Is it normal to cough?
It is part of my philosophy, that most things happen for a good reason and I tend to think that the glass is half full. As with many medical conditions, illnesses usually arise when a healthy defense mechanism of the body goes “amuck.” As far as cough is concerned, this is an excellent example of a healthy defense mechanism gone wrong. The important purpose of cough is to propel material out of the lung which would damage it; getting rid of anything that “doesn’t belong.” The other side of this is an annoying and persistent cough that is disruptive to one’s social life, if not one’s sanity.
Cough will keep nagging at you until you take care of it. It is one of the ways that the lungs let you know they have a problem. Unlike other organs, the nerves for the lungs are only on the outside (in the pleura). This means that anything that bothers the lungs doesn’t first trigger pain, so one of the best early warning systems that there is a problem is cough. No one needs to suffer with a chronic persistent cough.
Does drinking water make a cough stop?
If a cough is due to a dry mouth, water may help. Sometimes a small piece of bread may be more soothing. Cough drops usually give better relief.
What should I do if I am coughing blood?
If you are coughing blood (teaspoons and tablespoons, not just a few specks mixed with phlegm), then you need to go to the Emergency Room immediately. Hemoptysis, or the coughing of blood, is always an emergency.
What can be done about a chronic cough?
It most cases, the cause of a chronic cough can be determined and will improve or completely resolve with treatment. Cough is a normal response to airway irritation. You’ll know this when you drink something, and it goes down the wrong pipe. In lung terms, we call this aspiration. What it is that goes down the wrong pipe, usually gives a hint to the cause of cough. One of the main culprits is sinus congestion with post-nasal drip, fondly known as “allergic cough.” These people may have sinus congestion, watery or itchy eyes, and throat clearing. They may notice that their cough is seasonal. They may have had it all their lives and are so used to it that they don’t even notice the congestion, even though it may be quite apparent when a doctor examines them. There are many wonderful medications available for this type of cough. The danger is that many patients say that they have “tried everything and nothing works,” but what they consider a medication trial and physicians feel is a medication trial may not be the same thing. If allergens are present every day, and you only take your medication every couple of days when you are feeling bad, then the congestion will persist and you will rollercoaster up and down between good days and bad days. If you take the medication every day without fail, and the congestion resolves, then you need to continue it throughout the season. If you take the medication every day without fail, and it improves a little bit but not completely, you may need a second medication in combination with the first. With persistence, your cough can be successfully treated.
On the other hand, sometimes what is entering the airway is acid from the stomach, otherwise known as heartburn or reflux. The trick to this diagnosis is that not everyone feels the burn of heartburn and can have “silent heartburn.” This cough is usually worse after meals, or at nighttime. When you are lying flat, acid does not have to fight with gravity to travel up to your throat and back down into your lungs. While diet changes, upright posture, and antacids may make this type of cough better, it is important to be evaluated by a physician for a stomach ulcer and esophagitis, which can lead to future cancers.
Finally, the third common type of cough is due to asthma. Airway irritants: such as smoke, cold air, animal dander or perfume, can enter the lungs and provoke cough. Many people think of asthma as only wheezing, but frequently it can be present as a solely cough-variant. Sometimes hyperventilating or forceful exhalation can provoke this cough. Asthma is usually a controllable disease of the lungs, but sadly there are still patients who die from asthma. We will have a future chapter devoted to asthma, so for now we will suffice it to say that it may be a cause of cough.
Can a cough be a sign of a more serious condition?
Two important, but less common causes of cough should also be mentioned. The first is lung cancer. People who smoke, or used to smoke, may develop a chronic cough. The most likely cause of the cough is airway irritation from chronic obstructive lung disease or COPD. However, these people should also be evaluated for lung cancer. It is important to note, however, that lung cancer can also occur in those exposed to second-hand smoke and people who never smoked. Therefore, any persistent cough deserves a thorough evaluation. Second, there are some medications which can cause a cough as a side effect, especially angiotensin-converting enzyme inhibitors, commonly used for blood pressure control and heart failure (their generic names usually end with the suffix “-pril.” Patients who have a cough on this medication are also at risk for having “angioedema” or facial and throat swelling or closing that may make it difficult to breathe and be life-threatening. A physician can help you determine if either of these is a source of your cough.
What tests might my doctor do to evaluate my cough?
Common tests to evaluate a cough include a chest x-ray and pulmonary function test. Other tests may include a sputum culture, CAT scan of the chest or sinuses, upper endoscopy or EGD (camera evaluation of the esophagus and stomach) by a GI physician, bronchoscopy (camera evaluation of the lungs), swallowing evaluation or allergy testing. You may also receive medication trials with antacids, steroids, inhalers or decongestants and cough suppressants.
Self-Check for Managing Cough
- I have written a diary over the past week as to when my cough occurs and what makes it better or worse. I have also written down what over the counter medications I have tried.
- If I notice blood with my cough, I will go right to the Emergency Room.
- I notice that I have nasal congestion, a scratchy throat and cough, which means my cough may be associated with sinus congestion and allergies.
- I notice that I cough more after meals or when lying down at night, which may mean that my cough is associated with heartburn. I have taken alcohol, caffeine and acidic foods from my diet and elevate the head of my bed when sleeping.
- I notice that I cough more after being exposed to smoke, perfumes, cold air, pets or exercise, which means that my cough may be related to underlying asthma.
- I have chronic phlegm when I cough, which is usually a sign of infection.
- My cough has persisted for more than two weeks, I know I should seek medical attention instead of continuing to use over the counter medications.
- I used to smoke or am still smoking. I know I should seek medical attention for my cough.
- I take blood pressure medications; I will discuss my cough with my doctor.
Managing Doctors
- Primary Care
- Pulmonology
- Ears, Nose, Throat (ENT)
- Gastrointestinal (GI)
- Allergist