By Foluke Akinwalere. Freelance Health Writer and DLHA volunteer. With medical review and editorial support by the DLHA Team

 

Coughing lady

 

 

Highlights

 

• Coughing is an important spontaneous action (reflex) that helps protect your airway and lungs against irritants.

• Cough may be short-term and self-limiting, or long-term and serves as a warning sign of an underlying health issue. 

• In the absence of significant health issues, an acute cough is typically harmless and will resolve on its own.

• A chronic cough that comes with other symptoms like shortness of breath, mucus production, or bloody phlegm could be a sign of a more serious medical problem.

• Some germs use coughing to spread to new hosts.

 

Introduction

 

Cough is a common and often harmless spontaneous action) reflex that helps clear the airways of irritants and mucus.  

 

It is a natural defense mechanism of the body to protect the respiratory system. 

 

However, its impact on social well-being varies depending on individual circumstances and can lead to challenges in relationships, avoidance of public places, and disruptions in employment.

 

Even with a clear diagnosis, cough can be difficult to control and can negatively impact the quality of life of the patient.  

 

In this article, you will learn everything you need to know about cough, including the types of cough, causes, symptoms, diagnosis, and treatment options, plus what you need to do when you have a bad cough.

 

 

What is a cough?

 

Cough is a crucial defense mechanism in the respiratory system. It is a natural, usually explosive reflex that helps clear the airways of mucus, irritants, and foreign particles.  

 

It is a common symptom of respiratory illnesses and can be classified as acute or chronic.

 

In Nigeria for example, acute cough is found to be commoner in women < age 45 and chronic cough is commoner in older men. ¹

 

African healthcare providers are often approached by individuals seeking medical assistance for cough symptoms. 

 

 

Types of cough

 

There are many types of coughs, each with unique characteristics that can assist your doctor in determining the underlying cause. These include:

• Dry Cough: A dry cough produces no phlegm (mucus)

• Wet or Productive Cough: A wet cough is accompanied by phlegm production.

• Nocturnal cough: This is a cough that only occurs at night.

• Hemoptysis: This is when a person is coughing up blood or blood-stained mucus from the lungs

 

A study reported on the factors associated with nocturnal, productive, and dry cough in the young adult population in Sub-Saharan Africa where there is a lack of observational studies on cough.¹ These factors include tobacco smoking, HIV /AIDS, malnutrition, environmental pollution, and poverty.

 

 

Causes of Cough

 

Coughs can be triggered by various factors, and understanding the underlying cause is crucial for effective treatment. Here are some common causes of cough:
 

• Infections

Respiratory infections, such as the common cold, flu, bronchitis, and pneumonia are frequent culprits behind coughs. In Africa, these infections can be prevalent, especially during certain seasons.

 

Cough (that is initially dry and persistent) was identified as one of the early symptoms of COVID-19, along with fever, shortness of breath, and loss of taste or smell. The coughing may be productive of mucus as the condition worsens. 

 

The World Health Organization provided guidelines for the management and isolation of individuals with suspected or confirmed COVID-19 cases, including those with a cough.⁵
 

• Allergies

Allergic reactions to pollen, dust mites, pet dander, or other allergens can lead to coughing. Allergic conditions like hay fever are not uncommon.
 

• Environmental Factors

Exposure to smoke, air pollution, or other environmental irritants, which can be more common in some regions of Africa, can trigger persistent coughing.
 

• Gastroesophageal Reflux Disease (GERD)

Acid reflux can cause stomach acid to flow back into the oesophagus, leading to a chronic cough, particularly after eating or at night.
 

• Chronic obstructive pulmonary disease (COPD)

A group of lung diseases, including bronchitis and emphysema can also cause chronic cough.
 

