Cough, usually is nothing more than a reflex of the body to foreign particles. But it could be a nuisance and embarrassment when the cough gets too aggressive and for a very long time. In turn, what could your cough means?
I remember sometimes in 2013, I got this cough which doesn’t stop. And I mean it. It will go on and on for minutes. At times, as a long as 5 minutes. These went on for as long as 2 months. Not only I could not talk but was out of breath. It hindered my work as I need to talk, talk at meetings, with my managers and peers and so on. It affected my quality of life, sleep and … The list continues. I kept bugging my Family Physician to get it fixed. Nobody would want to end up in this manner. I hope it happens to no one and never.
What is Cough?
In the Murray & Nadel’s Textbook of Respiratory Medicine, it defines cough as “a series of respiratory maneuvers that leadds to a sudden explusion of air creating a characterist cough sound.”
Cough is not a diesease or illness but a symptom. This symptom could mean many other diseases depending on what other symptoms does the patient has.
It can be further classify to acute, sub-acute or chronic. Anything less than 3 weeks is considered acute, 3 – 8 weeks is sub-acute cough and > 8 weeks is chronic.
And you could be getting either a wet cough with phlegm or a dry cough (without phlegm).
What could it mean?
As per the many journal and medical website, it is always mentioned that cough is the most common symptoms that prompt patients to seek medical care. And it is no surprise since cough is such a nuisance that is disruptive to work and life.
Most importantly, what could it mean? And what are the causes?
Upper Respiratory Tract Infection / Post Infectious
When one is down with the common cold or flu, that is usually diagnose as Upper Respiratory Tract Infection. Other symptoms include sore throat, fever, running nose, and block nose.
Usually, when the patient recovers from the rest of the symptoms, cough persist for weeks. This is the Post Infectious phase but patient will soon recover.
Cough Characteristics: Either dry or wet cough is possible.
Lower Respiratory Tract Infection
When there is a secondary infection, the bacteria might gets further down the respiratory tract and may end up in the bronchi resulting in bronchitis. If worse, in the lung(s), that would mean pneumonia.
And when the patient is infected by Mycoplasma, Mycoplasma Pneumonia or also known as Atypical or Walking Pneumonia resulted. Such infection does not usually result in a full blown pneumonia. Usually, it is so mild till patient only has the flu-like symptoms. Patients would usually recover even without antibiotics. But with this infection, patients might cough up to a month. Usually the diagnosis of Mycoplasma Pneumonia is via a blood test.
Cough Characteristics: Initially a dry cough which after a few days turns to a wet cough with yellow, green, and/or red or rust-tinged mucus.
The Postnasal drip is now know as the the upper airway cough syndrome (UACS).
When mucus drip down to the throat (due to either allergies or a cold), it tickles the nerve endings and hence trigger cough. This type of cough is usually worse at night, especially upon lying down. One would feel the tickling feeling at the back of the throat. Itchy eyes and sneezing might accompanied if it is due to allergies.
Cough Characteristics: Can be either dry or wet cough.
Most of us would imagine an Asthma flare up to be breathless, wheezing, the classic symptoms. Not many would associate this disease with cough or even only cough alone. In fact, cough is the most common symptom in asthma flare up and in particular in Cough Variant Asthma patient. This group of patient does not have that classic Asthma symptoms other than cough.
Cough Characteristics: A dry, non-productive cough.
COPD – Chronic Obstructive Pulmonary Disease
COPD is a lung disease with irreversible permanent lung tissue damages to almost the entire lower respiratory systems. The cause is usually due to cigarette smoking. Other symptoms may include large amounts of mucus (a slimy substance), wheezing, shortness of breath, chest tightness, and other symptoms.
Cough Characteristics: A cough with mucus.
GERD – Gastroesophageal Reflux Diseas
Lesser known is the Gastric Reflux. This is acutally the second most common cause for the chronic cough.
Several mechanisms may result in the cough caused by GERD. The explanation can get too technical. In short the gastric juice that gets into any part of the throat, the body is reacting to it with a cough since it is a considered as a foreign particle as the gastric juice is not suppose to appear in this area. At times, patients with GERD might not experience heartburn but only cough.
Cough Characteristics: Chronic hacking cough with mucus produced, particularly in the morning
The percentage varies from research to research. It is noted as high as 35% of patients on ACE Inhibitors begin to cough a few weeks into the medication.
Cough Characteristics: Dry Cough
Whooping cough (pertussis)
Pertusis is a contagious bacterial disease. This should be rare in most countries due to vaccines that was introduced in the 1940s. But according to CDC, US is reported seeing an increase in Pertussis cases since 2012.
Cough Characteristics: Intense severe hacking cough that may end up throwing up or turn red or blue with ending whooping sounds.
Other Less Common Causes
The other less common causes might be due to Heart diseases, Abnormal swallowing, Lung cancer and Stress.
When to worry?
When you cough for more than 8 weeks, coughing up blood, feeling breathless, chest tightness, having a persistent fever, wheeze, greenish or rusty mucus
The symptoms of the various causes can prove too similar, to avoid incorrect self diagnose, seek prompt medical attention.
At the doctors office, when the cough is more than 8 weeks, a Chest X-Ray, blood test and detailed medical history will be taken for the evaluation of the diagnosis and coming up with the treatment plan for the patient.
V.Courtney Broaddus, Robert C Mason, Joel D Ernst, Talmadge E King Jr., Stephen C. Lazarus, John F. Murray, Jay A. Nadel, Arthur Slutsky, Michael Gotway. Murray & Nadel’s Textbook of Respiratory Medicine.
Overlack A. ACE inhibitor-induced cough and bronchospasm. Incidence, mechanisms and management. Drug Saf. 1996 Jul;15(1):72-8.
Dicpinigaitis PV1. Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 Suppl):169S-173S.
Pertussis Outbreak Trends. Found in http://www.cdc.gov/pertussis/outbreaks/trends.html
Akio Niimi* Cough and Asthma. Curr Respir Med Rev. 2011 Feb; 7(1): 47–54.
Irwin RS1. Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 Suppl):80S-94S.
Sidney S. Braman, MD, FCCP. Postinfectious Cough ACCP Evidence-Based Clinical Practice Guidelines. CHEST 2006; 129:138S–146S
Mycoplasma pneumonia. Found in http://www.nlm.nih.gov/medlineplus/ency/article/000082.htm
Chronic Obstructive Pulmonary Disease (COPD). Found in http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022631/
JOSEPH J. BENICH III, MD, and PETER J. CAREK, MD, MS, Medical University of South Carolina, Charleston, South Carolina. Evaluation of the Patient with Chronic Cough.
A.H. Morice, G.A. Fontana, A.R.A. Sovijarvi, M. Pistolesi, K.F. Chung, J. Widdicombe, F. O9Connell, P. Geppetti, L. Gronke, J. De Jongste, M. Belvisi, P. Dicpinigaitis, A. Fischer, L. McGarvey, W.J. Fokkens, J. Kastelik. The diagnosis and management of chronic cough. Eur Respir J 2004; 24: 481–492