What are the main symptoms of acute bronchitis. How is acute bronchitis diagnosed. When should you see a doctor for a persistent cough. What are the potential complications of acute bronchitis. How long does acute bronchitis typically last.

Understanding Acute Bronchitis: An Overview

Acute bronchitis is a temporary inflammation of the lower airways, specifically the bronchi of the lungs. This condition is often referred to as a “chest cold” and is typically caused by viral infections, frequently occurring alongside other cold symptoms. While it can be uncomfortable, acute bronchitis usually resolves on its own in otherwise healthy individuals, with complications being rare.

Recognizing the Symptoms of Acute Bronchitis

The primary symptom of acute bronchitis is a persistent cough. This cough often evolves over the course of the illness:

• Initially, it may present as a dry cough
• Later, it can develop into a productive cough with mucus (sputum) production
• The color of the mucus may change, sometimes shifting from whitish to greenish-yellow

Other common symptoms associated with acute bronchitis include:

• Mild fever
• Stuffy or runny nose
• Sore throat
• Hoarse voice
• Chest discomfort or pain behind the breastbone (due to frequent coughing)
• Difficulty breathing

Is nighttime coughing common with acute bronchitis? Yes, many people experience coughing at night, which can disrupt sleep patterns.

The Causes Behind Acute Bronchitis

Acute bronchitis is predominantly caused by viral infections, often the same viruses responsible for colds, flu, or sinusitis. Less commonly, it can be triggered by:

• Bacterial infections
• Inhalation of harmful substances (e.g., smoke or workplace pollutants)
• Fungal infections (very rare)

How do these pathogens lead to bronchitis? When viruses or bacteria enter the bronchi through inhalation, they settle in the mucous membranes and begin to multiply. The body’s immune response results in inflammation, causing the infected membranes to swell and produce more fluids and mucus. This increased mucus production helps expel pathogens and dead cells through coughing.

The Spread of Acute Bronchitis

Acute bronchitis can be contagious. When an infected person coughs, they release droplets containing the pathogens into the air. This process, known as a “droplet infection,” can lead to the spread of the illness to others who come into contact with these airborne particles.

Prevalence and Outlook of Acute Bronchitis

How common is acute bronchitis? In Germany, approximately 5 out of 100 people visit their family doctor annually due to acute bronchitis, with the majority of cases occurring during autumn and winter months.

What is the typical duration of acute bronchitis? While common cold symptoms like nasal congestion or fever usually improve within a few days, the cough associated with acute bronchitis can persist for several weeks. However, the condition generally resolves without treatment and doesn’t have lasting effects, unless there was pre-existing lung damage.

Potential Complications and Risk Factors

While acute bronchitis is usually a self-limiting condition, certain groups may be at higher risk for complications:

• Individuals with weakened immune systems
• Those with chronic heart or lung conditions
• People with Chronic Obstructive Pulmonary Disease (COPD)

In rare cases, acute bronchitis may progress to pneumonia in these high-risk groups. For COPD patients, an episode of acute bronchitis can potentially trigger a COPD flare-up (exacerbation).

Diagnosing Acute Bronchitis: When to See a Doctor

How is acute bronchitis typically diagnosed? Diagnosis often involves a combination of:

1. Discussion of symptoms and general health
2. Physical examination, including:
• Checking lymph nodes in the neck
• Examining throat and ears
• Gently tapping sinuses
• Listening to lungs and heart with a stethoscope
3. Measuring temperature, pulse, and blood pressure

When should you consult a doctor for a persistent cough? While it’s often unnecessary to see a doctor for acute bronchitis, certain warning signs warrant medical attention:

• A cough lasting longer than eight weeks
• Very high fever or fever that returns after initial improvement
• Cough accompanied by severe illness, chills, or night sweats
• Blood in coughed-up mucus
• Frequent breathing difficulties or noticeable wheezing

Treatment Approaches for Acute Bronchitis

How is acute bronchitis typically managed? In most cases, acute bronchitis doesn’t require specific medical treatment. The focus is often on symptom relief and supporting the body’s natural healing process. However, certain measures can help alleviate discomfort:

• Rest and adequate hydration
• Over-the-counter cough suppressants or expectorants
• Pain relievers for fever or chest discomfort
• Humidifiers to moisten the air and ease breathing
• Avoiding irritants like smoke or strong odors

Are antibiotics necessary for acute bronchitis? Generally, antibiotics are not recommended for acute bronchitis since it’s usually caused by viruses. However, in rare cases where a bacterial infection is suspected, a doctor may prescribe antibiotics.

Prevention Strategies for Acute Bronchitis

While it’s not always possible to prevent acute bronchitis, certain measures can reduce your risk:

• Practice good hand hygiene
• Avoid close contact with people who have respiratory infections
• Quit smoking and avoid secondhand smoke
• Maintain a healthy lifestyle to support your immune system
• Consider getting vaccinated against influenza and pneumococcal disease

Can regular exercise help prevent acute bronchitis? While exercise doesn’t directly prevent acute bronchitis, maintaining good overall health and a strong immune system through regular physical activity can help your body fight off infections more effectively.

The Role of Nutrition in Managing Acute Bronchitis

A balanced diet rich in vitamins and minerals can support your immune system during and after an episode of acute bronchitis. Foods that may be particularly beneficial include:

• Citrus fruits high in Vitamin C
• Leafy greens for their antioxidant properties
• Garlic and ginger for their anti-inflammatory effects
• Warm soups and broths to stay hydrated and soothe the throat

Long-term Outlook and Chronic Bronchitis

What’s the difference between acute and chronic bronchitis? While acute bronchitis is a temporary condition, chronic bronchitis involves long-term inflammation of the bronchi. Chronic bronchitis is often associated with smoking and can develop into Chronic Obstructive Pulmonary Disease (COPD) over time.

How can you differentiate between acute and chronic bronchitis? If you’re coughing up phlegm for several months, it could be a sign of chronic bronchitis. This condition requires medical attention and long-term management strategies.

The Impact of Acute Bronchitis on Quality of Life

Although acute bronchitis is generally not severe, it can significantly impact daily life during the illness. Common challenges include:

• Disrupted sleep due to nighttime coughing
• Reduced productivity at work or school
• Limitations on physical activities
• Social isolation to avoid spreading the infection

How can you manage these impacts? Prioritizing rest, staying hydrated, and using over-the-counter remedies as needed can help minimize the disruption to your daily routine.

Special Considerations for Children and the Elderly

How does acute bronchitis affect different age groups? While the general symptoms and treatment approaches are similar across age groups, there are some special considerations for children and the elderly:

Acute Bronchitis in Children

Parents often worry about when to seek medical attention for a child with a cough and fever. In most cases, acute bronchitis in children doesn’t require medical treatment and will resolve on its own. However, parents should be vigilant for:

• High or persistent fever
• Difficulty breathing or rapid breathing
• Signs of dehydration
• Lethargy or unusual irritability

Acute Bronchitis in the Elderly

Older adults may be more susceptible to complications from acute bronchitis due to:

• Weakened immune systems
• Pre-existing health conditions
• Decreased lung function

For these reasons, elderly individuals with symptoms of acute bronchitis should be monitored closely and may benefit from earlier medical intervention.

The Role of Environmental Factors in Acute Bronchitis

How do environmental factors influence the development and progression of acute bronchitis? Several environmental elements can play a significant role:

• Air pollution: Exposure to high levels of air pollutants can irritate the airways and increase susceptibility to respiratory infections.
• Climate: Cold, dry air can irritate the bronchial tubes and exacerbate symptoms.
• Occupational hazards: Certain professions that involve exposure to irritants or pollutants may increase the risk of acute bronchitis.
• Indoor air quality: Poor ventilation and the presence of mold or other allergens can contribute to respiratory issues.

What steps can be taken to minimize environmental risk factors? Improving indoor air quality, using air purifiers, and avoiding exposure to known irritants can help reduce the risk of developing acute bronchitis.

The Connection Between Stress and Acute Bronchitis

Can stress contribute to the development of acute bronchitis? While stress doesn’t directly cause acute bronchitis, chronic stress can weaken the immune system, making individuals more susceptible to respiratory infections. Additionally, stress may exacerbate symptoms and prolong recovery time.

How can stress management techniques help? Incorporating stress-reduction practices such as meditation, deep breathing exercises, or regular physical activity can support overall health and potentially reduce the frequency and severity of respiratory infections.

