All About Coughs

A cough is a reflex action that is necessary to keep your airway and throat clear of moisture and obstructions. It protects your lungs and body and promotes healing. There are basically 2 types of coughs – acute and chronic. Acute coughs are sudden and can be due to choking or an illness or health condition but normally last no longer than a couple of weeks. Chronic coughs are generally due to a more serious health condition, illness or disease but last a lot longer.

Acute coughs are usually caused by the common cold or flu but can be attributed to secondary infections in the nasal cavities or due to bronchitis or pneumonia and can last as long as 3 weeks. Subacute coughs on the other hand last longer than 3 weeks but under 8 weeks and hang around long after a primary or secondary infection has disappeared. Coughs that last longer than 8 weeks are considered to be chronic and can be due to GERD (Gastroesophageal reflux), a continuous post nasal drip, long term sinus infections, allergies as well as lung conditions like asthma, pulmonary fibrosis, COPD (Chronic Obstructive Pulmonary Disease) and interstitial lung disease or smoking.

A medical practitioner will take into consideration your medical history, current symptoms as well as results from a physical exam in making a diagnosis and finding an effective treatment to alleviate the problem. Keep in mind that a cough is a symptom of another condition and can be resolved by addressing the irritation such as quitting smoking, taking medication to alleviate allergies, sinus or post nasal drip conditions or cough medicine for acute, extreme or disruptive coughs.

In general, coughs result from a viral infection and will disappear once the viral infection has passed. These types of infections affect the throat or larynx, the airway or trachea, the esophagus or the bronchial tubes accessing the lungs. Infections of this type may be mild or severe and can include Laryngitis, Bronchitis and Tracheitis.

A cough may develop after a day or two of an infection and is often associated with other symptoms such as pain, fever and headaches. Cold and flu symptoms will occur if the infection has spread to the nasal area. In the case of these two viruses, symptoms should be most extreme after 2 or 3 days and then slowly dissipate. It can take up to 4 weeks for a cough related to a viral infection to clear up. This is due to the fact that viral infections cause inflammation that could take additional time to heal.

Most commonly, coughs are caused by an upper respiratory tract infection from viruses as explained above or a build up of mucous in the sinuses. This mucous runs or drips from the sinuses into the throat causing irritation that the results in a reflex action to prevent the moisture from entering the lungs. This “cough reflex” occurs when the nerves send a signal to the brain which reacts to the problem. These nerves are especially sensitive when an infection is present. The nerves may continue to send signals after the infection has disappeared or the infection could become prolonged resulting in a chronic cough.

Bacteria may also cause an infection of the upper and lower respiratory tracts. These are often more serious than viral infections and usually require treatment with an antibiotic.

While a cough can signify serious illness or disease, it is actually a defense mechanism that the body uses to prevent illness from occurring. Not only does it stop unwanted mucous from entering the lungs, it also discharges viruses, bacteria and other microbes that may be responsible for or become responsible for causing an infection.

The coughing action starts with inhaling a large breath of air, deep into the lungs. The windpipe or trachea is then shut by the glottis and the muscles in the chest, diaghragm and abdomen contract. These muscles contract nominally during natural and regular breathing, but with closing of the glottis, greater pressure builds up. When the glottis opens, the contracted muscles force the air out of the lungs in one big “whoosh” which we refer to as a cough.

A cough, both acute and chronic is one of the most common reasons for people to visit a doctor. While the cough may only be a symptom of another illness or health condition, the cough itself can become problematic, especially in chronic cases. Patients often refer to their illness as a cough rather than the condition causing the cough that they have been diagnosed with. Treatment for the cause as well as the cough is often the recommended route for physicians to take to combat both problems in one go.

Considering the extended period of time that a cough can continue for, it can cause significant stress, anxiety and affect the ability to function normally and disrupt sleep. This in turn causes fatigue, impaired concentration and disrupt other physical and cognitive function.

