Book menuCOUGHS - Full extract 

Carol has been a patient of mine for years. She and her three kids shifted into the area just after her husband died. She has had a pretty tough time and has always been a no-nonsense person. 

" I've had a lousy cough all week," she said. " It's keeping me up at night. Haven't you got something that will fix it? " I always feel uncomfortable with this sort of remark, the implication that as a doctor you can fix everything. 

Examining Carol gave me no extra information at all. Her throat was slightly reddened, but her chest was absolutely clear. She is a non-smoker and I presumed that she had some sort of viral infection. I recommended that she try a standard cough mixture from the chemist. " You mean this has cost me thirty five bucks and you can't even give me a script to fix it," she said, only half joking. 

I explained that the viral infection and the cough would probably just resolve over the next week or two. If it did not clear fully she was to come in for another check and perhaps a chest X-ray. Several weeks later I ran into Carol in the local newsagency. " That damn cough finally went," she said. " No thanks to you. It just went in its own good time!"  

Believe it or not, coughs do serve a purpose. They help to clear the lungs of excessive secretions and any foreign material such as dust and food particles that might have found their way into the breathing passages.

Although we do have some control over coughing, it is basically a protective reflex. Sometimes this reflex can be interfered with, for instance after an anaesthetic, a drug overdose or a head injury. In these situations pooling of secretions can occur, with the risk of serious lung infections.  

The main airways produce bronchial secretions all the time, about 150 mls per day. Tiny hair-like projections called cilia line the airways and sweep these secretions up to the back of the throat where they are swallowed. The whole mechanism is rather like a moving conveyor-belt. A slight cough or clearing of the throat may be quite normal. 

There are some features of a cough that point to it being more significant. A cough with any of these features should be checked with your doctor

  • A cough that is frequent, exhausting or persistent. 
  • If the cough produces a lot of discoloured mucus. 
  • If there is associated fever, shortness of breath or other symptoms such as chest pain or just feeling sick.
  • Coughing up blood is always an important symptom that has to checked out.

There are many causes of coughs. Dry, irritating coughs are often caused by viral infections. They can also be due to asthma, especially in young children. Inhalation of smoke, dust or foreign material can cause a dry cough, as can stress and nervous tension. Moist, phlegmy coughs can be caused by infections like bronchitis, especially the chronic form of bronchitis seen in people who smoke. More severe lung infections such as pneumonia can cause a phlegmy cough, as can asthma and heart failure. 

Occasionally a persistent cough can have a more serious cause, such as cancer of the throat or lung, conditions far more likely to occur in people who smoke. 

When someone complains of a cough it is important to find out how long it has been present, whether it is dry or phlegmy, and whether there has been a recent cold. We also need to know whether the person is a smoker and whether there have been other symptoms such as fever or shortness of breath. The person's occupation may also be relevant. 

The person is then carefully examined to see whether there is any sign of infection, asthma, or congestion on the lungs. In most cases we can work out the likely cause of the cough and offer some advice about treatment. 

Usually no investigations are required. However, if there is evidence of pneumonia or any other lung problem, a chest X-ray might be advised. Sometimes a blood test and a sputum examination may also be suggested. In more persistent cases, referral to a respiratory specialist for further assessment may be necessary. 

The treatment of a cough depends on its cause. There are several types of cough mixtures available. They are of variable benefit and of limited value in children. Some of these mixtures have a cough suppressant effect and are more suitable for dry irritating coughs. Others soften and break up mucus, making it easier to clear. 

Some over-the-counter cough mixtures contain decongestants such as pseudoephedrine. Because these preparations can cause a rise in blood pressure they should be avoided in people who have a history of hypertension. 

If a bacterial infection such as bronchitis is present, a course of antibiotics may be required. Any associated asthma should also be treated. 

Sometimes the breathing passages can be hypersensitive for several weeks after a viral infection or bronchitis. A chronic cough may follow. This may require a short course of inhaled steroids, the same medication used to prevent recurrences of asthma.

Health tip:
 * A cough that persists or is associated with other symptoms should be checked with your doctor.


 Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001