Emerging Research and Future Directions

What new developments are on the horizon for understanding and treating acute bronchitis? Current areas of research include:

• Improved diagnostic tools to differentiate between viral and bacterial causes
• Development of targeted antiviral therapies
• Investigation of natural remedies and their efficacy
• Exploration of the role of the microbiome in respiratory health

How might these advancements impact future treatment approaches? As our understanding of acute bronchitis evolves, we may see more personalized treatment strategies and potentially new preventive measures to reduce the incidence of this common respiratory condition.

The Economic Impact of Acute Bronchitis

What is the broader societal impact of acute bronchitis? While often considered a minor illness, acute bronchitis can have significant economic implications:

• Lost productivity due to work or school absences
• Healthcare costs associated with doctor visits and medications
• Strain on healthcare systems during peak seasons

How can public health initiatives address these impacts? Promoting preventive measures, such as vaccination programs and public education on respiratory hygiene, can help reduce the overall burden of acute bronchitis on individuals and society.

Acute bronchitis: Overview – InformedHealth.org

Introduction

In acute bronchitis, the lower airways (bronchi of the lungs) are temporarily inflamed. The inflammation is usually caused by cold viruses, so it often occurs together with other symptoms of a cold. It is also known as a chest cold.

The main symptom of acute bronchitis is a cough that can be unpleasant and persistent. In people who are otherwise healthy, the illness typically clears up on its own. Complications are rare. Treatment with medication usually isn’t necessary. At the most, it can help to relieve the symptoms.

Symptoms

The main symptom of acute bronchitis is a cough. This is usually a dry cough at first, but it may later develop into a phlegmy cough, where you cough up mucus (sputum). Doctors call this a “productive” cough. The color of the coughed-up mucus may change during the course of the illness – for instance, from whitish to a greenish yellow.

People often cough at night, which wakes them up. Because acute bronchitis often occurs together with a cold, many people also have other symptoms such as a mild fever, a stuffy nose, a sore throat and a hoarse voice. Frequent coughing can lead to pain behind the breastbone, and it is sometimes harder to breathe.

When children have a high temperature and a cough, parents often wonder whether to take them to the doctor or not. But acute bronchitis usually doesn’t have to be treated with medicine. So there’s nothing wrong with staying at home and waiting to see if it gets better first.

Causes

Acute bronchitis is usually caused by the same viruses that cause respiratory infections such as colds, the flu or sinusitis. In rarer cases, acute bronchitis is caused by bacteria. Other rare causes include harmful substances that have been breathed in, for instance in smoke or at the workplace (e.g. when welding without wearing a protective mask). Fungal infections may cause acute bronchitis too, but that is very rare.

Viruses and bacteria can get into the bronchi in your lungs when you breathe in. There they can settle in the mucous membranes and start multiplying (grow in number). In order to fight them, your body reacts with an inflammation: The infected membranes become swollen and produce more fluids and mucus to make it easier to cough up viruses, bacteria and dead cells.

When you cough, droplets of fluid containing the germs are released into the air. If other people come into contact with these droplets, they may become infected too. When germs spread in this way it is sometimes referred to as a “droplet infection.”

Prevalence and outlook

Every year, about 5 out of 100 people in Germany go to their family doctor because of acute bronchitis, especially because of the cough.  Most of them get it in the autumn or winter.

Acute bronchitis usually goes away without treatment and doesn’t have any lasting effects – unless the lungs were already damaged beforehand. Common cold symptoms such as a stuffy nose or fever usually get a lot better within a few days. But it might take several weeks for the cough to go away if you have acute bronchitis.

It’s a good idea to see your doctor if the cough lasts longer than eight weeks. If you cough up phlegm for several months, you could have chronic bronchitis. This is often triggered by smoking, and can develop into chronic obstructive pulmonary disease (COPD) over time.

Effects

In people who have a weakened immune system or a chronic heart or lung condition, acute bronchitis may develop into pneumonia in rare cases. The inflammation then spreads from the mucous membranes lining the lungs to the lung tissue itself. If someone has COPD, acute bronchitis can trigger a COPD flare-up (exacerbation).

Diagnosis

If you go to your doctor because of a persistent cough, they will usually ask you about your symptoms and general health.

The answers to these questions are often enough for the doctor to determine whether it’s acute bronchitis or more likely to be something else.

In the physical examination that follows, the doctor will usually feel the lymph nodes in your neck, look into your throat and ears, gently tap your sinuses, and listen to your lungs and heart with a stethoscope. He or she may also measure your temperature, pulse and blood pressure.

You will be diagnosed with “acute bronchitis” if the talk with the doctor and physical examination confirm that you have the typical symptoms, and if there is no reason to believe that the symptoms are being caused by a different medical problem.

It is often not necessary to see a doctor. But you should see a doctor if you have any of the following warning signs:

• A cough that lasts longer than eight weeks

• A fever that is very high or returns after going away for a while

• A cough accompanied by a feeling of being very unwell, chills and night sweats

• Blood in coughed-up mucus

• Frequent breathing difficulties and noticeable wheezing sounds when you breathe

If you have any of these symptoms, doctors will do more testing (e. g. x-rays or blood tests) to rule out more serious causes.

People who have a weakened immune system or a chronic heart or lung condition may be advised to already go to the doctor if they have milder symptoms.

Prevention

People who take steps to prevent common colds will also be less likely to get acute bronchitis. As with all respiratory infections, hygiene plays an important role here:  Washing your hands regularly, and trying not to touch your face with your fingers, lowers the risk of getting a common cold.

In order to stop colds from spreading to other people, you can

• cough or sneeze into your elbow, not into your hand,

• throw away used tissues immediately,

• avoid shaking hands and hugging or kissing people, and

• stay at home until you are no longer contagious.

Some studies have looked into whether things like vitamin supplements, probiotics, herbal medicines or regular exercise can prevent respiratory tract infections. But it wasn’t possible to draw any clear conclusions about  whether these measures can lower the risk of acute bronchitis in particular.

Treatment

Acute bronchitis gets better on its own without treatment. If you feel weak and ill, it’s best to take it easy for a few days. This includes not doing any sports or other strenuous physical activities. Many people find that drinking hot tea or broth has a soothing effect. But there’s no scientific proof that drinking a lot more fluids than usual helps.

If you go to the doctor, they may give you a sick note so that you can get enough rest at home and recover. But they won’t prescribe medicine specifically for acute bronchitis. It can sometimes make sense to take medicine such as acetaminophen (paracetamol) or ibuprofen, though, to relieve cold symptoms such as fever and pain.

There hasn’t been enough research on the effectiveness of cough medicines that are designed to make you cough less (cough suppressants) or make it easier to cough up phlegm (expectorants). Because coughing has the important function of getting rid of mucus and foreign objects, cough suppressants should only be used for short amounts of time, and only for really unpleasant, dry coughs that keep you awake at night. Honey and some herbal medicines may help to relieve the cough somewhat.

Because the symptoms are usually caused by viruses, antibiotics hardly help in the treatment of acute bronchitis. But they can have side effects and increase the likelihood of the bacteria becoming resistant (ineffective). So antibiotics aren’t recommended as a treatment for acute bronchitis.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

Sources

• Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). DEGAM-Leitlinie Nr. 11: Husten. AWMF-Registernr. 053-013. February, 2014.

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

The Diagnosis and Treatment of Acute Cough in Adults

Cough is the most frequent reason for visits to primary care physicians, accounting for around 8% of all consultations (1). The annual prevalence of cough in the general population is reported as circa 10–33% (2). By far the most common causes of acute cough are infections of the upper respiratory tract and acute bronchitis, which together account for more than 60% of diagnosed cases (1). The economic consequences are huge: respiratory tract infections are responsible for around 20% of cases of unfitness for work and circa 10% of the days off work due to illness (3).

This article summarizes the principal content and recommendations of the recently updated guideline on acute cough (cough of less than 8 weeks’ duration). The aim of the guideline is to depict the differential diagnoses of the symptom “cough” in adults and to guide the physician in identifying the cause and providing evidence-based treatment, with emphasis on relevance for primary care in practice. In line with the realities of primary care, the guidelines of the German College of General Practitioners and Family Physicians (DEGAM) are often not “diagnosis oriented. ” This guideline also proceeds from the reason for consultation or from the symptom. The underlying diseases are discussed only in relation to the cough, not in detail.

