Cough

Cough

Definition

A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions.

Description

While people can generally cough on purpose, a cough is usually a reflex triggered when an irritant stimulates one or more of the cough receptors found at different points in the respiratory system. These receptors then send a message to the cough center in the brain, which in turn tells the body to cough. A cough begins with a deep breath in, at which point the opening between the vocal cords at the upper part of the larynx (glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved in breathing press against the lungs, the glottis suddenly opens, producing an explosive outflow of air at speeds greater than 100 mi (160 km) per hour.

In normal situations, most people cough once or twice an hour during the day to clear the airway of irritants. However, when the level of irritants in the air is high or when the respiratory system becomes infected, coughing may become frequent and prolonged. It may interfere with exercise or sleep, and it may also cause distress if accompanied by dizziness , chest pain , or breathlessness. In the majority cases, frequent coughing lasts one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more than three weeks, it is considered a chronic cough, and physicians will try to determine a cause beyond an acute infection or irritant.

Coughs are generally described as either dry or productive. A dry cough does not bring up a mixture of mucus, irritants, and other substances from the lungs (sputum), while a productive cough does. In the case of a bacterial infection, the sputum brought up in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

Causes & symptoms

In the majority of cases, coughs are caused by respiratory infections , including:

• colds or influenza , the most common causes of coughs
• bronchitis , an inflammation of the mucous membranes of the bronchial tubes
• croup, a viral inflammation of the larynx, windpipe, and bronchial passages that produces a bark-like cough in children
• whooping cough, a bacterial infection accompanied by the high-pitched cough for which it is named
• pneumonia , a potentially serious bacterial infection that produces discolored or bloody mucus
• tuberculosis , another serious bacterial infection that produces bloody sputum
• fungal infections, such as aspergillosis, histoplasmosis, and cryptococcoses

Environmental pollutants, such as cigarette smoke, dust, or smog, can also cause a cough. In the case of cigarette smokers, the nicotine present in the smoke paralyzes the hairs (cilia) that regularly flush mucus from the respiratory system. The mucus then builds up, forcing the body to removed it by coughing. Post-nasal drip, the irritating trickle of mucus from the nasal passages into the throat caused by allergies or sinusitis, can also result in a cough. Some chronic conditions, such as asthma , chronic bronchitis, emphysema , and cystic fibrosis, are characterized in part by a cough. A condition in which stomach acid backs up into the esophagus (gastroesophageal reflux) can cause coughing, especially when a person is lying down. A cough can also be a side effect of medications that are administered via an inhaler. It can also be a side effect of beta-blockers and ACE inhibitors, which are drugs used for treating high blood pressure.

Diagnosis

To determine the cause of a cough, a physician should take an exact medical history and perform an exam. Information regarding the duration of the cough, what other symptoms may accompany it, and what environmental factors may influence it aid the doctor in his or her diagnosis. The appearance of the sputum will also help determine what type of infection, if any, may be involved. The doctor may even observe the sputum microscopically for the presence of bacteria and white blood cells. Chest x rays may help indicate the presence and extent of such infections as pneumonia or tuberculosis. If these actions are not enough to determine the cause of the cough, a bronchoscopy or laryngoscopy may be ordered. These tests use slender tubular instruments to inspect the interior of the bronchi and larynx.

Treatment

Coughs due to bacterial or viral upper respiratory infections may be effectively treated with complementary therapies. The choice of remedy will vary and be specific to the type of cough the patient has. Lingering coughs or coughing up blood should be treated by a trained practitioner.

Nutrition & diet

Many health practitioners advise increasing fluid intake and breathing in warm, humidified air as ways of loosening chest congestion. Avoiding mucous-producing foods can be effective in healing a cough condition. These mucous-producing foods can vary, based on individual intolerance, but dairy products are a major mucous-producing food for most people. Other foods to avoid are sugar and foods high in sodium . Others recommend hot tea flavored with honey as a temporary home remedy for coughs caused by colds or flu.

Various vitamins may be helpful in preventing or treating conditions (including colds and flu) that lead to coughs. They include vitamin C, vitamin E, zinc, vitamin A , and folic acid .

Herbal medicine

There are many Western herbs, as well as herbs used in traditional Chinese medicine (TCM), that soothe the throat, quiet coughs, and act as expectorants. Some include:

• marsh mallow
• licorice
• aniseed
• fritillaria
• loquat

Homeopathic remedies

Depending on the type of cough and its duration, several homeopathic remedies include:

• Aconite for dry coughs with fever
• Antimonium tartaricum for productive coughs
• Bryonia for intense, dry coughs accompanied by thirst
• Drosera for violent coughing
• Rumex crispus for tickling coughs

Allopathic treatment

Treatment of a cough generally involves addressing the condition causing it. An acute infection such as pneumonia may require antibiotics, an asthma-induced cough may be treated with the use of bronchodialators, or an antihistamine may be administered in the case of an allergy. Cough medicines may be given if the patient cannot rest because of the cough or if the cough is not productive, as is the case with most coughs associated with colds or flu. The two types of drugs used to treat coughs are antitussives and expectorants.

Expected results

Because the majority of coughs are related to the common cold or influenza, most will end in 7-21 days. The outcome of coughs due to a more serious underlying disease depends on the pathology of that disease.

Prevention

It is important to identify and treat the underlying disease and origin of the cough. Avoid smoking and coming in direct contact with people experiencing cold or flu symptoms. Wash hands frequently during episodes of upper-respiratory illnesses.

Resources

BOOKS

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Tiburon, CA: Future Medicine Publishing Inc., 1999.

Chandrasoma, Parakrama, and Clive R. Taylor. Concise Pathology. East Norwalk, CT: Appleton and Lange, 1991.

Schumann, Lorna. "Alterations in Respiratory Function." In Perspectives on Pathophysiology. Lee-Ellen Copstead, ed. Philadelphia: W.B. Saunders, 1994.

Time-Life Books Editors. The Alternative Advisor. Alexandria, VA: Time-Life Books, 1997.

PERIODICALS

Philp, Elizabeth B. "Chronic Cough."American Family Physician 56 (October 1, 1997).

ORGANIZATIONS

National Heart, Lung, and Blood Institute Information Center. P.O. Box 30105, Bethesda, MD 20824. (301)251-1222.