Hazards of Coughing

Coughing may appear to be a simple problem, but if it is persistent for a long time, it may lead to serious health problems
By Abhigyan

Hailing from Darbhanga in Bihar, Anju Sharma had been ignoring her cough for almost three weeks. Even though severe bouts of cough, especially at night had disturbed her sleep leaving her exhausted and irritable since the past couple of days, she had not done anything with regard to this problem.
Gradually, it started affecting her personal life as well as her performance at work. What began as a sporadic cough for her rang a daunting alarm when one morning she ejected blood stained sputum. Her problem would not have gone up to this level had she consulted a doctor on time.
According to Dr. J.K. Samaria, HOD Chest Medicine, BHU and Hon. Secretary, Indian Chest Society, the case of Anju is very common to the sudden changes in weather, dust, smoke and/or pollution. In such instances the patients require specific medical interventions that can help relieve them of the symptoms of dry cough which would improve their quality-of-life and help them get back to performing their daily chores with ease.”
Most cough episodes will clear up, or at least significantly improve, within two weeks. However, any cough that hasn’t improved after a few weeks may be a reflection of a serious health issue which should never be ignored and a doctor should be consulted on urgent basis. Also if you cough up blood or have a “barking” cough, never ignore it, but see a doctor immediately.
Ignoring the gradual escalation in coughing episodes accompanied by chest pain has been deemed by experts as the key cause of making it a serious health condition.

What causes coughing?
A cough results from a number of conditions, both temporary and permanent. Coughing is a defence mechanism of our body, which it uses to clear the air passage of mucus, dust, or smoke. In other words, a cough is a common reflex action that clears the throat of mucus or foreign irritants.
When your airways become clogged with mucus or foreign particles such as smoke or dust, a cough is a reflex reaction that attempts to clear the particles and make breathing easier. Usually, this type of coughing is relatively infrequent, but coughing will increase with exposure to irritants such as smoke, although there are a number of conditions that can cause more frequent bouts of coughing.
Therefore, when coughing becomes persistent in nature, a clinical examination is vital. The most common cause of a cough is a respiratory tract infection, such as a cold or flu. Respiratory tract infections are usually caused by a virus and may last from a few days to a week. Infections caused by the flu may take a little longer time to clear up.
Smoking is the second most common cause of coughing. A cough caused by smoking is almost always a chronic cough, with a distinctive sound. It’s often known as “smoker’s lung” or “smoker’s cough.”
Asthma is also one of the most common causes of coughing, especially in young children. Typically, asthmatic coughing involves wheezing, making it easy to identify. Mild cases of asthma may just be observed, but more severe cases will require treatment using an inhaler. However, it is possible for children to grow out of asthma as they get older.
Some medications may also cause coughing, although this is generally a rare side effect. Angiotensin-converting enzyme (ACE) inhibitors, commonly used to treat high blood pressure and heart conditions, can cause coughing. Two of the more common brands are known as Zestril and Vasotec. The coughing stops when the medication is discontinued.

When coughing becomes a health threat
In general, a cough that lasts for less than three weeks is an acute cough. A cough that lasts between three and eight weeks, improving by the end of that period, is a subacute cough. A persistent cough that lasts more than eight weeks is a chronic cough.
A dry cough is described as a non-productive cough, which means it produces little to no mucus. It is irritating and causes a tickly throat. In certain cases it may be a nasal allergy, acidity, asthma, chronic obstructive pulmonary disease (COPD) or even tuberculosis (TB). Hence, one should consider visiting a doctor if his/her cough persists.
Dr Anup Mohta, Director, Chacha Nehru Bal Chiktshalay, East Delhi, says, “Most coughs will clear up, or at least significantly improve, within two weeks. If you have a cough that hasn’t improved in this amount of time, see a doctor, as it may be a symptom of a more serious problem. If additional symptoms develop, such as a fever, chest pains, headaches, drowsiness, or confusion, contact your doctor as soon as possible. Coughing up blood or breathing difficulties require immediate medical attention in emergency.”
A cough that is the symptom of a more serious condition is unlikely to go away on its own. If left untreated, the condition may worsen and cause other symptoms. While infrequent coughing is necessary to clear the airways, there are ways one can prevent catching other coughs.
Smoking is the most common cause for a chronic cough. It can be very difficult to cure a smoker’s cough. There are a wide variety of methods available to stop smoking, from gadgets like electronic cigarettes to advice groups and support networks. After one can stop smoking, even it is less likely to that individual to catch cold or suffer from a chronic cough.

The treatment
There are not too many effective alternatives available for the treatment of dry cough. On the grounds of better efficacy and based on the number of patients who have responded positively to the drug over the years, antitussives like codeine will continue to be preferred choice for the treatment of dry cough to treating artificially induced, disease-related or unexplained dry cough.
Dr. J.K. Samaria adds, “As an expert physicians, it is imperative for us to have the choice to prescribe the best-suited medication with clinically proven efficacy. Codeine-based cough suppressants have been prescribed for years since they are the gold standard for symptomatic relief and treatment of dry cough. However, due to the abuse potential of this category of medication, there needs to be a strict adherence to selling of codeine-based cough syrups only against a physician’s prescription.”
“However, if your cough is likely due to bacteria, your doctor will prescribe oral antibiotics. You’ll usually need to take the medication for a week to fully cure the cough. She may also prescribe either expectorant cough syrups, or cough suppressants that contain codeine,” says Dr Manisha Yadav, Medical Practioner.
In most cases, a cough disappears naturally within a week or two after it first develops. However if it is prolonged the patient should be brought under medical observation for sure. “If your doctor can’t find a cause for your cough, they may order additional tests. This could include a chest X-ray to assess whether your lungs are clear, along with blood and skin tests if they suspect an allergic response. In some cases, phlegm or mucus may be analyzed for signs of bacteria or tuberculosis,” said Dr Shikha.
Though, a cough typically doesn’t cause any long-lasting damage or symptoms. In some cases, a severe cough may cause temporary complications like tiredness, dizziness, headaches and fractured ribs. These are very rare, and they will normally cease when the cough disappears. In cases where the previous treatments are either not possible or extremely unlikely to be successful, doctors may prescribe cough suppressants.
Throwing more light on the seriousness of this very simple disease as it may appear initially, Dr Mohta, said, “It is very rare for a cough to be the only symptom of heart problems, but a doctor may request an echocardiogram to ensure that your heart is functioning correctly and is not causing the cough. Difficult cases may require additional testing.”
“A CT scan offers a more in-depth view of the airways and chest, and it can be useful when determining the cause of the cough. If the CT scan doesn’t show the cause, your doctor may refer you to a gastrointestinal (GI) specialist or a pulmonary (lung) specialist. Some of the testing these specialists may use includes esophageal pH monitoring, which looks for evidence of GERD,” he added.