Method

Revision of the guideline

Fifteen years ago the DEGAM adopted a wide-reaching concept for the development, dissemination, implementation, and evaluation of guidelines (4). These guidelines are supplemented by practice-oriented short versions and patient information sheets. The original version of the cough guideline was published in 2008. In 2013 the guideline was comprehensively updated according to the standards for S3 guidelines under the moderation of the Association of Scientific Medical Societies in Germany (AWMF). The revision was necessitated by extensive new evidence regarding diagnosis and treatment.

Guideline group

Representatives of seven German medical societies were involved in revision of the guideline (Box 1). The members of the guideline group disclosed any potential conflicts of interest, and this process is documented in detail in the guideline report.

Box 1

Organizations and persons involved in the revision of the S3 guideline

• Institute for General Practice,

  Charité Universitätsmedizin, Berlin

  • Dr. Sabine Beck^*1

  • Prof. Vittoria Braun

  • Dr. Lorena Dini MScIH^*1

  • Dr. Christoph Heintze MPH^*1

  • Dr. Felix Holzinger MPH^*1

  • Christiane Stöter MPH

  • Dr. Susanne Pruskil MScPH

  • Mehtap Hanenberg

  • Max Hartog

• Representatives of medical societies

  • Prof. Stefan Andreas,

    German Respiratory Society (DGP), German Society for Internal Medicine (DGIM)^*1

  • Patrick Heldmann MSc,

    Federal Association of Self-employed

    Physiotherapists (IFK)^*1

  • Dr. Susanne Herold PhD,

    German Society for Infectious Diseases (DGI)^*1

  • Dr. Peter Kardos, German Respiratory League

  • Dorothea Pfeiffer-Kascha,

    German Association for Physiotherapy (ZVK)^*1

  • Dr. Guido Schmiemann MPH,

    German College of General Practitioners and Family Physicians (DEGAM)^*1

  • Prof. Heinrich Worth,

    German Respiratory Society (DGP),

    German Respiratory League^*1

• Guideline patrons (DEGAM)

  • Prof. Annette Becker

  • Dr. Günther Egidi

  • Dr. Detmar Jobst

  • Dr. Guido Schmiemann MPH

  • Dr. Hannelore Wächtler

• The authors also thank

  • Prof. Jost Langhorst

  • Dr. Petra Klose

  • Dr. Cathleen Muche-Borowski MPH

    (DEGAM, AWMF)

  • Dr. Monika Nothacker MPH (AWMF)^*2

  • Dr. Anja Wollny MSc (DEGAM)

^*1Participants of consensus conference

^*2Moderator of consensus conference

Literature review

The search strategy of the original version of the guideline was extended to July 2012. The MEDLINE, Cochrane Library, EMBASE and Web of Science databases were searched. This was followed by a search for national and international guidelines and a manual search that included sources with a publication date later than the end of the systematic database review period.

The identified sources were inspected (titles, abstracts, full-text versions). Relevant randomized controlled trials (RCTs), meta-analyses, and reviews (preferably systematic) were included, together with high-quality guidelines. Altogether, 182 publications were taken into account in updating the guideline (Box 2, ).

Box 2

Examples of search terms

^*Additional search in PubMed via corresponding MeSH terms;
MeSH, medical subject headings

Overview of the literature search

Consensus process

On 17 June 2013 the draft guideline was presented to a consensus conference moderated by the AWMF. The recommendations based on analysis of the available evidence were all adopted unanimously in a nominal group process, with the exception of one recommendation where one participant abstained owing to a self-perceived conflict of interest.

Strength of recommendation

The strength of recommendation depends on the strength of the evidence (study type, adequacy of study design, internal validity, likelihood of bias) and on the criteria of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group, e.g., uncertainty regarding the extent of benefit conferred by a given diagnostic/therapeutic procedure, observance of patient preferences, and cost efficiency (5). Three grades of recommendation are distinguished: A, B, and C ().

Table 1

Recommendations and evidence

Recommendation strength A	Evidence level
Clinical diagnosis of acute uncomplicated bronchitis renders laboratory testing, sputum evaluation, and chest radiographs unnecessary.	TIa, PII ↔
Uncomplicated acute bronchitis should not be treated with antibiotics.	TIa ↔
The patient should be informed about the spontaneous course of acute (cold-related) cough.	TIb, SIII ↔
Recommendation strength B	Evidence level
Technical investigations should be dispensed with in acute cough with no danger signs.	SIV ↑
Acute cough in the context of infection should not be treated with expectorants (secretolytics, mucolytics).	TIa ↓
Acute cough in the context of infection should only exceptionally be treated with antitussives.	TIIa ↔
Sputum evaluation should not be routine in community-acquired pneumonia.	DII, CII ↔
In the absence of risk factors, community-acquired pneumonia should be treated with an empirical oral antibiotic (an aminopenicillin, or alternatively a tetracycline or a macrolide) for 5 to 7 days.	TIa ↓
In the presence of risk factors, community-acquired pneumonia should be treated with an empirical oral antibiotic (an aminopenicillin with a betalactamase inhibitor, or alternatively with a cephalosporin) for 5 to 7 days.	TIa ↓
Laboratory testing (serology, direct demonstration of virus) should not be routine in suspicion of an influenza ‧infection.	TIa, DI ↓
Neuraminidase inhibitors should be used only exceptionally for treatment of seasonal influenza.	TIa ↓

Guideline contents and recommendations

History and clinical examination

In a large proportion of patients with acute cough in the primary care setting, the diagnosis can be established from the medical history and the findings of a symptom-oriented physical examination. More technical diagnostic investigations are of little value in these cases (6).

The basic elements of history taking and physical examination are outlined in .

Table 2

History, physical examination, and danger signs in acute cough

Danger signs

The aim of history taking and physical examination is differentiation of harmless infections from serious diseases and early detection of potentially endangered patients. In occasional cases a life-threatening illness may be present or imminent (). The major warning signs (“red flags”) are dyspnea, tachypnea, thoracic pain, hemoptysis, a severely worsened general state, and changes in vital signs (high fever, tachycardia, arterial hypotension), together with the presence of any complicating underlying disease (e.g., malignancy, immune deficiency).

In urgent cases immediate action is required. Usually this means rapid transport to hospital accompanied by a (emergency) physician.

Frequent diseases, diagnosis, and treatment options

The principal differential diagnoses are listed in . The most frequent causes of acute cough are discussed in the following.

Table 3

Frequent causes of acute cough

Colds and acute bronchitis

Clinical presentation—Upper respiratory tract infections (URTI; “common cold”) are the most common cause of acute cough. Other typical symptoms are sore throat, runny nose, headache, muscle aches, fatigue, and sometimes a high temperature. Viral infections are usually to blame (adenoviruses, rhinoviruses, influenza- and parainfluenzaviruses, coronaviruses, respiratory syncytial virus [RSV], coxsackieviruses). The cough in acute bronchitis is first dry, then productive. There is no clear cut-off between a cold and acute bronchitis (involvement of the lower respiratory tract). In two thirds of cases a cold is self-limiting and lasts no longer than 2 weeks, while in bronchitis the cough can persist for several weeks (7). Acute sinusitis in the context of a cold may also stimulate cough receptors.

Diagnosis—If the history and clinical findings are compatible with cold or bronchitis, neither a chest radiograph nor clinical chemistry is necessary, provided there are no danger signs (). It is not necessary to distinguish between viral and bacterial bronchitis by determination of leukocytes or C-reactive protein (CRP), because the findings have no consequences for treatment (8). The color of the sputum has no predictive value for the diagnosis of bacterial bronchitis or the differentiation between pneumonia and bronchitis (9, 10). Sputum examination in an otherwise healthy bronchitis patient is pointless, because antibiotics are not required (11). Spirometry is indicated in the presence of signs of bronchial obstruction, because acute bronchitis can cause temporary airway constriction (9). A patient whose cough persists should be investigated in more detail after no more than 8 weeks.

Treatment—There is scant evidence on the efficacy of nonmedicinal treatments. From the physiological viewpoint it is sensible to maintain an adequate fluid intake, but drinking excessive amounts may bear the risk of hyponatremia (12). Abstention from smoking is recommended, because active and passive smokers take longer to recover from a cold (13). The results of RCTs are inconsistent with regard to the efficacy of nasal rinses/sprays with saline solution or steam inhalation (14, 15). To prevent transmission, it is better to cough into the elbow rather than the hand. Frequent hand washing at times of year when colds are prevalent is a sensible prophylactic measure (16).

