

A productive or chesty cough is useful as it clears mucus from the airways. A productive cough should not be suppressed. If the mucus is not cleared, then it can lodge in the airways making breathing more difficult and increasing the chances of causing a secondary bacterial infection. There is usually no need to treat a productive cough with a cough medicine. Inhaling steam from a bowl of hot water with a towel over the head will help loosen the mucus. If necessary, oils such as Olbas Oil or Karvol capsules can be added to the hot water to clear any nasal congestion.

A congested non-productive cough needs to be treated with an expectorant. The expectorant will thin and loosen the thick, sticky mucus allowing it to be cleared from the airways by coughing. There are a number of expectorant cough medicines available that include substances such as guaifenesin, ipecacuanha, ammonium chloride or squill. These substances stimulate the production of a watery mucus in the airways which helps thin the sticky congested mucus. Sometimes, the mucus is so thick that even expectorants will not work. In these circumstances, medicines such as carbocisteine, erdosteine and mecysteine may be used. These medicines are called mucolytics, they break down the mucus into smaller pieces, so helping it to be cleared more easily.

A dry, tickly cough serves no useful purpose and can be very tiring and annoying if it persists for a long time. It is treated by medicines known as cough suppressants or antitussives such as pholcodine and dextromethorphan. Antitussives work by suppressing the cough reflex in the brain. Preparations called demulcents may also be used. These preparations which include glycerin, honey and lemon have a soothing effect, helping to relieve the tickling sensation that is causing the dry cough. They may be taken in the form of a cough medicine or as pastilles.
When to consult your pharmacist
Almost all types of cough medicine can be purchased from a local pharmacy without the need for a prescription. Describe your symptoms of your cough to your pharmacist, and he or she will recommend a product that is suitable for you. Some cough medicines may make you drowsy, so check with the pharmacist if you plan to drive or use machinery.

Your pharmacist will advise you to see your doctor if you are coughing up green or yellow coloured mucus, or if you have had a cough for more than two weeks following a viral infection. These symptoms indicate that you may have a secondary chest infection and your doctor may need to prescribe an antibiotic.

Preparations containing codeine and dihydrocodeine should not be used to treat coughs and colds as they are not considered appropriate and may cause addiction if taken for more than 3 days.

Always describe your symptoms fully to your pharmacist and say whether you have any other illnesses or are taking any other medicines. If the pharmacist thinks that your cough is a symptom of a more serious condition, or if a medicine could be the cause of your cough, the pharmacist will recommend that you see your doctor.
When to see your doctor
If your cough produces mucus that is green or yellow coloured or has an unpleasant smell, or if there is blood in the mucus you should see your doctor. Also see your doctor if your symptoms are not getting any better after about two weeks. You should also see your doctor if you have a persistent, high temperature, a painful cough, wheezing and shortness of breath or if you have trouble swallowing.
Living with a cough
If your cough is caused by a cold or influenza, you can normally expect the cough to go within a week. During this time, drink plenty of fluids to help soothe a dry cough or to help improve a productive and non-productive cough. Cough medicines, as described above, can also be taken if considered necessary.

If the cough persists, there are a number of changes in lifestyle that may provide comfort. If you smoke, make every effort to stop smoking. Your cough may be a sign of the damage that smoking is causing to your lungs and your cough and breathing will continue to get worse if you continue to smoke. Talk to your pharmacist or doctor for help to give up. If your partner or other members of your family smoke, your cough may be caused by passive smoking. Encourage them to try to give up smoking too, or not to smoke in your presence.

Try to avoid irritants and allergens that make you cough. Examples of irritants include paint fumes, perfumes and air fresheners. Examples of allergens include dust, animal fur, mould, and pollens from trees, grasses, and flowers. A room humidifier or steam vaporiser may help relieve an irritated throat and loosen mucus.

Follow a healthy diet that includes fresh fruit and vegetables and be as physically active as you can.

If you suffer from asthma, chronic obstructive pulmonary disease (COPD) or heart disease and your cough is usually followed by a chest infection, go to see your doctor at the first signs of a cough. Take any prescribed antibiotics as directed and ensure that you have adequate supplies of your reliever and preventer inhalers, and that you have the influenza vaccine each year.

If your cough gets worse, if treatments are no longer effective, if you develop chest pain, or if blood appears in your mucus see your doctor immediately.

Reviewed on 22 June 2010


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