COUGH


Dr. B.B. Mathur,
M.D. (Tuberculosis & Respiratory diseases)
Professor & Head,
Deptt. of Pulmonary Medicine.
S.P. Medical College, Bikaner
Address, 3/7, Medical College Campus,
Bikaner–334003
Telephone : R-0151–2528789, O-0151–2226333, Mo 9414138689
Email id : drmathurbb@yahoo.co.in




(Cough is not a disease itself but is one of the commonest complaints of most respiratory ailments. It is caused by very simple disease like common cold to dreaded disease like Lung Cancer. It is always wise not to ignore it. Author has nicely explained the mechanism of production of cough with causes and process of reaching a diagnosis.)
Editor


                  Cough is very common respiratory symptom. Cough is one of the most common reasons for a patient to consult a doctor at all ages. Coughing is a reflex action started by stimulation of sensory nerves in the lining of the respiratory passages. As a result air is escape out forcefully under high pressure. Cough is a defensive mechanism of body from getting entry of various dust or dirt which may further lead to infection in the respiratory tract. Coughing means there is something in the respiratory passages that should not be there. This can be caused by breathing dust particles in the air or when a piece of food goes in the airway. Cough can be done voluntarily by a person but generally it is an involuntary process.
Causes of cough: According to duration of cough can be classified in two types:
1. Acute cough: This type of cough begins suddenly and usually last no more then 2-3 weeks.
Common causes of acute cough are:
URI (common cold), allergic rhinitis, bronchitis, COPD, pneumonia, inhalation of foreign body, whooping cough, acute heart failure etc.
2. Chronic cough: Cough persisting for more than 3 weeks.
Common causes of chronic cough are:
Smoking, COPD, post nasal drip, tuberculosis, bronchial asthma, bronchiectasis, drugs and environment related irritants like dust, fumes, pollution, Pollens, Animal dander, industrial chemicals etc.
Cough associated symptoms:

• Sometimes cough is associated with expectoration then it is called as productive cough. If there is no expectoration along with cough then it is called as dry cough.
• Dry cough is usually caused by Upper Respiratory Tract Inflammation (URTI), smoking, asthma, lung cancer etc.
• Productive cough is usually caused by pneumonia, pulmonary tuberculosis.
• Fever, throat pain, running nose associated with cough suggests URTI (upper respiratory tract infection or common cold).
• Seasonal cough and wheezing occurs in patients of asthma.
• Nasal discharge and frequent throat clearing indicates post nasal drip.
• Heart burn or sensation of regurgitation indicative of GERD (gastro esophageal reflux disease).
• Smoking is the only cause in some patients of cough.
• Nocturnal cough observed in asthma patients.
• Some medicines used for lowering the blood pressure (ACE inhibitors) may be the cause of cough.
• Hemoptysis (blood in sputum) is commonly observed in patients of pulmonary tuberculosis, lung cancer, bronchiectsis, pneumonia, lung abscesss etc.
(ICS website, Public Forum, I issue, Nov. 2011, article No.2) 2PD.

• Smoker’s cough may improve if smoking is stopped by the person.
• Replacement of certain antihypertensive drugs (ACE inhibitors) with another drug is useful in cough caused by it.
• Anti acidity drugs and elevation of head end of bed are useful in decreasing the cough caused by GERD.
• Cough caused by postnasal drip usually treated with decongestant therapy, nasal spray and antihistaminics.
• For whooping cough, antibiotics (Erythromycin) treatment is necessary. But for prevention vaccine is available against it and can be given to a child in the form of pertusis vaccine in combination (DPT).
• If a cough is related to environmental irritants like dusts, pollens, pet dander, industrial chemical, pollution and fumes, then it may be improved by stopping the exposure to offending agent and some anti allergic medications.
Non specific therapy: Non specific therapy or symptomatic therapy of cough should be considered when cause of cough is not known and specific treatment is not possible or cough causes marked discomfort to patient. Cough may be suppressed by a cough sedative agents like codeine, dexomethorphan or benzonatate. These drugs provides symptomatic relief. Some cough sedative are narcotic medications so one should take care to avoid operating machinery, driving, and avoid to alcohol while using these medicines.
(ICS website, Public Forum, I issue, Nov. 2011, article No.2) 3

Dr. B.B. Mathur