Cough accompanying a cold or acute bronchitis/sinusitis usually resolves without any specific medicinal treatment. The patient should be told that the illness is self-limiting and harmless, and that therefore no drugs need to be given. Medications to relieve the symptoms can be prescribed, however, if the patient so wishes.

Analgesics such as acetaminophen and ibuprofen are recommended for symptomatic treatment of headache and muscle aches. RCTs have shown no advantage of antitussives (e.g., codeine) over placebo in reducing the urge to cough in the common cold. Nevertheless, they may improve sleep at night (17, 18). Expectorants are often prescribed to patients with productive cough, despite the lack of evidence for their efficacy against acute cough — there are no high-quality observational studies or RCTs for this indication (19). It is uncertain whether the findings of studies on chronic bronchitis are applicable to acute bronchitis or colds. Decongestant nose drops or nasal sprays ameliorate the symptoms in the short term, but their use for more than 7 days yields no persisting relief and may lead to atrophic rhinitis (20).

The evidence in respect of phytotherapeutics is difficult to interpret owing to the methodological heterogeneity of the available studies and the variable composition of plant-based preparations. A few RCTs found favorable effects of myrtol standardized with regard to severity of symptoms and time to recovery (21, 22). In one study the daytime coughing frequency was reduced by 62.1% on day 7 with myrtol, compared with 49.8% in patients who received placebo (22). The adverse effects are predominantly restricted to mild gastrointestinal symptoms. One RCT showed slightly improved symptom relief for a preparation of thyme and ivy leaf (77.6% reduction of cough attacks on day 9, compared with 55. 9% for placebo). Comparable effects were found for a combination of thyme and primrose root. For these preparations too, there are no reports of severe side effects (23, 24). A small number of studies have shown slight dose-dependent acceleration of recovery from bronchitis for Pelargonium sidoides (25, 26). In placebo-controlled studies, the rate of gastrointestinal adverse effects was higher than for placebo. It should be noted that no firm conclusions can yet be drawn with regard to the benefit-to-harm ratio of Pelargonium sidoides owing to reports of possible severe hepatotoxicity. A Cochrane Review described the possible therapeutic efficacy of early administration of the above-ground parts of Echinacea (27). With oral intake the risk of adverse effects such as allergies is low. The contraindications (e.g., tuberculosis, AIDS, and autoimmune diseases) must be observed. No preventive or therapeutic effect could be found for the components of Echinacea root.

Regular intake of vitamin C has no effect on the frequency of colds in the average population. Only in those exposed to extreme physical demands (e.g., marathon runners) is the risk of a cold reduced (28). No therapeutic effect has been demonstrated for the use of vitamin C at the outset of a cold. A meta-analysis (29) showed that regular intake of zinc reduced the occurrence of cold symptoms; however, the adverse effects included nausea and an unpleasant taste in the mouth. Zinc cannot presently be recommended generally because the required dosage and duration of intake have not been established.

No antibiotic treatment is necessary in uncomplicated acute bronchitis. Antibiotics relieve the symptoms only marginally and shorten the recovery times by less than a day, while their disadvantages include potential adverse effects and development of resistance (11). The prescription frequency of antibiotics can be reduced by specific education of patients (9, 30). Administration of antibiotics can be considered in individual patients with serious chronic diseases or immune deficiencies, because in such cases it is often difficult to rule out pneumonia (9). Even in these patients antibiotics should not be prescribed routinely, however, because—as in general—the bronchitis is usually viral in origin.

Pneumonia

Clinical presentation—Coughing accompanied by tachypnea, tachycardia, high fever, typical auscultation findings, and pain on respiration indicates pneumonia. The manifestation of pneumonia may be atypical, e.g., without fever, in older or immune-suppressed patients or in those with chronic lung disease (31).

Diagnosis—Chest radiography in two projections is desirable particularly in the case of diagnostic uncertainty, severe illness, or comorbidities (31). Determination of neither leukocytes nor CRP absolutely confirms the diagnosis of pneumonia (32). CRP measurement may be helpful in monitoring the disease course, but routine determination is not advised in patients being treated out of the hospital setting. Studies have shown that measurement of procalcitonin may shorten or even avoid treatment with antibiotics, but routine procalcitonin determination cannot currently be recommended on grounds of cost (33, 34). In patients with community-acquired pneumonia who are being treated out of hospital, sputum tests have low sensitivity and specificity. Moreover, since targeted antibiotic treatment is not superior to empirical treatment (31, 34), sputum testing cannot be advised in a patient with community-acquired pneumonia.

Treatment—Clinically stable patients with community-acquired pneumonia can be treated by their primary care physician. Calculated antibiotic treatment depends on whether risk factors are present, meaning that an extended spectrum of pathogens must be taken into account (31). Clinical verification of treatment success is required after 48 to 72 hours. Continuation of treatment beyond 7 days does not increase the success rate (35). Fluoroquinolones should be used only exceptionally in the out-of-hospital setting owing to the severe adverse effects and development of resistance ().

Table 4

Antibiotic treatment in community-acquired pneumonia^*

Patients without risk factors
Substances	Dosage	Duration
Penicillin (oral): Amoxicillin	<70 kg: 3 x 750 mg ≥ 70 kg: 3 x 1000 mg	5–7 days
Tetracycline (oral): Doxycycline	<70 kg: first day 200 mg, then 100 mg ≥ 70 kg: 200 mg
Macrolide (oral): Roxithromycin Clarithromycin	1 x 300 mg 2 × 500 mg
Azithromycin	1 × 500 mg	3 days
Patients with risk factors (antibiotic treatment in previous 3 months, severe comorbidity, care home resident)
Substances	Dosage	Duration
Aminopenicillin + betalactamase inhibitor: e. g., sultamicillin (oral)	2 x 750 mg	5–7 days
Alternative: cephalosporins: e.g., cefuroxime axetil (oral)	2 x 500 mg

Influenza

Clinical presentation—The onset of symptoms is usually fulminant with high fever, pronounced malaise, and muscle pains.

Diagnosis—Influenza is usually diagnosed by clinical examination. Antibody determination or direct demonstration of virus on swabs should be carried out only in cases of doubt and when required to decide on the appropriate treatment (see below).

Treatment—Treatment with neuraminidase inhibitors is possible within the first 48 hours. The evidence on efficacy is not conclusive, however, so due to the poor cost–benefit ratio these substances can be recommended only in individual patients (e. g., in some cases of severe immune suppression) (36). Given the sometimes severe course of influenza, admission to hospital should be considered especially for multimorbid and elderly patients and those with complications.

Vaccination of the over-60s is recommended by the German Standing Committee on Vaccination Recommendations (STIKO). However, a new meta-analysis with strict inclusion criteria found that the efficacy of vaccination was sometimes inadequate. Moreover, there are no RCTs for the age group over 65 (37).

Pertussis

Clinical presentation—Increasingly, adults too are being affected by pertussis. Adult patients often present an atypical mild disease course with nonspecific dry cough. Vaccination secures immunity for no more than a few years. In the initial catarrhal stage differentiation of pertussis from a cold is difficult. The paroxysmal whooping cough sets in after 1 to 2 weeks (second peak) and can persist for 4 weeks (or longer).

Diagnosis—Identification of the pathogen by culture of nasopharyngeal secretions is reliable only within 2 weeks (38). Polymerase chain reaction (PCR) is more sensitive and may demonstrate the infection up to 4 weeks after onset, but is considerably more costly. In the late phase of disease only serology can confirm the diagnosis; the results should be interpreted in the context of the clinical presentation and after discussion with the laboratory.

Treatment—In the catarrhal stage recovery can be accelerated by treatment with azithromycin or clarithromycin. Antibiotic treatment is also useful later in the disease course, as it shortens the period of contagiousness (39). Antibiotic prophylaxis is advised for contact persons who share a household with a child under the age of 6 months. Vaccination according to the STIKO recommendations is urged. The vaccine against pertussis is available only as a combined vaccine.

Asthma and infection-exacerbated COPD

Chronic diseases of the respiratory tract may present acute crises, or may first manifest themselves with cough symptoms. The National Disease Management Guidelines should be consulted for advice on the diagnosis and treatment of asthma and chronic obstructive pulmonary disease (COPD).

