Cough – Types, Causes, Symptoms, Prevention and more

Cough is common in the life of a human. We would have coughed innumerable times due to several reasons. It may be due to dust particles, pollution, common cold and other diseases and infections.

Coughing is a reflex action that helps clear the airway filled with mucus and other foreign substances like dust or smoke. It serves as a part of the body’s immune system. It is mostly not a severe issue.

What is Cough?

Coughs are one of the most common medical complaints, accounting for up to 30 million clinical visits each year.

A cough is the body’s reaction to something irritating the throat or airways. Coughing is the abrupt expulsion of air from the lungs via the epiglottis, the small trapdoor that covers the entrance to the windpipe.

The incredible speed with which a cough occurs generates a strong force of air that aids in the removal of unwanted irritants from the breathing passageways.

Cough is usually not painful but the effort of coughing can make a person fatigued.

An occasional cough is normal and causes no concern. A cough that lasts for several weeks or more, or produces discoloured or bloody mucus, may indicate a medical condition.

Most coughs resolve within three weeks and do not require medical treatment.

A dry cough is one that does not produce phlegm or thick mucus. A chesty cough indicates that phlegm is being produced to help clear the airways.

Classification of Cough

Coughs are classified according to the time period that it lasts.

Acute cough

An acute cough is defined as a cough that is present for three weeks or less. It is one of the most common reasons patients seek medical attention.

It is usually caused by a viral infection of the upper respiratory tract called the common cold or the lower respiratory tract known as acute bronchitis.

Subacute cough

Coughs that last at least three weeks but no longer than eight are classified as subacute.

According to The American College of Chest Physicians (ACCP), subacute cough is defined as a cough that lasts no longer than 8 weeks.

When the chest radiography findings are negative, pneumonia is ruled out and the cough resolves eventually, it signifies subacute cough.

The first step in treating patients with subacute cough is to determine whether they have a postinfectious cough.

Chronic cough

A chronic cough is one that lasts at least eight weeks and often much longer.

Although cough is a common symptom of many lung diseases, chronic cough is not always associated with another disease or condition. The chronic cough usually does not respond to treatment.

Chronic cough can burden regular activities by affecting the quality of life like lack of sleep and physical and mental exhaustion.

Refractory cough

Chronic Refractory Cough (CRC) is referred to as a persistent cough that lasts even after treatment.

It affects 20-46 % of patients who visit specialist cough clinics. It has a significant impact on quality of life.

Types of cough

Dry cough 

A dry cough is known as a non-productive cough since there is no mucus present. There is no specific cause for dry cough and can occur in many people.

Dry cough can be caused by a variety of factors, including irritation, physical strain, dry respiratory issues or inflammation.

Wet cough

A wet cough is known as a productive cough as they produce mucus or phlegm. It is extremely low and heavy.

Mucus is expelled from the lungs, causing chest pain and a persistent cough. Allergies, pneumonia, colds and flu can cause wet cough.

Whooping cough

Whooping cough is threatening as it causes a large amount of oxygen to be released from the lungs.

It's a bacterial infection that affects many people. It can also cause asthma attacks, pneumonia and tuberculosis. If a person is diagnosed with whooping cough, treatment must be started immediately.

Burning Cough

Burning cough occurs when there is burning in the throat along with cough. Acid reflux and heartburn are symptoms of a burning cough.

The irritation feels like a burning sensation and results in coughing. Medicines that help reduce acid in our stomachs can aid in controlling the acid produced by the stomach. This can calm the burning feeling.

Severe Cough 

A severe cough that necessitates medical treatment. Symptoms of severe cough include pale skin due to lack of oxygen, high fever for 3 - 4 days and coughing for more than a couple of weeks.

These symptoms do not indicate a severe illness, but medical attention is required when the cough is persistent and discomforting.

Causes of cough

Various factors cause cough. It can be temporary due to dust particles or as a symptom of diseases. It can also be permanent signifying a prolonged illness.

Chronic bronchitis

Bronchitis commonly occurs when irritation and inflammation of the airway happen due to an infection causing more mucus to be produced than usual.

Coughing is the body’s attempt to get rid of the excess mucus. Factors such as air pollution can also cause such coughs.

