Cough

Symptoms

DEFINITION

• Cough is non-productive (dry cough) if there is minimal clear-white or no phlegm (sputum)
• Cough is productive (wet cough) if there is yellow, green, or brown phlegm (sputum)

General Information

• A cough is the sound made when the cough reflex suddenly expels air and secretions from the lungs.
• Cough is one of the most common symptoms that patients experience.. It is the fifth most common reason for visits to physicians.
• The common cold is the single most common cause of acute cough (i.e., cough less than 3 weeks in duration).
• Smokers may have a chronic cough, especially in the morning.

Why We Cough - A cough has two important functions:

• It serves to clear the airways of infection, mucus, foreign bodies, and other irritants.
• It protects against aspiration of oral and stomach contents.

Causes of Coughing

• Most common causes: postnasal drip syndrome from a cold, allergic rhinitis, and sinusitis.
• Other common causes: asthma, bronchitis, pneumonia, gastroesophageal reflux, and smoking.
• Less common causes: lung cancer, congestive heart failure, pulmonary embolism, TB, Whooping Cough, and ACE inhibitor drugs

Angiotensin-Converting Enzyme (ACE) Inhibitors can cause a dry chronic cough. Generic and trade name listing:

• Benazepril - Lotensin
• Captopril - Capoten
• Cilazapril - Inhibace
• Enalapril, Enalaprilat - Vasotec
• Fosinopril - Monopril
• Lisinopril - Zestril
• Moexipril - Univasc
• Perindopril - Aceon, Coversyl
• Quinapril - Accupril
• Ramipril - Altace
• Trandolapril - Mavik

Honey for Cough

• Recent Research Study: A recent research study compared honey to either dextromethorphan (DM) or no treatment for the treatment of nocturnal coughing. The study group contained 105 children age 2 to 18 years. Honey consistently scored the best for reducing cough frequency and cough severity. It also scored best for improving sleep. Dextromethorphan (DM) did not score any better than "no treatment" (showing DM's lack of effect).
• How Might Honey Work? One explanation for how honey works is that sweet substances naturally cause reflex salivation and increased airway secretions. These secretions may lubricate the airway and remove the trigger (or tickle) that causes a dry, nonproductive cough.
• Adult Dosage: 2 teaspoons (10 ml) at bedtime

See More Appropriate Topic (instead of this one) If

• You are coughing because of an ASTHMA ATTACK
• You have a COMMON COLD
• Any CHEST PAIN
• EARACHE is your main concern

Should I Call?

WHEN TO CALL YOUR DOCTOR

Care at Home

HOME CARE ADVICE

General Care Advice for Mild to Moderate Cough

1. Reassurance
   • Coughing is the way that our lungs remove irritants and mucus. It helps protect our lungs from getting pneumonia. 
   • You can get a dry hacking cough after a chest cold. Sometimes this type of cough can last 1-3 weeks, and be worse at night.
   • You can also get a cough after being exposed to irritating substances like smoke, strong perfumes, and dust.
2. Cough Medicines:
   • OTC Cough Syrups: The most common cough suppressant in OTC cough medications is dextromethorphan. Often the letters "DM" appear in the name. 
   • OTC Cough Drops: Cough drops can help a lot, especially for mild coughs. They reduce coughing by soothing your irritated throat and removing that tickle sensation in the back of the throat. Cough drops also have the advantage of portability - you can carry them with you.
   • Home Remedy - Hard Candy: Hard candy works just as well as medicine-flavored OTC cough drops. Diabetics should use sugar-free candy.
   • Home Remedy - Honey: An old home remedy has been shown to help decrease coughing at night. The adult dosage is 2 teaspoons (10 ml) at bedtime.
3. OTC Cough Syrup - Dextromethorphan:
   • Cough syrups containing the cough supppresant dextromethorphan (DM) may help decrease your cough. Cough syrups work best for coughs that keep you awake at night. They can also sometimes helpin the late stages of a respiratory infection when the cough is dry and hacking.They can be used along with cough drops.
   • Examples: Benylin, Robitussin DM, Vicks 44 Cough Relief
   • Read the package instructions for dosage, contraindications, and other important information. 
4. Caution - Dextropmethorphan:
   • Do not try to completelysuppress coughs that produce mucus and phlegm. Remember that coughing is helpful in bringing up mucus from the lungs and preventing pneumonia.
   • Research Notes: Dextromethorphan in some research studies has been shown to reduce the frequency and severity of cough in adults (18 years or older) without significant adverse effects. However, other studies suggestthat dextromethorphan is no better than placebo at reducing a cough.
   • Drug Abuse Potential: It shouldbe noted that dextromethorphan has become a drug of abuse. Overdose symptoms can range from giggling and to hallucinations or coma.
   • CONTRAINDICATED: Do not take dextromethorphan if you are taking a monoamine oxidase (MAO) inhibitor now or in the past 2 weeks. Examples of MAO inhibitors include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate). Do not take dextromethorphan if you are taking venlafaxine (Effexor). 
5. Coughing Spasms:
   • Drink warm fluids. Inhale warm mist (Reason: both relax the airway and loosen up the phlegm).
   • Suck on cough drops or hard candy to coat the irritated throat.
6. Prevent Dehydration:
   • Drink adequate liquids
   • This will help soothe an irritated or dry throat and loosen up the phlegm.
7. Avoid Tobacco Smoke: Smoking or being exposed to smoke makes coughs much worse.
8. Fever Medication:
   • For fevers above 101° F (38.3° C) take acetaminophen or ibuprofen. The goal of fever therapy is to bring the fever down to a comfortable level. Remember that fever medicine usually lowers fever 2 degrees F (1 - 1 1/2 degrees C).
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
9. Expected Course: Viral bronchitis causes a cough that lasts 1 to 3 weeks. Sometimes you may cough up lots of phlegm (sputum, mucus). The mucus can normally be white, gray, yellow or green.
10. Call Your Doctor If:
    • Difficulty breathing
    • Cough lasts more than 3 weeks
    • Fever lasts longer than 3 days
    • You become worse