Implementation and outlook

With regard to uncomplicated colds and acute bronchitis, the central recommendation of the guideline is diagnostic and therapeutic restraint. It is crucial to inform patients with these benign, self-limiting diseases that technical investigations and medicinal treatment are usually unnecessary. The guideline—and the corresponding patient information sheet—provides evidence-based arguments to assist the primary care physician confronted with insecurity and questions about treatment options. Even in the case of bronchitis with yellow–green sputum or mild fever, the patients can be reassured that the infection is most likely viral, so antibiotic treatment is unnecessary. In practice, patients with URTI or bronchitis are often prescribed antibiotics, promoting development of resistance (10, 40). If the patient insists on treatment, general symptom-relieving agents can be recommended (nonsteroidal anti-inflammatory drugs, decongestant nose drops). Another option could be phytotherapeutic substances, some of which have been shown to abbreviate or relieve the symptoms to some modest extent. However, the patients have to bear the costs and adverse effects—albeit mostly harmless—may occur. The physician and patient have to discuss whether use of such preparations is desirable (shared decision making). Furthermore, in the face of the widespread use of cough treatments for which there is no adequate evidence of benefit, methodologically sound, publicly financed studies are required in which these substance groups can be systematically investigated with regard to the indication “acute cough.”

Bronchitis | Johns Hopkins Medicine

What is bronchitis?

Bronchitis is an inflammation of the main air passages (bronchi) to the lungs. Coughing often brings up yellow or greenish mucus. There are two main types of bronchitis: acute and chronic. Acute bronchitis, often caused by the same viruses that cause colds, usually starts as a sore throat, runny nose or sinus infection, then spreads to your airways. It can cause a lingering dry cough, but it usually goes away on its own. In chronic bronchitis, a type of chronic obstructive pulmonary disease (COPD), the inflamed bronchi produce a lot of mucus, leading to cough and difficulty getting air in and out of the lungs. 

Symptoms

Symptoms of acute bronchitis include: 

• Cough 

• Shortness of breath 

• Wheezing 

• “Rattle” sensation in chest 

• General ill feeling, or malaise 

• Slight fever 

• Tickle feeling in back of throat that leads to soreness 

• Chest pain, soreness, and tightness in the chest 

• Poor sleep 

• Chills (uncommon) 

Symptoms of chronic bronchitis include: 

• Cough that produces mucus (sputum), which may be blood streaked 

• Shortness of breath aggravated by exertion or mild activity 

• Frequent respiratory infections that worsen symptoms 

• Wheezing 

• Fatigue 

• Headaches 

Diagnosis

Tests to diagnose acute and chronic bronchitis include: 

Treatment for Acute Bronchitis

• Antibiotics usually aren’t helpful because acute bronchitis is almost always caused by a virus, which will not respond to antibiotics. Antibiotics are usually only needed if your doctor diagnoses you with whooping cough or pneumonia. 

• Medications called bronchodilators are used to open tight air passages in the lungs. Your doctor may prescribe this type of medicine if you are wheezing. 

• Decongestants may also help relieve symptoms of bronchitis. Medications that loosen mucus can also be prescribed, but how well they work remains uncertain. 

• Your doctor will tell you to drink more fluids to help thin mucus in the lungs, rest and soothe your airways by increasing humidity in the air with a cool mist humidifier. 

Symptoms will usually go away within seven to 14 days if you don’t have chronic pulmonary disease. However, in some people it may take much longer for the cough to go away. 

Treatment for Chronic Bronchitis

There is no cure for chronic bronchitis. Treatments to relieve symptoms and prevent complications include: 

• Inhaled medications that dilate (widen) the airways and decrease inflammation may help reduce symptoms such as wheezing.

• Antibiotics to fight infections

• Corticosteroids may occasionally be used during flare-ups of wheezing or in people with severe bronchitis that does not respond to other treatments. 

• Oxygen therapy may be needed in severe cases. 

Treatment will help symptoms, but chronic bronchitis is a long-term condition that keeps coming back or never goes away completely. 

Prevention

Good handwashing is one of the best ways to avoid getting viruses and other respiratory infections. 

• Since flu viruses have been shown to be a major cause of bronchitis, getting a flu shot may also help prevent acute bronchitis. 

• Limit exposure to cold, damp environments.

What Does Your Cough Say About Your Illness? – Cleveland Clinic

A persistent cough can disrupt your daily activities and drive you to distraction. But, whether it stays around for a few days or turns into a nagging annoyance that lingers for weeks, the type of cough you have can often give you a clue about what’s ailing you.

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Pulmonologist Rachel Taliercio, DO, says upper respiratory infections cause a significant percentage of acute cough. Knowing more about your cough (whether dry or wet, acute or chronic) can help determine the best treatment options, especially if the cough does not resolve.

Acute coughs from temporary illness

An acute cough most likely appears when you have a cold, flu or other temporary infection. It may last up to eight weeks, and medication usually helps quiet this type of cough.

If you’re not getting relief from over-the-counter medication or the condition persists beyond a week or two, consult your doctor.  He or she will determine whether a treatable infection is causing your cough.

Whooping cough or pneumonia also may prompt an acute cough, Dr. Taliercio says. She describes how these coughs may sound and how to treat them.

Whooping cough (pertussis). A vaccine can prevent this virus, which once was on the decline. If you get pertussis, the cough can become so intense, you may vomit.

• How does it sound? Severe, hacking cough, including a “whooping” sound with inhalation
• How to treat it: Antibiotics

Pneumonia. This condition inflames the lungs and can make them fill with fluid. Vaccines can prevent some pneumonia infections.

• How does it sound? Initially a dry cough that later turns wet with yellow, green or red-tinged mucus
• How to treat it: Antibiotics for bacterial infections; rest and cough medication for viral infections

Chronic coughs from underlying conditions

Chronic cough is defined as a cough that lasts eight weeks or more, and it can have several different causes. Treatment options for chronic cough caused by underlying conditions varies, depending on the illness.

Chronic obstructive pulmonary disease (COPD). This condition causes lung inflammation that constricts your airways, making breathing difficult. It’s usually caused by long-term exposure to lung irritants, such as cigarette smoke.

• How does it sound? A chronic, hacking cough that creates a significant amount of mucus, particularly in the morning
• How to treat it: Bronchodilators (drugs that help open airways), inhaled steroids, oxygen therapy, quitting smoking

Gastroesophageal reflux disease (GERD). GERD occurs when stomach acid irritates your esophagus. It’s the second most common cause of chronic cough, accounting for 40 percent of cases.

• How does it sound? Dry, spasmodic cough; occurs most often when you lie down
• How to treat it: Over-the-counter medications to reduce acid production

Post-nasal drip.  Mucus dripping down the back of your throat causes this type of cough, which may occur with allergies, colds or sinus infections.

• How does it sound? Dry or wet; worsens at night
• How to treat it: Antihistamines dry up post-nasal drip from allergies. Saline washes and steam relieve congestion from lingering colds. See a doctor if symptoms last more than a week to check for a potential sinus infection.

Asthma. Asthma causes airway inflammation, swelling and increased mucus production that makes breathing more difficult.

• How does it sound? Dry or wet cough that ends with a rattle or wheeze; often worsens at night, in cold air or with exercise
• How to treat it: Inhaled bronchodilators (such as albuterol) or corticosteroids (such as fluticasone) for quick relief

Medication-related cough. This type of cough may appear a few weeks after you start taking a new medication. For example, 20% of patients taking ACE inhibitors for high blood pressure experience a cough.

• How does it sound? Dry cough
• How to treat it: Consult your doctor about switching medications.

Dealing with a cough reflex you can’t control

A refractory chronic cough, or a cough you can’t control, lasts for more than eight weeks and doesn’t respond to treatment. It occurs less than 20% of the time, Dr. Taliercio says.

It happens when inflammation irritates the nerves in the larynx, causing an involuntary cough reflex. Patients also often feel as if there’s something stuck in their throat.

“People are most bothered by and distraught over the unpredictable coughing episodes,” she says. “Sometimes, they can cough so hard they pass out.”

• How does it sound? Dry coughs that occur in spasms and are difficult to control
• How to treat it: Off-label use of existing medications for other conditions, including neuromodulators (such as neurontin) and low doses of tricyclic antidepressants (such as amitriptyline)

Behavioral speech therapy can also help patients manage this type of cough, Dr. Taliercio says. In two or three sessions, patients will learn about cough suppression techniques, cough causes, breathing exercises, vocal hygiene and personal cough triggers.

“This type of therapy gives people control over their cough,” she says.

