nhsManagers.net | Briefing | 20 January 2018

Medicine for Managers

Dr Paul Lambden BSc MB BS BDS FDSRCSEng MRCS LRCP DRCOG MHSM FRSM

Why Do I Cough?

The cough is a protective mechanism. It may be voluntary or involuntary. It is a rapid expulsion of air from the lungs, up through the bronchi and the trachea (windpipe) and out through the mouth and its purpose is to clear debris, such as mucus, dust particles, microbes, fluids and any other irritants, from the respiratory tract. Without the cough mechanism, the debris could not be

Cleared and it would fall into and remain in the lung where it would cause or set up a focus for infection. Ultimately, without being able to cough, you would die!

The cough has three phases:

1. You breathe in 2. The throat and vocal cords are closed and pressure rises in the lungs. 3. The vocal cord and the throat opens and there is an explosive release of air carrying away the debris and giving the cough its characteristic sound.

Coughs can be divided into two principal groups:

• Acute (short-term) coughs • Chronic (long-term) coughs

Acute coughs • Viral illnesses. These may

include colds, influenza and laryngitis

Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.

A lexicon of words describes coughing; dry, hacking, irritating, persistent, productive, whooping, rasping, annoying and many more. We have all had them. The symptom is ubiquitous, especially during the winter and the large majority and not serious and resolve spontaneously. Some, however, indicate something more serious.

• Bacterial infections. These include acute bronchitis and pneumonia.

• Whooping cough • Perenniel rhinitis (Hay Fever)

and other allergies.

Chronic coughs • Smoking. The chronic cough

produced as the lung struggles to clear the detritus of smoking; tar, dead lung cells and other debris, as well as the irritation of the smoker.

• Asthma. The persistent and reversible cough associated with allergy

• Post-nasal drip. Induced by the lung trying to clear mucus which falls backwards down the throat from the sinuses and upper airway.

• Medication such as the angiotensin-converting enzyme (ACE) inhibitors used in the treatment of raised blood pressure.

• Reflux, which occurs as a result of the regurgitation of acid stomach contents up the oesophagus and which irritate the larynx inducing the cough.

• Heart failure with accumulation of fluid in the lung.

• Fungal infection of the lung which is relatively rare and may be associated with compromised immunity.

• The more sinister and much less common causes which include tuberculosis and lung cancer

Post-viral coughs may persist for weeks after a cold or other respiratory virus infection. It occurs because, during the infection, mucus producing cells proliferate to increase mucus production which, in turn, engulfs bacteria and which is then coughed up. After the infection is resolved, it takes weeks for the glands to return to normal mucus production and during that time the extra mucus must be coughed up.

Most coughs will resolve quickly and are not associated with any sinister underlying cause.

However, if the cough lasts more than three weeks without obvious signs of improvement, it is important to have it reviewed by a doctor and investigated and treated.

Such causes include serious infections, uncontrolled asthma, heart failure and lung cancer.

The cough may not be the only symptom and other features which make obtaining medical assistance important include:

• Worsening cough • Coughing up blood • Vocal changes • Dyspnoea (breathlessness) or

dysphagia (difficulty swallowing)

• Chest pain • Unremitting or recurrent fever

Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.

If visiting a doctor with a persistent cough the doctor will:

• Take a history • Listen to the lungs with a

stethoscope • Ask for a sample of sputum to

send to the laboratory for analysis for organisms or cells

• Order a chest X-ray • If asthma is suspected he may

order spirometry which measures the airflow in and out of the lung and indicates whether there is any obstructive or restrictive element to the airflow.

Depending on findings the patient may be reassured, treated in primary care or referred on to secondary care for further investigation if there are concerns or suspicions of a sinister cause.

The reversible coughs may be treated with home remedies such as soothing pastilles to suck, honey and lemon and steam inhalations.

Pharmacies will sell cough suppressants and expectorants. Suppressants should be considered carefully and only used with caution.

The cough usually has a purpose - the removal of debris – and suppressing it may frustrate its purpose. On occasion, doctors prescribe cough suppressants such as codeine, pholcodeine or dextromethorphan where the cough is

confirmed to serve no purpose and is causing distress.

So, troublesome though it may be, it is usually present to protect your lungs. I doubt that, knowing that, you will feel more benign towards the man standing next to you on a crowded tube train who is coughing persistently.

When the cough is yours, it is there to help. When it is someone else’s it is downright irritating.

As Alec Guiness said:

“Only a few of those who cough go to doctors; the rest go to theatres!”

paullambden@compuserve.com

Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.