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Health Update: Coughing - Causes and Treatments

Health Update: Coughing - Causes and Treatments

A cough is a reflex that assists you to clear your airways of irritants. Nerves in the airways become stimulated by allergens, medical conditions, medications, and other irritants, resulting in a vigorous expulsion of air from the lungs.

There are a multitude of causes for coughing. Typical causes of cough include:

  • Allergens: pollen, dust, animal dander, mold
  • Irritants: smoking, inhaling secondhand smoke, pollution, chemical odors, perfumes, air deodorizers
  • Medical conditions: common cold, upper respiratory tract infection, flu, pneumonia, Pertussis (whooping cough), asthma, gastroesophageal reflux disease (GERD), sinus infections, postnasal drip, bronchitis, , bronchiectasis, chronic obstructive pulmonary disease (COPD), lung cancer, heart failure
  • Medications: ACE inhibitors, beta blockers.
  • A dry cough is commonly the result of cold and flu viruses, allergies, acid reflux, ACE inhibitor medications, and irritants such as cigarette smoke.
  • A wet cough is often caused by cold or flu viruses, or chronic obstructive pulmonary disease (COPD).
  • Heart disease, asthma, lung disease, bronchitis, and whooping cough may be the culprit if a person experiences a persistent, or chronic, cough lasting more than 3 weeks.

Being aware of which type of cough you have will help in discovering the underlying cause and whether it is infectious or noninfectious.

Once the cause of your cough is diagnosed and any serious underlying medical conditions have been ruled out, symptoms of cough often may be treated successfully with home remedies. Here are some helpful tips:

  1. Stay hydrated: Drink lots of water to thin mucus.
  2. Use a humidifier to loosen mucus.
  3. Cough drops or lozenges soothe an irritated throat (do not use in young children).
  4. Saltwater gargle clears mucus from the throat.
  5. Use an extra pillow to elevate your head at night.
  6. Don't smoke and avoid secondhand smoke.
  7. Avoid inhaled irritants such as dust, perfumes, or pollutants.
  8. Chicken soup may ease symptoms of upper respiratory tract infections.
  9. Chocolate! Theobromide, and ingredient in chocolate, may in fact suppress vagal nerve activity that causes coughing.

Talk to your doctor before using any herbal remedies or natural supplements as some may be contraindicated with medications you already take.

There are a number of over-the-counter (OTC) cough medicines available to relive or cure coughs. These fall into two main categories; cough suppressants, and expectorants. They can be purchased in tablet or syrup form.

  • Cough suppressants
    • Cough suppressants, also called antitussives, block the cough reflex to relieve cough. A common OTC cough suppressant is dextromethorphan.
  • Expectorants
    • Expectorants work by thinning mucus. The only OTC expectorant is guaifenesin, found in products such as Mucinex and Robitussin Chest Congestion.
  • Combinations (cough suppressants and expectorants)
    • Dextromethorphan and guaifenesin are often found in combination products, for example, combined with each other in Robitussin DM. These medications also may be combined with other medicines that help relieve other symptoms of colds such as pain relievers, decongestants, or antihistamines.
    • For cough secondary to postnasal drip, decongestants such as pseudoephedrine (Sudafed) or antihistamines such as diphenhydramine (Benadryl) may improve symptoms.
    • Cough that is a result of gastroesophageal reflux disease (GERD) may be helped by medications such as: Pepcid, Tagamet, Zantac and Prilosec

When cough is severe, over-the-counter (OTC) medications and home remedies may not be enough to relieve symptoms, and prescriptions may be needed.

  • Codeine and other narcotic medications are often prescribed as effective cough suppressants. Often these are combined with the cough suppressant dextromethorphan, or the expectorant guaifenesin.
  • If cough is due to Pertussis (whooping cough), bacterial pneumonia, complicated bronchitis, or sinusitis it is usually treated with antibiotics.
  • For cough due to allergies, such as hay fever, inhaled nasal steroids may be prescribed.
  • For postnasal drip that does not respond to OTC drugs, nasal inhalers can be useful.
  • If cough is a result of asthma, prescription inhaled bronchodilators and inhaled steroids help decrease inflammation of the airways. Short-term oral steroids, which help reduce inflammation, are sometimes prescribed to relieve chronic cough.

Many times cough symptoms will worsen in the evening. This may be due to postnasal drip from a cold, bronchitis, or allergies or acid from the stomach backing up into your throat from acid reflux.

Your primary care provider (PCP) or pediatrician may diagnose and treat a cough. People suffering from chronic or persistent cough may be referred to different specialists depending on the underlying cause. If you have allergies, you may be referred to an allergist. If your cough is due to gastroesophageal reflux disorder (GERD) you may be directed to a gastroenterologist, who specializes in diseases of the digestive tract. If you have lung disease you may need to be seen by a pulmonologist, who specializes in diseases of the airways. If your cough seems to be related to an underlying heart disorder, you may need an appointment with a cardiologist, who concentrates on diseases of the heart and circulatory system.

Most often, a cough is not serious however; in some situations you should see a healthcare provider. If you have a cough and the following symptoms, see your doctor:

  • Fever higher than 101 F/38.3 C
  • Coughing up blood
  • Coughing up yellow or green phlegm
  • Shortness of breath
  • Difficulty swallowing
  • Loss of appetite
  • Weight loss
  • Excessive production of mucus
  • Chest pain that is not a result of the cough
  • Wheezing
  • Fatigue
  • Weakness
  • Night sweats
  • Your cough is not improving over time
  • If you know you have been exposed to the flu, whooping cough, or other infections

These signs and symptoms in addition to cough may indicate a more serious condition that needs immediate treatment.