• Other chronic respiratory conditions 

Some other chronic respiratory conditions apart from COPD can cause coughing, wheezing, and shortness of breath. Common causes in this category in adults are associated with such lung diseases like cancer, TB (tuberculosis), fungal infections of the lung, etc., which affect 2.5 million people in Africa Region according to a WHO report.²
 

• Medications

Some medications, particularly ACE inhibitors, a commonly used blood pressure reducing medication, might cause or potentiate cough. The cough may take some months to settle following the withdrawal of ACE inhibitors ³. 

 

In Nigeria, a study reported on the prevalence of ACE inhibitors-induced cough among Nigerian hypertensive patients. ⁶ It found a 20.2% rate of occurrence of frequent dry, non-productive cough among the patients that was linked to ACE inhibitors.

 

No patient with a troublesome cough should be placed or be continued on ACE inhibitors.
 

• Occupational Hazards

Workers in certain industries may be exposed to harmful substances that can lead to occupational diseases and persistent coughs
 

• Heart condition

Several heart disorders like congestive heart failure, are associated with chronic cough.
 

• Psychosocial stressors

Psychosocial stressors and other behavioural and mental health issues like anxiety may cause what is known as Habit or Psychogenic cough. This type of cough is typically harsh, barking and dry. It is common in children, adolescents, and rarely adults and it typically disappears during sleep and distractions. 

 

 

Symptoms of Cough

 

The symptoms of a cough can vary depending on its underlying cause. In most cases, there will not be anything serious underlying the cough, but in some cases, a long-term cough can be a sign of something that needs treatment, such as lung cancer, chest infections, or heart failure.

 

Cough symptoms that require medical attention include:

• The cough is getting worse

• There are swelling or lumps present in the neck region

• Weight loss

• Severe coughing 

• Difficulty breathing

• Difficulty swallowing

• Coughing up blood

• Chest pain

• Fever that is not getting better

• Permanent change in the sound of the voice

 

 

Classification of Cough

 

Cough can be classified in different ways as follows:

• According to the length of time that the cough persists, e.g., acute, sub-acute and chronic

• According to the characteristic features of the cough, e.g., dry, brassy or hacking, paroxysmal, etc.

• According to time of day and other conditions, e.g. nocturnal (at night), early morning and exercise-induced.

 

• Acute Cough

Duration: An acute cough is typically short-lived and can last for up to three weeks. Most acute coughs resolve within a few days to a week.

Characteristics: Acute cough is usually accompanied by other symptoms like runny nose, sore throat, fever, and general malaise. It tends to improve as the underlying infection resolves.

 

• Sub-acute Cough

This falls between acute and chronic coughs in terms of duration. Sub-acute cough is defined as lasting between three and eight weeks. If the cough persists or worsens beyond the eight-week mark, it may transition into a chronic cough, and further evaluation and management may be necessary to identify and address any underlying chronic conditions.

 

• Chronic Cough

This type of cough persists for an extended period and is typically defined as lasting for eight weeks or longer in adults. In children, it may be defined as lasting for four weeks or more.

Characteristics: Chronic cough may be dry or productive (producing mucus), and may occur throughout the day and night. It can be associated with other symptoms related to the underlying condition such as lung cancer.

 

Distinguishing between acute and chronic coughs is crucial for determining appropriate treatment and management. Chronic coughs often require more in-depth investigation and management due to their association with underlying health conditions.

Table 1 below summarises the characteristics of chronic cough and their indicative causes.

 Click on image to enlarge

 

 

Diagnosis and Treatment Options for Cough

 

The diagnosis and treatment of cough depend on its underlying cause.  

 

Physicians may take medical histories, conduct physical examinations, and order diagnostic tests such as chest X-rays, pulmonary function tests, or blood tests to determine the cause of the cough.

 

Here are some treatment options for a cough:
 

• Hydration: Drinking plenty of fluids can help thin mucus and soothe the throat.

 

• Rest: Adequate rest is essential, especially when coughing is accompanied by other symptoms like fever or fatigue.

 

• Avoid Irritants: Stay away from smoke, pollutants, and allergens that can aggravate coughing, or wear a face mask.

