Persistent Coughs: Understanding infection, Symptoms, and Treatment

 

It is the natural reflex of our respiratory system to clean our Airways (throat or lungs) by removing any irritant (smoke, dust particles, pollens, strong smelling perfumes etc.) or mucus accumulated due to any allergy or infection. Our respiratory airways usually have a thin mucus covering that provide protection against irritants or germs. If any irritant enters the airway then mucus entraps them, it stimulates nerves in airways lining causing cough to expel it out. 

Common Allergens and Germs Causes Cough 

Uncommon causes of cough involve:

1.     Chronic obstructive pulmonary disease (COPD): It is the disease of lungs causing chronic inflammation in airways mainly due to old age, obstructive asthma or excessive smoking. In this condition the bronchial tubes (airways to lungs) and sac like structures in lungs called alveoli may become weak and produce more mucus causing chronic cough.

Treatment involves use of bronchodilator inhalers e.g. salbutamol and terbutaline which can subside inflammation, relaxes and widens the airways.

 

2.     Cardiac Cough: Inappropriate oxygen supply to the heart due to heart failure can leads to fluid retention in alveoli (sac like structures of lungs for oxygen exchange) of lungs. This initiate cough to clear the airways. The cough may expel pink colored of blood tinted mucus and produces wheezing sounds with shortness of breath. Additional symptoms include swelling in body specially feet, legs and hands.

Treatment involves solving heart related issues and use of diuretics to remove excessive fluid form the body and lungs.

 

Common causes and treatment of cough include:

1.  Exposures to Irritants: Certain irritants such as smoke, cold air, pollutants, strong perfumes or chemicals etc. can irritate the lining of airways in throat causing cough.

Preventive measures involve use of masks or avoiding pollutants or irritants.

2.     Post nasal drips: It involves excessive fluid formation and discharge from nasal or sinus cavity which drips into the throat causing cough. This is very common in case of children with allergic conditions (exposure to moulds, dust, pet dander, spores, pollens etc.), asthma, cold, flu or sinus infections. It can happen at any time of the day but mostly aggravates at night during sleep when fluid accumulates in throat.

Treatment involves steam inhalation, sinus rinse and salt water gargles to remove excessive mucus accumulated in nasal and sinus cavity. Consume hot fluids containing herbs like ginger and garlic known to reduce inflammation and try to avoid allergens. If required, for quick relief use steroid (cortisone) based nasal sprays, non-steroid saline nasal sprays or consume antihistamines (levocetirizine and fexofenadine) tablets.

3.   Acid Reflux: It means movement of acid from stomach towards the throat. It happens due to excessive acid formation in the stomach or any problem in functioning of valve separating oesophagus from the stomach. In that case acid severely irritates vocal cards and airways which leads to repeated cough. This problem mostly aggravates during sleep at night or when we lie down because it became easy for acid to flow back from stomach to the throat.

Treatment involves avoid overeating, take small meals throughout the days, lose weight, avoid stress, elevate the head in bed, consume the meal 2 hour before going to bed and no smoking please. If required use over the counter available antacids syrups after the meal to stop acid reflux. After discussing the healthcare provider, you may consume histamine blocker or proton pump inhibitors 30 min before taking the meal once in a day to stop excessive acid formation in stomach.  

 

4.     Throat infection: It may be caused due to viral or bacterial infection. The viral infection resolves by its own after few days but bacterial infection mostly caused by streptococcus bacteria and needs treatment using antibiotics (amoxicillin). The symptoms appear as pain in throat, swelling of lymph glands, tonsils, fever, cough and change in voice.

Treatment involves rest, increased intake of fluid (wash away extra fluid/mucus and bacteria/virus), avoid spicy food (irritates the swollen throat or its lining causing cough), use steam (improve voice, relief congestion, pain and mucus}, Acetaminophen (for pain relief) and dextromethorphan (cough suppressant).

5.     Sinusitis: Sinus is the cavity at the back of nose behind the forehead and in the skull filled with air. But infection in this cavity causes excessive formation of mucus, swelling or inflammation of sinus lining. The symptoms appear as bad breath, cough which worsen at night, headache, stuffed nose, nasal discharge and postnasal drip.

Treatment involves steam inhalation, use of nasal saline (Neti pot) to flush and clean the sinus cavity, nasal decongestants e.g. oxymetazoline, antibiotics usually not required but may be prescribed if there is persistent cough, fever or nasal discharge for more than 2 weeks.