Cough

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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.

See More Appropriate Topic (instead of this one) If

• You are coughing because of an ASTHMA ATTACK
• You have a COMMON COLD
• Any CHEST PAIN
• EARACHE is your main concern

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Passed out (fainted)
• Severe difficulty breathing (e.g. struggling for each breath, unable to speak)
• Lips or face are blue
• Wheezing or coughing 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 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

HOME CARE ADVICE FOR COUGH

1. Mild Coughs: Use cough drops.
2. 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 (DM). An example is Robitussin DM.
     • Do not try to suppress coughs that produce mucus and phlegm. Cough suppression medications are 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, you can 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.
3. 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.
4. Hydration: Drink plenty of liquids (6-8 glasses of water daily). If the air in your home is dry, use a humidifier
5. Avoid Tobacco Smoke: Smoking or being exposed to smoke makes coughs much worse.
6. Fever Medication:
   • For fevers above 101° F (38.3° C) take acetaminophen or ibuprofen. The goal of fever therapy is to bring the fever down to a comfortable level. Remember that fever medicine usually lowers fever 2 degrees F (1 - 1 1/2 degrees C).
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: 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.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
7. 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.
8. Call Your Doctor If:
   • Difficulty breathing
   • Cough lasts more than 3 weeks
   • You become worse

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

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