If you’re struggling with a lingering cough, try listening to what it’s telling you. And if it persists, your doctor can likely help pinpoint a cause and prescribe an appropriate treatment.

What Is a Cough? Symptoms, Causes, Diagnosis, Treatment, and Prevention

How to Stop Coughing

A cough can be treated in a variety of ways, depending on the cause. For healthy adults, most cough remedies will involve self-care.

A cough that results from a virus can’t be treated with antibiotics. You can, however, soothe it with the following home remedies: (1)

• Keep hydrated by drinking plenty of fluids. Liquid helps thin the mucus in your throat, and warm liquids, such as broth, tea, or lemon juice, are soothing.
• Suck on cough drops or hard candies, which may ease a dry cough (one that doesn’t produce phlegm/mucus) and soothe an irritated throat.
• Have a spoonful of honey. One teaspoon of honey may help loosen a cough (never give honey to children younger than 1 year old because honey can contain bacteria harmful to infants).
• Use a cool mist humidifier or take a steamy shower to moisturize the air.

Other natural remedies include:

• Elevating your head with extra pillows when you’re sleeping
• Gargling warm salt water to remove mucus and soothe your throat

Medication Options

Cough medicines are typically used only for acute coughs that cause a lot of discomfort, interfere with sleep, and are not associated with any potentially more serious symptoms. (1)

Over-the-counter cough and cold medicines, like cough syrups and cough suppressants, may help you treat the symptoms of a cough. But research suggests that these medicines don’t work any better than placebos (inactive medicines). (1)

If your cough is caused by an infection, your doctor might prescribe an antibiotic or antiviral medication. (3)

If you have GERD, you may be prescribed a proton pump inhibitor, which is a kind of medicine that reduces the amount of stomach acid produced by glands in the lining of your stomach.

Learn More About Home Remedies for Coughs

Prevention of Coughs

Many coughs are caused by the common cold. To help reduce your risk of getting a cold, wash your hands often with soap and water for 20 seconds (use an alcohol-based hand sanitizer when soap and water are not available), avoid close contact with sick people, and try not to touch your face with unwashed hands, according to the Centers for Disease Control and Prevention (CDC). (7)

Home remedies like staying hydrated and moisturizing your bedroom with a humidifier can help you ease a cough if you already have one. Also avoid tobacco smoke, which can make your cough worse or may be the main cause of it.

RELATED: 10 Tips for Day and Night Cough Relief

The difficult coughing child: prolonged acute cough in children | Cough

Cough in children is the most common presenting symptom to general practitioners and persistent cough is commonly referred to paediatricians for further investigation and treatment [1]. The cough can be very distressing for parents to watch especially if it interferes with daily activities and often disturbs both the parents and child’s sleep [2]. While coughing may be seen as a mere troublesome symptoms without any serious consequences, ignoring cough that may be the sole presenting symptom of an underlying respiratory disease may lead to delayed diagnosis and progressions of a serious illness or chronic respiratory morbidity. In most children acute coughing is usually due to a viral upper respiratory tract infection (URTI) such as a simple head cold with bronchitis or croup. Less often, but still common, pathogens can involve the lower respiratory tract system causing bronchiolitis, whooping cough, or pneumonia. Symptomatic URTI with cough in school children typically occurs around 7–10 times per year.

When does an acute cough typically end

The majority of children with acute coughing with a simple head cold have an associated bronchitis and the coughing typically abates by 10 to 14 days. In one study parents assessed the cough as moderate or severe in more than 80% cases and the coughing to be frequent or continuous in more than 70% cases [3]. The longest cough duration in this study was 21 days and initially more than 50% of parents described the cough as dry with the remainder reporting the cough to be productive or of a mixed type. Recently Mitra et al. followed the course of acute URTI in children and reported cough to be the second commonest symptom to runny nose occurring in more than 80% of children [4]. The coughing occurred after an initial 1–2 days of systemic illness with fever and a feeling of un-wellness. The coughing lasted a median of 5 days and in this study, all children had stopped coughing by 20 days. Prospective studies of acute cough in young children in general practice have suggested that about 50% recover by 10 days and 90% by 3 weeks, so 10% of children still have problems in the third to fourth weeks [5, 6]. This is supported by a recent systematic review of the natural history of acute cough in which it was estimated that about one-quarter will still be unwell with cough at 2 weeks [7].

When should a cough be called ‘chronic’

No studies have clearly defined when a cough should be labelled as chronic. It has been recognised in adult studies that many patients whose chief complaint was cough lasting for more than 3 weeks the cough usually resolved spontaneously without any treatment. However, spontaneously resolving cough was exceedingly rare in adults who had experienced a long duration of cough such as for several months or years [8]. Thus patients with cough of a relatively short duration must be regarded separately from patients with a cough of a longer duration.

The BTS Recommendations for the assessment and management of cough in children defined chronic cough as a cough which had lasted longer than 8 weeks rather than the 4 weeks recommended in the American College Chest Physicians (ACCP) guidelines [9, 10]. The thinking behind the decision to include an intermediate time zone defined as ‘prolonged acute cough’ in this guideline was to allow a period for cough resolution for the 10% of normal children who are still coughing with a simple head cold after 2–3 weeks. If the child is otherwise normal and the cough is resolving no further investigations would be indicated. Warnings were included that a ‘wait and see’ policy was not recommended if a retained inhaled foreign body is considered a possibility, if the child has already signs of chronic lung disease or when the coughing is progressively becoming worse (e.g. consider pertussis, retained inhaled foreign body, expanding mediastinal neoplasm, lobar collapse secondary to mucus plug and tuberculosis (often with accompanying weight loss). Most children with a prolonged acute cough were thought to have a post viral syndrome or a pertussis like illness. This approach mirrors the adult recommendations where a cough lasting more than 8 weeks was defined as chronic and a cough lasting more than 3 weeks but resolving by 8 weeks was called a subacute cough [11]. On the other hand, the Australian and American College Chest Physicians (CACP) guidelines on cough in children defined chronic cough as a cough that lasts longer than 4 weeks [10, 12]. Here the authors observed only 13.9% of the total 346 children’s’ cough had resolved without any specific diagnosis and the remaining primary aetiology observed needed medical investigations. The authors also observed no differences in duration of cough or cough score in children with serious underlying disease compared to those with less serious conditions.

This approach theoretically might encourage earlier and possibly unnecessary investigations. However, it may highlight to primary care physicians and paediatricians the need to consider earlier the treatment of persistent bacterial bronchitis (see below). A recent RCT has confirmed the benefits of a 2 week course of amoxicillin-clavulanate in children with a prolonged wet or productive cough lasting more than 3 weeks [13].

What are the causes of prolonged acute cough in children

There is limited information regarding the causes and clinical courses of prolonged acute cough in the paediatric literature. It is important to remember that the causes of chronic cough in children must have started at some time and gone through the prolonged acute coughing phase and need to be thought of but chronic cough is not the focus of this article. In addition, many children experience recurrent acute cough/prolonged acute cough which parents will not readily distinguish from chronic cough. The causes of and approach to chronic coughing has been clearly described in guidelines (9,10). Therefore, our intention is to highlight some of the possible causes and clinical courses of prolonged acute cough where complete resolution is to be expected.

Aetiology of prolonged acute cough

The most common cause for prolonged acute cough in children is post viral or post-infectious cough. Post-infectious cough can be defined as a cough that began with symptoms related to the common cold and persists. It has a high rate of spontaneous resolution without any therapeutic intervention.

Some specific causes of prolonged acute coughing are as follows:

Infants with acute bronchiolitis

Acute bronchiolitis is a common acute respiratory infection especially in children less than 1 year. The children clinically present with tachypnoea, crackles, dry cough and audible wheeze. The symptoms typically worsen in the acute phase of bronchiolitis before resolving by 14 days. Although bronchiolitis is usually a self-limiting condition, a significant number of children have persistent respiratory symptoms such as cough in the post-acute phase [14].

Indeed, a generally dry, irritating cough is the most common symptom in bronchiolitis (98% of Respiratory Syncytial Virus (RSV) positive infants and causes significant levels of concern to parents of children affected [14, 15]. Cough is recognised by parents with a less variable interpretation than other potential markers (increased work of breathing, wheezing) and so reduction in cough duration would be considered an important benefit.

Systematic reviews looking at the therapeutics strategies in reducing the morbidities following acute bronchiolitis showed that neither the use of inhaled glucocorticoids or leukotriene antagonists during acute bronchiolitis prevent post-bronchiolitic wheezing or cough [16].