Cough with Cold Symptoms

1. Reassurance:
   • Colds are very common and may make you feel uncomfortable.
   • Colds are caused by viruses, and no medicine or "shot" will cure an uncomplicated cold.
   • Colds are usually not serious. An uncomplicated cold can be treated at home.
2. For a Stuffy Nose - Use Nasal Washes: 
   • Introduction: Saline (salt water) nasal irrigation is an effective and simple home remedy for treating cold symptoms and other conditions involving the nasal and sinus passages. Nasal irrigation consists of pouring, spraying, or squirting salt water into the nose and then letting it run back out.
   • How it Helps: The salt water rinses out excess mucus, washes out any irritants (dust, allergens) that might be present, and moisturizes the nasal cavity.
   • Methods: There are several ways to perform nasal irrigation. You can use a saline nasal spray bottle (available over-the-counter), a rubber ear syringe, a medical syringe without the needle, or a Neti Pot.

Step-By-Step Instructions:

• Step 1:Lean over a sink.
• Step 2: Gently squirt or spray warm salt water into one of your nostrils.
• Step 3: Some of the water may run into the back of your throat. Spit this out. If you swallow the salt water it will not hurt you.
• Step 4: Blow your nose to clean out the water and mucus.
• Step 5: Repeat steps 1-4 for the other nostril. You can do this a couple times a day if it seems to help you.

How to Make Saline (Salt Water) Nasal Wash: Add 1/2 tsp of table salt to 1 cup (8 oz; 240 ml) of warm water.

1. For a Runny Nose With Profuse Discharge:  Blow the Nose.
   • Nasal mucus and discharge helps to wash viruses and bacteria out of the nose and sinuses.
   • Blowing the nose is all that is needed.
   • If the skin around your nostrils gets irritated, apply a tiny amount of petroleum ointment to the nasal openings once or twice a day.
2. Medicines for a Stuffy or Runny Nose:
   • Most cold medicines that are available over-the-counter (OTC) are not helpful.
   • Antihistamines: Are only helpful if you also have nasal allergies.
   • If you have a very runny nose and you really think you need a medicine, you can try using a nasal decongestant for a couple days.
3. Nasal Decongestants for a Very Stuffy or Runny Nose:
   • If you have a very stuffy nose, nasal decongestant medicines can shrink the swollen nasal mucosa and allow for easier breathing. If you have a very runny nose, these medicines can reduce the amount of drainage. They may be taken as pills by mouth or as a nasal spray.
   • Most people do NOT need to use these medicines.
   • Pseudoephedrine(Sudafed) is available OTC in pill form. Typical adult dosage is two 30 mg tablets every 6 hours. Read package instructions.
   • Pheylephrine(Sudafed PE) is available OTC in pill form. Typical adult dosage is one 10 mg tablets every 4 hours. Read package instructions.
   • Oxymetazoline Nasal Drops(Afrin) are available OTC. Clean out the nose before using. Spray each nostril once, wait one minute for absorption, and then spray a second time. Read package instructions.
   • Phenylephrine Nasal Drops(Neo-Synephrine) are available OTC. Clean out the nose before using. Spray each nostril once, wait one minute for absorption, and then spray a second time. Read package instructions.
4. Caution - Nasal Decongestants:
   • Do not take these medications if you have high blood pressure, heart disease, prostate enlargement, or an overactive thyroid.
   • Do not take these medications if you are pregnant.
   • Do not take these medications if you have used a MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the past 2 weeks. Life-threatening side effects can occur.
   • Do not use these medications for more than 3 days (Reason: rebound nasal congestion).
5. Pain and Fever Medication:
   • For pain and fever relief, take acetaminophen or ibuprofen.
   • Acetaminophen(e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen(e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, heart failure, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
6. Contagiousness:
   • The cold virus is present in your nasal secretions.
   • Cover your nose and mouth with a tissue when you sneeze or cough.
   • Wash your hands frequently with soap and water.
   • You can return to work or school after the fever is gone and you feel well enough to participate in normal activities.
7. Expected Course:
   • Fever may last 2-3 days
   • Nasal discharge 7-14 days
   • Cough up to 2-3 weeks.
8. Call Your Doctor If:
   • Difficulty breathing occurs
   • Fever lasts more than 3 days
   • Nasal discharge lasts more than 10 days
   • Cough lasts more than 3 weeks
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.