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Cough



Marmara University Faculty of Pharmacy

"Can cough be a symptom of some diseases?"

Öksürük

What is cough?

Cough is a strong physiological defense mechanism that cleans the airways center from excess secretions and foreign substances. Breaking up mucus with a violent exhalation provides the high flow rate required to remove foreign particles from the larynx, trachea, and bronchi. In survey studies in Europe and the USA, cough is observed in 9-33% of the population, including teenagers and children.

What are the risk factors for cough?

There are many risk factors for developing cough.
● History of asthma, bronchitis
● Atopy or allergic constitution
● Cigarette
● Air pollution
● Contagious respiratory infections
● History of chronic lung disease

What causes cough?

Acute upper respiratory tract infections caused by viruses are the most common causes of cough. Another type of cough is caused by increased mucus production or a chronic respiratory disease such as asthma. Excessive secretion, which stimulates the sensory nerves in the airway, causes a cough with phlegm.
Some of the most common causes of chronic cough are smoking-related chronic bronchitis and diseases that can be easily diagnosed with a plain chest X-ray, such as lung tumors, tuberculosis, or interstitial lung conditions. Therefore, chest radiography plays an important role in the diagnosis of chronic cough. However, most patients with chronic cough do not show any abnormality on chest X-ray. Additional diagnostic procedures are often needed to determine the underlying cause of cough in these patients. The most common causes of chronic cough in non-smoking adults with normal chest radiographs may be conditions such as upper respiratory tract cough syndrome, chronic rhinitis, sinusitis, gastroesophageal reflux disease, asthma and non-asthmatic eosinophilic bronchitis.

What are the types of cough?

4.1. Acute cough
It is a self-limiting cough that lasts a maximum of 3 weeks and subsides within one to two weeks as the infection clears.
4.2. Subacute cough
It is a cough that lasts 3-8 weeks and persists for several weeks as a result of the excessive increase in bronchial sensitivity following specific infections (for example, M. pneumoniae).
4.3. Chronic cough
It is a cough that lasts longer than 8 weeks and its prevalence in the adult population varies between 10% and 20%.
4.4. Asthmatic cough
Cough in asthma usually occurs at night and is characterized by shortness of breath and wheezing. Sometimes it may occur with a cough alone.
4.5. Cough due to bronchiectasis
In bronchiectasis, cough develops due to excessive secretion production in the bronchi and recurrent infections. Usually, 30 ml or more of sputum is produced per day.
4.6. Angiotensin Converting Enzyme (ACE) Inhibitor-induced cough
ACE inhibitors are used to treat heart failure and hypertension. It causes cough in approximately 2-33% of cases. The cough is typically dry and characterized by a tickle in the throat.
4.7. Cough Due to Chronic Bronchitis/Chronic Obstructive Pulmonary Disease (COPD)
In chronic bronchitis, a cough accompanied by sputum is observed, mostly in the winter months, lasting at least 3 months a year and continuing for at least two years. In smokers, this may be a sign of irreversible airway stenosis. Bronchiolar inflammation and excessive phlegm produced in mucus cells are the factors that cause cough.
In treatment, first of all, irritants should be removed and smoking should be stopped. When smoking is stopped, cough decreases within 4-5 weeks.

Is cough contagious?

Although the cough itself is not contagious, if it is caused by an infection in the airway, the infection can be transmitted to others and cause cough. This is why it is important to isolate when suffering from a contagious infection. It is recommended to use protective equipment such as disinfectant and mask.

When should I consult a doctor?

If your cough continues for 3-4 weeks and is accompanied by:
● Fever
● Fainting
● Green-yellow or bloody sputum
● Shortness of breath, bruising
● If you experience symptoms such as fainting, it is recommended to consult a doctor.

Treatment of cough

First, smokers with chronic cough should quit smoking, and patients taking ACEI should consult their doctor to change their medications. To reduce discomfort caused by cough, drink plenty of water, eat warm foods to prevent possible throat irritation during a dry cough, and adjust the room temperature.

Nonspecific Treatment/Antitussive drugs

Nonspecific therapy is a treatment that does not address the cause or mechanism of the cough but simply relieves the symptoms. Its main indication is in cases where the cause cannot be determined and targeted treatment cannot be performed. The aim is not to stop the cough completely, but to control it and relieve the patient's symptoms. Antitussives used in non-specific treatment; codeine, dextromethorphan, dextrophenamine and pseudoephedrine.

Chronic cough due to asthma

It is treated with a combination of corticosteroids and bronchodilators (agonists). Likewise, cough associated with asthma and eosinophilic bronchitis responds well to inhaled steroids.

Cough due to allergic rhinitis, nonallergic rhinitis, vasomotor rhinitis

Treated with intranasal corticosteroids, antihistamine decongestants, or decongestants alone. Rhinitis is treated with intranasal corticosteroids for at least 3 months. New generation antihistamines are more effective than first generation antihistamines in the treatment of allergic rhinitis.

Are antibiotics required?

Taking antibiotics is not the first choice in acute cough. If the cough has become chronic and/or the diagnosis can be attributed to bacterial infections, antibiotics may be prescribed.

Cough in babies and children

In children with acute cough; 
Although the possibility of an acute upper respiratory tract infection is high, it should be evaluated for a more serious problem:
● Are there any symptoms indicating lower respiratory tract disease? (tachypnea, dyspnea, wheezing, crackling breath sounds)
● Does the child seem uncomfortable in any other way? (poisoning, muscle stiffness, thirst or vomiting)
● Is there a foreign object in the trachea? (history of acute drowning)

In children with chronic cough;
● Especially in terms of symptoms of a disease, underlying diseases should be considered, and a doctor should be consulted.
● A cough with phlegm should be evaluated carefully as it may be mistaken for a dry cough.

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https://www.ncbi.nlm.nih.gov/pubmed/18424325

De Blasio F, et al., Cough management a practical approach. (2011).

Dabrowska M, et al., Causes of Chronic Cough in Non-smoking Patients. (2015).

https://www.ncbi.nlm.nih.gov/pubmed/26285610

Ertürk NE. Kronik Öksürük Ve Yönetimindeki Nonfarmakolojik Bir Yaklaşım: Konuşma Patolojisi Tedavisi. (2017).

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Irwin RS and Curley FJ, The treatment of cough. A comprehensive review. (1991).

https://www.ncbi.nlm.nih.gov/pubmed/2036833

Zhang J, et al., Risk factors for chronic cough in adults: A systematic review and meta-analysis. (2022).

https://www.ncbi.nlm.nih.gov/pubmed/34658107

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