Pertussis infection

While infants too young to have been vaccinated are at particular risk for severe whooping cough disease there has been a recent epidemic of pertussis as a cause of prolonged acute coughing in older children and adolescents in many countries [17].

In a non-outbreak setting, Cornia et al. determined that 32% of prolonged acute cough was due to pertussis and that the diagnosis needs to be considered even when the classical pertussis symptoms are not present [18].They performed a systematic evaluation of the utility of traditional signs of pertussis. Paroxysmal cough had a sensitivity of 86% and specificity of 26%, post-tussive whoop had a sensitivity of 50% and specificity of 73% and post-tussive vomit had a sensitivity of 70% and specificity of 61%. The presence or absence whooping or vomiting only modestly increased the likelihood of pertussis. Because the current peak in one study was in children aged 8–11 years, the authors speculated that older children remained better protected as they had received whole cell vaccine which was in widespread use for infants until the late 1990’s [19]. The newer acellular vaccines may not protect children for as long as the older whole cell vaccine and the newer vaccine was introduced at the same time as media scares may have reduced uptake. In a community study that recruited children (5–16 years of age) coughing for longer than 2 weeks, 37% of them had serological evidence of a recent pertussis infection and the median duration of coughing was 112 days (range: 38 to 191 days) [20, 21]. Those children who were negative to pertussis (many with mycoplasma infection) also had prolonged coughing but this was shorter than the pertussis group (median duration 58 days, range 24 to 192 days). Virtually all children in this study had complete resolution of the cough (Figure 1). It is thus important to note that if a trial of treatment such as inhaled corticosteroids (ICS) had been started the ICS would have appeared to have worked but the resolution would have been due to the natural resolution that occurs.

Figure 1

Proportion of children continuing to cough each day after onset according to serology. Reproduced with permission [20].

Treatment with a macrolide antibiotic may be beneficial in pertussis but only when administered in the early stages of the disease. This is difficult to implement because the diagnosis is often not thought about until the cough has become chronic unless there is known contact with an index case. It is recommended to only treat patients aged above 1 year within 3 weeks of cough onset and infants aged less than 1 year within 6 weeks of cough onset [22]. Antibiotics decrease the duration of infectiousness and thus prevent spread [23]. If the patient is diagnosed late, antibiotics will not alter the course of the illness and, even without antibiotics, the patient should no longer be spreading pertussis.

Children recovering from a complicated acute pneumonia (e.g. empyema)

At least a third of children who initially have a treated empyema are still coughing by 4 weeks with one quarter at 6 months reducing to around 3% at 12 months. Some of these patients have prolonged cough due to residual of disease and as a result will benefit from a prolonged course of antibiotics 1–4 weeks from discharge or longer [24, 25].

Rhinosinusitis

The criteria used to diagnose rhinosinusitis in children are nasal secretions with or without a wet or dry cough occurring longer than 10 days. Chronic rhinosinusitis is more common in those with atopy and is considered present if symptoms persist longer than 4–8 weeks. Facial pain and discomfort is not so common in children when compared with adults.

Antibiotics are generally recommended for acute bacterial sinusitis but two of the four placebo controlled clinical trials were negative. This may have resulted from including those with allergic rather than an infective cause or an inappropriate antibiotic dosage. In the other two studies using amoxicillin-clavulanate showed considerable benefit although at the cost of increased side-effects [26, 27].

Retained inhaled foreign body

Foreign body aspiration (FBA) is most commonly seen in children below 24 months [28]. The diagnosis should be suspected if there is a history of choking followed by prolonged cough and non-resolving pneumonia. The yield from physical examination and radiological studies in the diagnosis of FBA is relatively low but is increased when the presentation is delayed and when history is doubtful. The sensitivity and specificity for each diagnostic criterion are as follows: clinical history (63% and 32%), symptoms (68% and 53%), physical examination findings (70.5% and 63%), radiological findings (73% and 68%) and the triad of cough, wheeze and diminished breath sound (88% and 51%) respectively [29]. Delayed diagnosis may be related to an unobserved aspiration event or lack of physician awareness and has serious consequences such as chronic cough, recurrent pneumonias and eventually localised areas of bronchiectasis. The immediate management is endoscopic removal of the foreign body and this should be done in case where there is parental or clinical suspicion.

Persistent bacteria bronchitis

Persistent bacterial bronchitis (PBB) has been defined as the presence of a chronic wet cough with resolution of cough with appropriate antibiotics and absence of pointers suggestive of alternative specific cough [30, 31] Recently, an association between PBB starting in infancy and airway malacia (tracheal, bronchial) has been described [32]. The cough of PBB resolves after a course of antibiotic such as amoxicillin-clavulanate for 2 weeks but some require a longer 4–6 weeks antibiotic. If PBB fails to respond to antibiotics or if PBB becomes recurrent, then further investigations are required to rule out the other conditions such as subtle immunodeficiencies or other causes of chronic suppurative lung disease [33]. The long term natural history of PBB is unknown. It has been speculated that it might be a precursor for chronic suppurative lung disease with formation of bronchiectasis but could also be a fore runner for adult chronic obstructive pulmonary disease. However, if children with immune deficiencies are excluded, PBB is associated with an augmented rather than deficient innate immune system [34]. It is important not to forget that persistent endobronchial infections occur in other conditions known to cause chronic coughing including cystic fibrosis, immune deficiencies, primary ciliary dyskinesia and recurrent pulmonary aspiration.

A Cough Can Be Benign or the Sign of Something Deadly

TYPES OF COUGH

A cough presents in many medical conditions and can indicate anything from a simple clearing of the throat to a serious medical condition. The type of cough can help clinicians differentiate possible causes.

The duration of a cough is an important factor in determining cause. An acute cough has a rapid onset and lasts up to 3 weeks. A subacute cough lasts between 3 and 8 weeks, and a chronic cough lasts for more than 8 weeks.² Coughs are further classified as a dry cough (does not bring up phlegm), hemoptysis (brings up blood), a nocturnal cough (happens only at night), and a productive cough (brings up phlegm).²

COMMON COMORBID SYMPTOMS

A cough can occur alone or with other symptoms. A cough that occurs with other symptoms is typically a sign of certain diseases of the heart, lungs, nervous system, and stomach.² These symptoms can include chills, decreased exercise tolerance, difficulty swallowing, fever, heartburn, night sweats, runny nose, shortness of breath, sore throat, weight loss, and wheezing.

CAUSES

Acute cough has many causes, the most common being upper respiratory tract infections such as the common cold, the flu, and viral laryngitis. Other causes include gastroesophageal reflux disease (GERD), hay fever, inhalation of irritants, lower respiratory tract infections, pulmonary embolism, pneumothorax (collapsed lung), postnasal drip, and pulmonary edema (heart failure).²

Causes of a chronic cough include asthma, chronic lung infections, chronic obstructive pulmonary disease, lung cancer, and pulmonary disease. Some medications, such as angiotensin-converting enzyme inhibitors, can also cause a chronic cough.²

MANAGING A COUGH

Patients can manage their coughs nonmedically and with OTC medications.

Nonmedical therapies include plenty of fluids to keep phlegm pliable and thin and soothe a dry throat. Use of a humidifier, as well as breathing in and drinking warm fluids such as soup and tea, also helps. Patients should avoid alcohol, as it impairs the body’s immune system, and dairy products, as they tend to thicken mucus.³

Natural remedies can be quite effective in relieving a cough. Bromelain is an enzyme found in pineapple and has both antiinflammatory and mucolytic properties. Ginger has anti-inflammatory properties and is also good for an asthmatic or dry cough. Honey can coat the throat and relieve a dry cough. Marshmallow root and slippery elm bark produce a thick substance that coats the throat. Marshmallow root is available online and in health stores as an ingredient in herbal cough syrup and as a dry herb or bagged tea. A saltwater gargle can reduce mucus and phlegm, thereby reducing the need to cough.⁴ Slippery elm bark is found in health stores and online in capsule and powder forms.⁴

Dietary changes may be necessary to help ease a cough caused by GERD. Patients should avoid the beverages and foods that typically trigger GERD, including alcohol, caffeine, chocolate, citrus foods, fatty and fried foods, garlic and onions, mint, spices and spicy foods, and tomatoes and tomato-based products.⁴

OTC medications can help relieve a cough. For a dry, nonproductive cough, the cough suppressant dextromethorphan works well. For a productive cough, an expectorant, such as guaifenesin, loosens mucus in the airways to keep it thin and better able to be expelled.³ A nasal lavage or a saline nasal spray can help prevent a cough caused by dry throat or postnasal drip by keeping the back of the throat clear.³

Parents should not use OTC cold and cough products, aside from saline nasal spray, in children age 2 years. Additionally, some cold and cough products carry the potential to be abused. Some states allow only individuals 18 years and older to purchase them.

