When to See Your Health Care Provider about Your Cough

Everyone coughs. There is no reason to worry about an occasional cough. Allergies and short-term illnesses, such as the common cold, can cause repeated coughing. Although coughing can be annoying, it is the body’s way of clearing the throat and airways and helps to prevent infection. Coughing due to a cold or the flu usually goes away on its own without treatment.¹ However, if your cough is not getting better—and especially if it brings up blood, disrupts your sleep, or affects your work—it may be time to call your health care provider (HCP).

Cough symptoms are divided into 3 categories: acute, subacute, and chronic.

Common Causes of Acute Cough

Acute coughs often begin suddenly and go away in 1 to 3 weeks. They are typically caused by the common cold or other upper respiratory infections, including the flu, pneumonia, and whooping cough. Coughs caused by the common cold often get better within a week without specific treatment, although symptoms may continue for up to 3 weeks.

Common Causes of Subacute Cough

Subacute coughs last 3 to 8 weeks, persisting after a cold or another respiratory infection is over. Airways may remain swollen and inflamed after an infection, causing you to keep coughing. This is called airway hyper-responsiveness.

Causes of Chronic Cough

When a cough persists longer than 8 weeks (4 weeks in children), it is considered to be chronic. Chronic cough can have many causes. Postnasal drip syndrome (also known as upper airway cough syndrome), asthma, and gastroesophageal reflux disease are the most likely causes of chronic cough in adults. These conditions, alone or in combination, are responsible for 90% of cases of chronic cough.²

Other important causes of chronic cough include pertussis (whooping cough), chronic obstructive pulmonary disease caused by smoking, angiotensin- converting-enzyme inhibitors (blood pressure medications), pneumonia, heart failure, and chronic bronchitis from exposure to cigarette smoke or other irritants. Less common causes include tuberculosis, lung cancer, cystic fibrosis, pneumothorax, bronchiectasis, and pulmonary embolus (a blood clot in the lung).²

Tips to Ease Your Cough

If you feel well and have only had a cough for a short while, you may not need to do anything but wait for it to go away on its own. Steps you can take at home to ease an acute cough include the following:

• Inhale steam using a vaporizer or take a steamy shower to sooth a dry, sore throat
• Drink plenty of fluids, including warm liquids with honey or lemon, to help thin mucus and soothe your throat
• Avoid exposure to irritants that can trigger a cough; if you smoke, make an effort to stop
• Try hard candy or cough drops to soothe a dry, tickling cough (never give these to children younger than 3 years)

When to Call Your HCP

A cough that persists for longer than 3 weeks, or is getting worse, requires a trip to your HCP for prompt medical care and to rule out something more serious. Immediately call your HCP if you have any of the following³:

• Coughing up of thick, yellow, or green mucus
• A fever of 101.5°F or higher
• Coughing up of blood
• Wheezing or shortness of breath
• Trouble sleeping
• Night sweats
• Weakness, fatigue, or loss of appetite
• Chest discomfort
• Unintended weight loss

Determining the cause of a nagging, chronic cough is essential to effective treatment. Your HCP will request a thorough medical history and perform a physical exam. He or she may ask questions about the duration of your cough, your symptoms, your medications, whether you smoke, and how exercise and cold air affect your breathing and cough (Table^5,6). Chest x-rays, computed tomography scans, lung function tests, and laboratory tests may be performed.

Medications

Coughing is important for clearing mucus and other irritants, and may help prevent infection. For this reason, cough medicines are generally used only when a cough causes a lot of discomfort and disrupts daily activities. Your HCP may recommend the following medicines:

• Expectorants. Some coughs are dry, whereas others, known as productive coughs, bring up mucus (phlegm). For a productive cough, an expectorant called guaifenesin (brand names include Mucinex and Robitussin) helps to thin or loosen mucus, making it easier to move the mucus. Drink lots of fluids if you take guaifenesin.
• Decongestants. Phenylephrine and pseudoephedrine are examples of decongestants used to help clear a stuffy or runny nose and relieve postnasal drip. Use of these drugs is not advised in individuals with high blood pressure.
• Steroid nasal sprays. A steroid nasal spray may help postnasal drip. Flonase (fluticasone propionate) and Nasacort (triamcinolone acetonide) are examples of OTC steroid nasal sprays.
• Antihistamines. If you have allergies or a cold or flu, antihistamines may work better than nonprescription cough medicines.4 In fact, antihistamines such as brompheniramine and chlorpheniramine decrease the production of mucus and widen airways. Unfortunately, these drugs can make you sleepy and may be better to take only at night.
• Analgesics. Pain relievers, such as Tylenol (acetaminophen) and Advil (ibuprofen) can be taken for fever and aches and pains. Be careful not to take more than the recommended acetaminophen dosage because too much can cause liver damage, and even death. Be aware that some combination cough and cold medicines contain acetaminophen.
• Bronchodilators. Albuterol and other bronchodilators help to relax the airways and make breathing easier.
• Antitussives. When nothing else works, prescription cough suppressants may be useful to suppress a dry cough. There is no evidence to show that OTC cough suppressants relieve a cough.

Talk to your child’s HCP before you give a child 6 years or younger an OTC cough medicine, even if it is labeled for children. These medicines may not be helpful, depending on the case, and can have serious adverse effects.

Beth is a clinical pharmacist and medical editor residing in northern California.

References

• Cough medicine: understanding your OTC options. FamilyDoctor.org website. familydoctor.org/familydoctor/en/drugs-procedures-devices/over-the-counter/cough-medicine-understanding-your-otc-options.printerview.all.html. Accessed March 10, 2016.
• Chronic cough. MayoClinic.org website. mayoclinic.org/diseases-conditions/chronic-cough/basics/definition/CON-20030883?p=1. Accessed March 10, 2016.
• That nagging cough. health.Harvard.edu website. health.harvard.edu/staying-healthy/that-nagging-cough. Accessed March 10, 2016.
• Cough: MedlinePlus website. nlm.nih.gov/medlineplus/cough.html. Accessed March 10, 2016.
• Chronic cough: preparing for your appointment. Mayo Clinic website. mayoclinic.org/diseases-conditions/chronic-cough/basics/preparing-for-your-appointment/con-20030883. Accessed March 10, 2016.
• Chronic cough: questions your doctor may ask. National Jewish Health website. nationaljewish.org/disease-info/symptoms/questions.aspx. Accessed March 10, 2016.