Cough

COUGH

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

  • Cough is a very common symptom. It is the fifth most common reason for visits to physicians.
  • 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.

Common Causes

  • Most common cause: postnasal drip syndrome from a cold, from allergic rhinitis, or from sinusitis.
  • Other common causes: asthma, bronchitis, pneumonia, gastroesophageal reflux, smoking.

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WHEN TO CALL YOUR DOCTOR

Call 911 (you may need an ambulance) if:

  • Passed out
  • Severe difficulty breathing (e.g. struggling for each breath, unable to speak)
  • Lips or face are blue
  • Wheezing started suddenly after medicine, an allergic food or bee sting
  • Difficulty breathing after exposure to flames, smoke, or fumes

Call your doctor now (night or day) if:

  • You feel weak or very sick
  • Chest pain (EXCEPTION: mild chest pain lasting only a few seconds that occurs only when coughing)
  • Difficulty breathing
  • Wheezing is present
  • Coughing started suddenly after bee sting
  • Coughing up blood and more than a few streaks
  • Fever of 103 F (39.4 C) or higher
  • Fever of 100.5 F (38.1 C) or higher and you
    • Are over 60 years of age OR 
    • Have diabetes mellitus or a weakened immune system (e.g. HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy) OR
    • Are bedridden (e.g. nursing home patient, stroke, chronic illness, recovering from surgery)
  • Increasing ankle swelling

Call your doctor within 24 hours (between 9am and 4pm) if:

  • You think you need to be seen
  • Sinus pain or pressure (around cheekbone or eyes)
  • Fever present for more than 3 days
  • Earache is present

Call your doctor during weekday office hours if:

  • You have other questions or concerns
  • Coughing up blood
  • Coughing has kept you home from school or work for 3 or more days.
  • Nasal discharge lasts more than 10 days
  • Fever returns after being gone for more than 24 hours
  • Symptoms of nasal allergy are also present  (e.g. itchy eyes, clear nasal discharge, postnasal drip)
  • Taking an ACE Inhibitor medication (Including: benazepril/LOTENSIN, captopril/CAPOTEN, enalapril/VASOTEC, lisinopril/ZESTRIL)
  • Exposure to TB (Tuberculosis)
  • Cough lasts more than three weeks

Self care at home if:

  • Cough with no complications and you don't think you need to be seen
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HOME CARE ADVICE

  • Mild Coughs: Use cough drops.
  • Cough Medications: In cough and cold medications, there is either a "cough suppressant" to reduce the cough or a "cough expectorant" to thin thick phlegm. Some medications contain both a cough suppressant and an expectorant. Generally, medications containing a cough suppressant should be avoided if you are coughing up phlegm.
  • Cough Suppression Medications:
    • The most common cough suppressant in over the counter cough medications is dextromethorphan. An example is Robitussin DM.
    • Do not try to suppress coughs that produce mucus and phlegm. Dextromethorphan is best used in the late stages of a respiratory infection when the cough is dry and hacking.
    • Read the package instructions thoroughly on all medications that you take.
    • Special notes about dextromethorphan. Some recent research suggests that dextromethorphan is no better than placebo at reducing a cough. However, there is no over-the-counter medicine that works better than DM and generally DM has no side effects. It should also be noted that dextromethorphan has become a drug of abuse. This problem has been seen most commonly in adolescents. Overdose symptoms can range from giggling, euphoria, to hallucinations or coma.
  • Cough Expectorant Medications:
    • To loosen and cough up thick phlegm, try using a cough medication that contains guaifenesin (e.g. plain Robitussin).
    • Breathing in the mist from a steamy shower probably works even better. It moistens and helps loosen up the phlegm.
  • 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.
  • Hydration: Drink plenty of liquids (6-8 glasses of water daily). If the air in your home is dry, use a humidifier
  • Avoid Tobacco Smoke: Smoking or being exposed to smoke makes coughs much worse.
  • Fever Relief: For fever relief, take acetaminophen every 4-6 hours (Adults 650 mg) OR ibuprofen every 6-8 hours (Adults 400 mg).
    • 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.
    • Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  • 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.
  • Call Your Doctor If:
    • Difficulty breathing
    • Cough lasts more than 3 weeks
    • You become worse

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

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REFERENCES

  1. American College of Chest Physicians. Cough as a Symptom. Chest. 1998;114(2):143-164.
  2. Anzueto A, Niederman MS. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. 2004; 18(4): 919-37; x.
  3. O’Connell MA. Mosquito bite anaphylaxis. Infecious Disease Children. 2003;50-51.
  4. Paul IM, Yoder KE, Crowell KR, et al. Effect of Dextromethorphan, Diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics. 2004;114:e85-e90.
  5. Small P, Fujiwara PI. Management of tuberculosis in the United States. N Eng J Med. 2001;345:189-200.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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