Coughs

A cough occurs when the throat or airway has been irritated, usually by mucus or foreign particles such as dust or smoke. It is the body’s way of clearing the irritant from the throat and getting more air into the lungs. Coughs are not usually a sign of serious disease, but can be very annoying to the sufferer, especially if they occur at night, disrupting sleep or persist for longer than a couple of weeks. Most coughs will clear up on their own, or at least improve, within two weeks. These are called ‘acute’ coughs. Coughs that persist for longer than eight weeks are called chronic coughs.

The majority of acute coughs are caused by viruses and clear up without any treatment. In children, an upper respiratory tract infection caused by a virus (eg the common cold) is the most usual cause of cough. Influenza, laryngitis, bronchitis and pneumonia also cause an acute cough.

Chronic coughs are often present in smokers, people suffering from post-nasal drip, GERD (gastro-oesophageal reflux disease) and asthma. Both asthma and GERD can initially present as a persistent night-time cough. Some medicines (e.g ACE inhibitors) can cause a chronic cough which only stops when the medicine is discontinued. In rare cases a chronic cough can be caused by heart failure or cancer which is why it is important that any cough that does not seem to be improving after three weeks should be seen by a doctor.

Other common causes of cough can be hayfever and illnesses that occur more often in childhood such as croup and whooping cough. Both whooping cough and croup have quite distinctive sounding coughs, which parents should be alert for. Whooping cough is a severe, choking cough that sounds like a ‘whoop’ when the child breathes in. The child can vomit or turn blue if the airways become blocked due to the mucus plug produced as a result of this bacterial infection. Vaccination is the best prevention for this as there is no treatment to ease the cough. With croup, a viral illness, the windpipe becomes narrow and inflamed. The resulting cough sounds harsh, like a barking seal. Although croup is usually a mild illness and responds well to moist, cool air, some children will develop stridor, a squeaking sound as they inhale and/or very fast breathing, which needs immediate medical attention.

Coughs can be classified as either wet/productive or dry/non-productive. A wet cough produces phlegm (mucus) and is described as sounding ‘chesty’. A dry cough doesn’t produce any mucus and is often described as sounding harsh, like a bark or a whoop. Over-the-counter cough medicines can help with both productive or non-productive coughs, although they are not recommended for children under the age of six years. Cough medicines containing the expectorant guaiphenesin thin and loosen mucus and lubricate irritated respiratory tracts. Bromhexine is a mucolytic that breaks down mucus and makes it easier to cough up. Cough suppressants such as pholcodine and dextromethorphan can ease a dry, tickly cough.

Non-medicinal treatment for a cough includes rest, hydration, and throat gargles. For children try chest rubs (containing eucalyptus or tea tree), warm drinks such as honey and lemon (avoid honey in children under the age of one year). Invest in a cold steam vaporizer to create moist cool air in the bedroom to relieve irritated throats. Elevating the head by using extra pillows at night or raising the head end of the cot/bed can help with cough caused by post-nasal drip. Try to avoid irritants such as dust and smoke. Be alert for warning signs that may indicate a worsening condition or more serious disease such as difficulty breathing (including fast breathing or breathing that looks like hard work), finding it hard to talk or can’t finish a sentence due to cough, coughing up blood, chest pain, weight loss, lumps/swelling in the neck, difficulty swallowing, whistling or wheezing noises on inhalation, temperatures over 38.5°C, or permanent changes to the sound of the voice. These all require immediate medical attention.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.