Social interactions may also suffer as a result as people shy away from a person coughing as this is a common way to spread disease and illness. In addition, it may result in other side effects such as incontinence, dizziness and fainting and in extreme cases, a coughing fit can cause broken ribs. Treatment for a chronic cough can become costly due to the expense of medical treatments as well as lost work hours.

However, it is important to note that coughing is a natural mechanism of the body and coughing once or twice a day is normal to expel any unwanted detritus that may be breathed in through the mouth or nose. The concern should be around identifying a natural cough and a cough that could signify an underlying health condition. So how do you know the difference, how can you tell a chronic cough from an acute cough and when should you seek medical attention?

Answer this very important question:

What is the type of cough that you have?

1. Ticklish Cough

A ticklish sensation in the back of the throat can cause a cough reflex and is the most common cause of a cough and probably the most irritating as coughing does not actually alleviate the tickle. This tickle may be the result of a post nasal drop or other irritation in the upper throat and is normally non-productive meaning no mucous or phlegm is expelled during the cough.

A post nasal drip is caused when the natural amount of mucous production in the nasal cavity is increased, normally due to inflammation or infection. The excess liquid then drips down the back of the throat causing that irritating tickle and initiating the cough reflex.

Post nasal drip may be caused by:

– A viral infection like a cold or flu.
– An allergy such as hay-fever or allergic rhinitus.

A great home remedy for a tickly cough is honey dissolved in warm water. Extracts from pine needles available over the counter at your pharmacy may also be effective. However, if the cause is an allergy, it is best to consult your doctor or pharmacist to prescribe an antihistamine or other medical treatment.

2. Chest Cough

Chest coughs are most significantly triggered from the chest area rather than the throat. This is usually a productive cough that expels mucous or lumpy phlegm that may build up in the upper or even lower respiratory tract. The cause of a chest cough is most often due to increased mucous production that is a result of inflammation of the lining of the upper respiratory tract. This type of cough is generally worse in the morning because mucous will build up while you are sleeping and need to be discharged by coughing in the morning.

Colds and flu are the most common cause of a chest cough and appears at the beginning of the infection but may linger long after the infection has cleared up. Smoking is the other most common cause of a chest cough resulting from a build up of tar and other residue that can cause increased mucous production that is necessary to expel these unwanted substances. Secondary infections such as bronchitis or pneumonia may also cause a chesty cough. It is essential to seek medical attention if the coughing results in shortness of breath, chest pain or if the phlegm has a bad odor or is blood stained.

You should avoid smoking or exposure to secondhand smoke and other pollutants when you have a chest cough. Steam can help loosen the mucous making it easier to expel as can some light exercise. There a a number of herbal remedies that can also be helpful like liquorice, menthol, thyme and ivy.

3. Nervous Cough

This is a dry, unproductive cough that isn’t caused by a tickle in the throat or any other type of irritation. This can be referred to as psychosomatic illness caused by stress, anxiety or other emotions. In other words, the cough only presents or worsens when a person is stressed, anxious or emotional. This is a rare diagnosis and a doctor will only consider this as an option when all other causes for the cough have been eliminated. A telling factor is that the cough does not affect sleep and in fact disappears when you are sleeping.

However, this type of cough is not purely in the mind. The nerves in the throat may react to stressful situations causing the reflex or the brain itself may send the signal when it is under stress. Treatment for this type of cough normally relies on alleviating anxiety and stress.

4. A Persistent Cough

This can also be referred to as a chronic cough that lasts for a period exceeding 8 weeks (4 weeks for a child). It is important to consult a medical professional as soon as possible to find the underlying cause of the cough. Most often, a persistent cough is a symptom of a serious health condition, illness or disease. If you smoke or have a family history of respiratory or lung disease, it is even more important to seek a medical diagnosis.

It is however important to keep in mind that a persistent cough may also be due to minor health conditions as described above for the other types of coughs. But it is still important to get a cough that lasts longer than 8 weeks checked out to rule out more serious causes.