The condition also makes one cough up mucus, wheeze and experience chest discomfort.

Asthma

Cough is induced in Asthma patients as a result of the narrowed airway and increased mucus secretions.

A type of asthma has chronic cough as the only symptom. This is referred to as cough-variant asthma.

Allergies

Allergic rhinitis is caused by an allergic reaction to substances in the environment. It is an inflammation of the nasal mucosa.

This irritation increases mucus secretion and causes post-nasal drip. The postnasal drip piques the airways, causing coughing.

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) makes the lungs produce excess mucus, resulting in frequent coughs.

A cough does not always clear excess mucus in the lungs. Violent or uncontrollable coughs cause the airways to collapse, trapping the mucus.

GERD

Gastroesophageal reflux disease (GERD accounts for 40% of chronic coughs. GERD causes the backflow of acidic contents from the stomach into the pharynx and larynx. 

This illness frequently causes a cough that worsens in the evenings when the patient is lying flat, allowing for easier stomach reflux.

Smoking

Smokers frequently develop a cough. This cough is caused by the body's attempt to clear out the chemicals that enter the airways and lungs as a result of tobacco use.

A smoker’s cough is a cough that persists for more than three weeks. The cough commences as a dry one and ultimately produces phlegm.

Throat disorders

Throat disorders like laryngitis, the inflammation of the voice box, produce a dry cough and render a hoarse voice as the person feels a constant need to clear the throat.

Medications

Drug-induced chronic cough is a rare cause of chronic cough. This is caused due to certain drugs taken for other conditions.

Drugs that have been linked to cough are

• Angiotensin-converting enzyme inhibitors (ACEs)
• Lotensin (Benazepril)
•  Vasotec (Enalapril)
•  Accupril (Quinapril)
•  Altace (Ramipril)
•  Prinivil (Lisinopril)
• Angiotensin receptor blockers (ARBs)
• Other drugs like omeprazole and leflumide

Symptoms of cough

Cough is signified by symptoms like running nose, throat clearing, heartburn, etc. Sometimes coughs are a symptom of several other conditions.

Runny or stuffy nose

Running nose occurs due to excess mucus production in the nasal passage.

Postnasal drip

Postnasal drip is the flowing of liquid down the back of the throat. When the mucus runs down the back of the throat and is swallowed, a cough or sore throat occurs.

Frequent throat clearing

Frequent throat clearing can sometimes indicate a health problem. Acid reflux, nasal allergies, tic disorders and vocal cord growths can cause this, due to which cough occurs.

Seeing a doctor can help if this symptom is persistent or bothersome.

Hoarseness

Postnasal drip causes mucus to drip from the back of the nose into the throat. This can be due to a cold, smoking or allergy. Postnasal drip causes cough and makes the voice hoarse.

Shortness of breath

Coughing can result in temporary shortness of breath and a sore throat. Aspiration pneumonia occurs when a person's lungs are unable to expel the cough-causing particles. This results in shortness of breath.

Heartburn

The most common symptom of acid reflux or GERD is heartburn, which can also manifest as a chronic cough.

Coughing up blood

Chronic bronchitis is the most common cause of coughing up blood, also known as hemoptysis. COPD exacerbation causes worsening of symptoms and results in coughing up blood. It can also be due to cystic fibrosis.

Treatment for cough

Coughs usually take only 3 to 4 weeks to resolve on their own. It is not always necessary to consult a doctor for a cough unless it is chronic and persistent.

Hydration

Hydrating by drinking plenty of water relieves cough by thinning the mucus in the throat. When the body is hydrated, a person is less likely to cough to clear things out.

Sleeping position

Coughs caused by postnasal dripping can worsen when a person lies down due to gravity. If the cough worsens while lying down, propping up the head and neck is recommended.

The cough can subside by using pillows and elevating the head above the rest of the body. While this may be beneficial for adults, it is not recommended for young children. 

Use cough drops 

Cough syrups and drops work best for cough relief. They work as a cough suppressant or an anaesthetic in the mouth. Taking cough drops strops coughing and soothes mild infections in the throat.

Cough drops can contain any combination of the following OTC medications:

• Dextromethorphan
• Decongestants include pseudoephedrine
• Guaifenesin, an expectorant, has the ability to loosen secretions. It's the most secure option.

