Cough

When air passes out through our voice box with force, a sound is made that we all recognize as a “cough”. The act of coughing usually begins with a deep breath in, followed by air leaving the mouth with force. A cough is your body’s way of preventing material from entering your breathing tubes (airways) and clearing mucus or foreign material from your airways. Cough is the most common complaint for which patients seek medical care.

A cough is not a disease, but can be a common symptom of different upper and lower respiratory tract diseases. Even if you do not have a lung disease, you may cough.

What causes a cough?

A cough can happen when something irritates your nerve endings, called cough receptors. These nerve endings are in many areas inside your body, from your head and neck area, to just above your navel (belly button). Inhaling particles, vapors, smoke, fumes, dust, or cold air may irritate these receptors and may make you cough.

Can a cough spread infection?

Cough can be a way of spreading infection to others. Influenza (the flu) and tuberculosis (TB) are examples of infections that can be spread by coughing infected droplets into the air. While a cold virus (the common cold) can be passed on to others by coughing, cold viruses are much more likely to be spread to others by hand to nose contact. Hand-to-nose contact is when you shake hands with someone who has the infection or touch something that has the cold virus on it and then your touch your nose or eyes.

To help decrease the spread of infection, you should:

Is there anything special that I should know about my cough?

If you have a cough, keep track of how long you have been coughing. Your healthcare provider may also ask questions about whether or not it is wet or dry, or whether it wakes you from sleep, but research suggests that this information may not help determine the true cause of cough. We do know, though, that a forceful cough can lead to vomiting. A respiratory infection that is typically associated with coughing that provokes vomiting is called pertussis (whooping cough). Such a cough-vomit syndrome, according to the CDC, should alert one to the possibility of pertussis. For more information on whooping cough, see the ATS patient information series piece “Pertussis” at www.thoracic.org/patients/.

Acute, Sub-acute and Chronic Cough

There are three time periods to use as you describe how long you have had your cough: acute (lasts less than 3 weeks), subacute (lasts 3 to 8 weeks) or chronic (lasts more than 8 weeks and does not let up).

When should I contact my healthcare provider about my cough?

Any time that your cough concerns you, you should discuss Any time that your cough concerns you, you should discuss:

When might I need specialist care?

Your primary healthcare provider often will be able to answer your questions about your cough. If your primary healthcare provider is unable to find the reason for your cough or find solutions to reduce your cough, you may be referred to a lung specialist (pulmonologist). If the pulmonologist cannot explain or find the cause of your cough, you should ask to be referred to a cough specialist. Sometimes, a complete evaluation of your cough may include more than just your respiratory system. You may, for example, need an evaluation of your gastrointestinal (GI) tract. You may also need to see an otolaryngologist (specialist who deals with the nose, sinuses, ears, and throat).

Frequently asked questions about cough

Can medications cause cough? Yes, some medications can cause you to cough. A common cause is from a category of drugs called angiotensin converting enzyme inhibitors, also referred to as “ACE inhibitors”. These drugs are commonly given for high blood pressure or heart failure. If you start coughing after you start a new medicine, tell your healthcare provider.

Should I take over-the-counter cough medications? Over-thecounter (OTC) cough and cold medications are drugs that you can buy without a prescription. For this reason, you should discuss using them with your healthcare provider before using them. In adults, if you choose to use OTC medications for cough due to the common cold, the use of one of the antihistamines such as diphenhydramine, brompheniramine or chlorpheniramine or a non-steroidal anti-inflammatory drugs (NSAID) may be tried for a common cold as long as there is no reason why you should not take them. These drugs can cause side effects or problems for some people, such as an allergy, possible drug interaction, or other health problem. For example, for those with glaucoma, chlorpheniramine or brompheniramine can cause problems with glaucoma or an enlarged prostate. NSAID medications such as ibuprofen or naproxen can cause kidney problems or stomach irritation or worsen other health problems such as heart failure. If you take an OTC cough medicine and your cough does not get better or you begin to feel worse, contact your healthcare provider.

Since 2008, the US FDA has recommended that cold and cough products not be used in children under the age of 2 because of the risk of serious and potentially life-threatening side effects. The Consumer Healthcare Products Association (CHPA) representing most of the manufacturers of these OTC products volunteered to modify the product labels of OTC cough and cold medicines to state “do not use” in children under 4 years of age.

Are there any vaccines that can help prevent cough in adults? Yes, consider getting the influenza (flu) shot each year. Those with allergies to eggs should speak to their healthcare provider before getting this shot. Other important vaccines for adults include the pneumonia (pneumococcal) shot and the whooping cough vaccine. Ask your healthcare provider if and when you should get these shots. For more information on these vaccines, see the ATS Patient Information Series at www.thoracic.org/patients/.

Is there one treatment that will stop my cough? While one treatment might work, several medications may be needed. If you have a chronic cough, you may need to use several medications to address each condition causing the cough. What should I do if I am told to “live with” my chronic cough? You should ask your healthcare provider for a referral to someone who specializes in the care and treatment of chronic cough. With some chronic conditions, such as bronchiectasis, Interstitial Lung Disease (ILD), or CF, you may have a daily cough. If the cough changes or worsens over time, or negatively impacts your quality of life, talk to your healthcare provider about a referral to a center that specializes in the evaluation and treatment of cough.

TAKEAWAY POINTS

✔ Contact your health care provider if you spit up blood, blackout, have trouble breathing, have unexplained weight loss, develop sharp pain when you cough, if your cough that did not come on after a respiratory infection has lasted longer than 3 weeks, or if your cough lasts longer than 8 weeks or causes you concern.

✔ Cover your nose and mouth whenever you cough or sneeze.

 ✔ Do good handwashing regularly.

 ✔ Do not smoke and avoid contact with secondhand smoke, strong fumes and air pollution.

 

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