Been coughing for a while? Maybe it’s time to start paying attention to the type of cough you have! Although a cough is merely a symptom of an underlying medical condition, the type of cough you have can definitely give some helpful clues as to the possible cause…
1) What is the purpose of coughing?
- we cough as a reflex to help clear the throat and upper airway of any mucous or foreign substances, in an attempt to make breathing easier.
2) What are some of the clues that can point towards the cause of a person’s cough?
- how long the cough has lasted:
- acute: present for less than 3 weeks
- subacute: present for between 3 – 8 weeks
- chronic: present for longer than 8 weeks
- the character or sound of the cough: for example, hacking, wheezy, barking or staccato in
nature - whether the cough is wet (producing mucous), dry (not producing mucous) or if blood is
coughed up (haemoptysis) - the timing of the cough: whether it occurs only in the day, only at night, or during both day
and night - specific associated symptoms: for example, a cough accompanied by vomiting, chest pain,
shortness of breath or weight loss
Remember, a cough is only a symptom and it can have many different possible causes.
3) Here are the most common causes of coughs and what can be done about them:
Asthma
- causes a wheezy-sounding cough
- often associated with feeling short of breath, fatigue, a tight chest and other allergy-related
conditions (hayfever, eczema) - often worse at night/in the early hours of the morning, or during exercise
- treatment: bronchodilator inhalers, cortisone inhalers, combination inhalers and
leukotriene receptor antagonists
Gastro-oesophageal reflux
- a common cause of a chronic cough
- causes a dry cough
- may be associated with heartburn (but not in all cases), chest discomfort, bitter taste in the mouth
- often starts after eating, especially after lying down
- treatment: usually responds to weight loss, dietary changes, antacid medication (PPI’s),
anti-biotics if associated with H.pylori infection, anti-reflux surgery in some cases.
Post-nasal drip
- causes an acute cough if associated with a sinus or upper respiratory infection
- more commonly, a cause of a chronic cough when due to an allergy
- may cause a wet or dry cough, depending on the amount of mucous draining down the
back of the throat - often worsens at night when lying down
- treatment: saline nasal irrigation or nasal sprays, anti-histamine tablets, cortisone nasal
sprays, short-term use of decongestant nasal sprays
Infections
- the common cold, acute bronchitis, pertussis, pneumonia and TB can all cause a cough. Viral infections usually cause an acute cough, resolving without the need for anti-biotics
- pertussis/whooping cough starts with mild symptoms, progressing to a severe cough
ending with a classic whooping sound and vomiting in some cases - TB often causes a chronic cough, associated with weight loss, night sweats, chest pain and
coughing up of blood - pneumonia causes a dry cough which often becomes wet, fever and chills, chest pain,
difficulty breathing and possible coughing up of blood - treatment: depends on the underlying cause. Anti-biotics will only be necessary in bacterial
but, not viral infections. Supportive treatment can include medication to open the airways
(bronchodilator cough syrups), decrease inflammation (cortisone) and anti-inflammatories
to reduce fever and chest pain.
Medication side effects
- ACEi medication (used for high blood pressure and certain heart conditions) can cause a dry
cough in 10-25% of patients within a few weeks of having started it. - treatment: cough resolves on discontinuation of the medication and replacing it with an
alternative medication from a different class
COPD (chronic obstructive pulmonary disease)
- a common cause of a chronic cough in smokers
- often a wet cough which produces a lot of mucous in the morning
- associated with shortness of breath, a tight chest, fatigue and wheezing
- treatment: quit smoking, get regular exercise, bronchodilator, anti-cholinergic and
cortisone inhalers
Other causes of coughs:
- Heart failure: a cough associated with swollen ankles, shortness of breath, needing to sleep
propped up, possible coughing up of blood - Lung tumours: A chronic cough associated with weight loss, chest pain, shortness of breath,
possible coughing up of blood