Gargle with warm saltwater  

A saltwater gargle is exactly what one requires for treating sore throat and mucus produced while coughing.

Saltwater will aid in the removal of mucus and phlegm from the back of the throat, reducing the need to cough.

Avoid irritants 

Few individuals are allergic to certain substances called irritants that induce cough. The following are some common irritants to be avoided.

• Dust
• Pollen
• Mold
• Smoke
• Perfumes and other strong odours
• Dander from pets
• Medications like ACE inhibitors

Add honey or ginger to hot tea  

Tea with ginger and honey is useful for coughs and sore throats. Ginger reduces the inflammation caused due to sore throat while honey soothes and manages rough cough.

Use decongestant sprays 

Postnasal drip can cause coughing and symptoms like throat pain and swallowing difficulty. Decongestants reduce postnasal drip, Making a person cough less frequently and feel less pain and discomfort.

Diagnostic tests

When the cough is accompanied by additional symptoms like chest pain, fever, drowsiness, confusion, headache, blood cough or difficulty breathing, further tests will be required.

Chest X-Ray  

A chest X-ray assists doctors in determining the source of a cough and shortness of breath. Signs of pneumonia, collapsed lung, broken ribs and heart problems can be detected after an injury with the help of a chest x-ray.

Blood Test  

Blood tests are not usually used for diagnosing cough, but certain tests can indicate the presence of pneumonia or certain auto-immune health conditions that causes cough.

• White blood cell count - High levels indicate inflammation or infection.
• Sputum analysis
• Cough & cold profile test

CT Scan  

CT scans are used to look for conditions that cause chronic coughing and for finding the infections in the sinus cavities.

Oesophageal pH monitoring 

Oesophageal pH monitoring is a diagnostic method to confirm the diagnosis of GERD-related cough.

Oesophageal pH monitoring is a valid measure of oesophageal acid exposure and can be useful in correlating cough with acid reflux episodes. This helps in identifying patients with wheezing or respiratory symptoms for whom GERD is an aggravating factor.

Cough prevention

The last thing anyone would want is to spread cough to their close ones. It is what we expect from others as well. Some of the most basic and effective methods for preventing person-to-person or object-to-person transmission are as follows.

Practice good hand hygiene

Hands touch random surfaces and objects that can possess infection-causing bacteria. It is, therefore, necessary to practice good hand hygiene.

Handwashing should be done after using hands to cover cough or sneeze. This can prevent the spread of respiratory illnesses like whooping cough, pneumonia and influenza.  

Cover your cough  

Covering the mouth while coughing or sneezing is an effective way to help prevent germs from spreading among those around us.

Avoid irritants 

Acute exposure to some fumes and vapours can cause throat and airway inflammation that results in coughing. Avoid inhaling irritants like dust, perfumes and pollutants that cause cough.

Ginger tea helps in relieving throat irritation and cough.

Practice social distancing  

Cough can easily spread between people who are in close quarters. It is recommended for people coughing to maintain a social distance of at least 2 to 6 meters to prevent transmitting the germs.

Self-quarantine  

Self-quarantine is usually not required for random and normal coughs. When coughs occur as a symptom of a communicable disease like coronavirus, quarantining becomes mandatory.

When to see a doctor? 

Doctor consultation is necessary when a person has a persistent cough along with the below-mentioned symptoms.

• Too much mucus while coughing.
• The mucus is red.
• Wheezing, shortness of breath or a tight chest is present.
• Fever that doesn’t subside for more than 3 days.
• Experiencing chills or nighttime coughing fits.
• Constant coughing for 7 days and more.

Conclusion

Coughs are one of the most common medical complaints that are a reflex action that helps clear the airway filled with mucus and other substances. Cough has many types and it can be a symptom of some other medical condition.

A cough usually resolves on its own, but when it is persistent, treatment and medical attention are required. Home remedies like saltwater gargle, tea with honey and ginger and adequate hydration can be provided as primary treatment.

If the symptoms don’t subside, a doctor’s consultation will help. It is advisable to be prepared and follow hygienic practices to avoid acquiring a cough.

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