 

• Over-the-counter Medications: Non-prescription cough medicines may provide relief for acute coughs, but they should be used as directed and not for extended periods.

 

• Prescription Medications: If your cough is due to a specific medical condition like asthma or GERD, your healthcare provider may prescribe medications to manage the issues.

 

• Surgery: Surgery may be indicated in certain cases in the treatment of cough. For example, removal of a foreign body in the respiratory pathways, resection of lung cancer, repair of heart valves associated with heart failure, etc.

 

• Natural Remedies: Some individuals find relief from natural remedies like honey, ginger, or steam inhalation, but these should not replace medical advice or treatment.

 

• Lifestyle Changes: Though lifestyle changes are not a cure for chronic cough, they may help in managing it such as tobacco cessation, regular exercise, and eating a balanced diet. 

 

A recent study revealed that the risk of coughing increases with tobacco smoking and the number of sticks smoked per day.⁴ 

 

 

What you can do when you have a bad cough

 

If you experience a bad cough, it is important to take prompt action to reduce your discomfort and promote healing. Here are some recommendations:

 

1. Stay hydrated

 

2. Use a humidifier 

Dry air can worsen coughing. Using a humidifier or taking a steamy shower can help moisten the airways, providing relief and reducing coughing fits.

 

3. Avoid irritants

Smoke, strong perfumes, and other irritants can trigger or worsen coughing.

 

4. Rest and sleep

Give your body ample time to rest and recover. 

 

5. Use over-the-counter remedies

These are cough suppressants or expectorants. They reduce the cough severity and frequency and help to soften mucus so they can be expelled.

it is essential to read and follow the instruction label on these medications carefully and consult a healthcare professional if the cough persists or worsens.

 

6. Seek medical advice 

If the above first aid or home remedies do not provide relief within 24 hours, go to the emergency unit of your local hospital or visit with your doctor or other healthcare professional for further care.

 

 

Conclusion

 

Cough is a common occurrence, and in most cases, it is harmless and resolves on its own. However, persistent or severe coughing should not be ignored, as it can indicate underlying health issues.

 

If you or your loved one is experiencing a prolonged or troubling cough, it is essential to consult a healthcare provider for a proper diagnosis and appropriate treatment. 

 

Taking steps to prevent respiratory infections and minimise exposure to environmental irritants can also help reduce the risk of developing a troublesome cough, especially in regions where these factors are more prevalent.

 

REFERENCES

1.  Desalu OO, Ojuawo OB,,  Aladesanmi AO, Adeoti AO,  Opeyemi CM, Oloyede T,  Afolayan OJ, and Fawibe AE. Etiology and Clinical Patterns of Chronic Cough in the Chest Clinic of a Tertiary Hospital in Nigeria. Int J Gen Med. 2022 May 27;15:5285-5296. doi: 10.2147/IJGM.S363326.

 

2.  World Health Organization Tuberculosis in the WHO Africa Region - September 2023 Progress Report. Accessed October 11, 2023.

 

3.  Morice AH, McGarvey L, and Pavord I, British Thoracic Society Cough Guideline Group Recommendations for the management of cough in adults.  Thorax. 2006 Sep;61 Suppl 1(Suppl 1):i1-24. doi: 10.1136/thx.2006.065144.

 

4.  Desalu OO, Salami AK, Fawibe AE. Prevalence of cough among adults in an urban community in Nigeria. West Afr J Med. 2011 Sep-Oct;30(5):337-41.

 

5.  World Health Organization Advice for the public: Coronavirus disease (COVID-19) updated March 18, 2023. Accessed October 10. 2023.

 

6.  A. K. Salami and I. A. Katibi.  Angiotensin Converting Enzyme-Inhibitors Associated With Cough: A Prospective Evaluation In Hypertensives. Annals of Africans Medicine Vol. 4, No 3, 2005, p118 - 121

 

 

 

Related: How to investigate the causes of chronic cough in adult Africans

 

 

 

Published: October 12, 2023

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