SEEKING MEDICAL HELP

Pharmacists should advise individuals to seek medical attention if they experience a cough that worsens; ear pain; a flare-up of any chronic lung problems, such as asthma and chronic obstructive pulmonary disease; a high-grade fever; severe or unusual cold symptoms; or a sinus headache.³

Individuals should seek immediate medical attention if they have a cough for more than 8 weeks, experience an improvement in a cough and a worsening or unexplained weight loss with a cough, have chest pain or trouble breathing with a cough, spit up blood with a cough, or vomit with a cough.

DEBUNKING MYTHS

Patients are taking much more interest in their own health care now more than ever before. This is good. Unfortunately, the array of false information out there often confuses and misinforms patients.

Below are some of the most common myths associated with a cough⁵:

• All coughs are contagious. A cough from airway irritation, allergies, or asthma is not contagious. Coughs caused by a bacterial or viral infection, on the other hand, are most likely contagious. A cough can propel air and particles from the lungs and the throat at speeds nearing 50 mph.¹ Therefore, practitioners should remind patients to reduce the spread of infection by following proper protocol for coughing, hand washing, sneezing, tissue use, and wearing a mask.⁶
• Antibiotics cure a cough. A cough is most commonly caused by viral infections. Because antibiotics kill only bacteria, they seldom have an effect on cough. Bronchitis and pneumonia are 2 diseases caused by bacteria that do have a cough as a symptom. Therefore, antibiotics may be effective.
• Hot soup can cure a cough. Although hot soup can decrease irritation and soothe the throat, thereby easing the cough, it does nothing to cure the respiratory condition causing the cough.
• Infections cause all coughs. An occasional cough does not indicate a health condition or problem. However, frequent coughing may be a sign of something more serious irritating the throat. This may or may not be due to an infection.
• Vaccinations will prevent a cough. Vaccinations have no effect on noninfectious causes of cough. The pertussis vaccine is effective, especially within the first year after vaccination. After 2 years, the effect decreases over time. The annual flu vaccine will help protect against the flu and its associated cough. However, patients may not be fully protected.

CONCLUSIONS

Pharmacists are often the first line of contact with patients, as they are trusted professionals and often more accessible than other health care providers. They have the opportunity to help patients with a cough by knowing when to recommend natural or OTC remedies, which can also reduce health care costs. More important, pharmacists know when to recommend that a patient seek medical attention or immediate medical attention. Pharmacists are among the few who can look at a patients’ medication histories to see whether they are taking any medications that cause cough, which ultimately can be benign or very serious.

Kathleen Kenny, PharmD, RPh, has more than 25 years of experience as a community pharmacist and is a freelance clinical medical writer based in Colorado Springs, Colorado.

REFERENCES

• Learn about cough. American Lung Association website. lung.org/lung-healthand-diseases/lung-disease-lookup/cough/learn-about-cough.html. Updated March 13, 2018. Accessed February 2, 2020.
• Cough symptoms, causes and risk factors. American Lung Association website. lung.org/lung-health-and-diseases/lung-disease-lookup/cough/cough-symptomscauses- risks.html. Updated July 11, 2019. Accessed February 2, 2020.
• Patient education: cough or cold, what to take. University of Florida website. shcc.ufl.edu/services/primary-care/self-help-resources/health-care-info-online/patienteducation- cough-or-cold-what-to-take/. Accessed February 11, 2020.
• Leonard J. What can I do to make my cough go away? Medical News Today website. medicalnewstoday.com/articles/322394.php#tips-to-help-prevent-a-cold. Published January 1, 2020. Accessed February 11, 2020.
• 7 myths about cough. Health 24 website. health34.com/Medical/Cough/News/ 7-myths-about-cough-20170508. Updated October 23, 2017. Accessed February 2, 2020.
• Cough. American Thoracic Society website. thoracic.org/patients/patientresources/ resources/cough.pdf. Accessed February 2, 2020.

How to treat dry cough in adults

Contents:
Possible causes of dry cough or cough with hard sputum in adults
How to treat dry cough or cough with hard phlegm in adults

Dry cough is not just a simple symptom , this is a signal from your body. Thus, he reports that not everything is in order and that the sputum secreted by the mucous membranes of the respiratory system has become too viscous, it is difficult or impossible to cough up it.As a result, you are tormented by more and more attacks of coughing. The most important thing in this situation is to determine what exactly causes a dry cough. This is the only way to understand what actions need to be taken to alleviate and eliminate this condition.

However, it is worth remembering that in addition to dry, unproductive cough, there is a cough with sputum that is difficult to separate. It also requires the adoption of a set of measures that help to translate this state into a productive form – the form of a wet cough, in which the ability to excrete phlegm returns to the bronchi.

Possible Causes of Dry Cough in Adults

There are several reasons for this symptom. The choice of drugs for the treatment of dry cough depends on their correct definition.

• Respiratory diseases . It can be inflammation in the bronchi, trachea and larynx, pneumonia, bronchial asthma and even whooping cough, which occurs much less frequently in adults than in children, and passes in a mild form. Depending on the causative disease, the cough may be characteristic.For example, with laryngitis, it acquires a “barking” character, and with bronchitis, it may be accompanied by wheezing and wheezing chest sounds.
• Adverse drug reaction. Medications to lower blood pressure can cause a rare but regular dry cough in some people. It usually goes away when choosing another drug for hypertension.
• Long-term smoking. This bad habit causes irritation of the bronchi with substances that make up tobacco smoke.The so-called smoker’s bronchitis, which is manifested by a dry, regular cough, is familiar to everyone who cannot live without cigarettes. The same is observed in people whose professional or daily activities involve being in a gassed or dusty environment. In this case, particles of dust, smoke, gas have the same irritating effect on the mucous membrane of the respiratory tract as smoking, and cause a cough.
• Allergic reactions. Any allergens – smells, pollen, food, medicines, dust – can cause a sore throat and a sudden, harsh dry cough.
• Dewatering . With an elevated body temperature and a lack of water, tea and other drinks consumed, a productive, wet cough can quickly transform into a dry one: the sputum thickens due to a lack of fluid in the body.
• Stressful situations and emotional experiences . In this case, the individual characteristics of the human nervous system become the cause of dry cough. As a rule, when the normal emotional state is restored, it goes away on its own and does not require taking any medications.

How to treat a dry cough in adults

To cure a dry cough, an integrated approach to the problem is required. It includes eliminating the cause of this symptom (disease or provoking circumstances), following all the doctor’s recommendations, taking prescribed medications and adhering to bed rest in cases where the cough is accompanied by a high body temperature. In addition, it is important to follow some rules that help reduce the burden on the respiratory system and facilitate the process of their treatment and recovery.

Humidity and Freshness

When treating dry cough in adults, try to keep the air in the room fresh and humid. Ventilate the room more often or, if possible, keep the window ajar, if the weather outside the window allows it. The supply of fresh air reduces the concentration of pathogens present in the air in the room. If there is a humidifier, turn it on; the humidity in the room must be at least 50%. If there is no such device, and the heating is already on, put wet towels on the batteries and change them as they dry.Wiping the floor in the patient’s room with a very damp cloth once or twice a day is also fine. By getting rid of dry air, you can reduce the likelihood of drying out of the lining of the respiratory tract and, as a result, relieve cough caused by insufficient moisture.

Drinking plenty of water

Drink as much as possible, keep a cup of warm liquid close at hand. It can be just water, herbal, fruit or black tea, fruit drink or milk with butter familiar to everyone from childhood.Warm water with lemon and honey (if you are not allergic to honey) or a ginger drink at night helps to treat dry coughs at home. The temperature of the liquid should be at the level of body temperature. Drinking plenty of fluids will help get rid of dehydration or prevent the thickening of phlegm in the bronchi caused by a lack of fluid.

Medicines

Many dry cough remedies contain substances to thin phlegm or to relieve expectoration. If, as in the case of cough syrup Doctor MOM ^® , preparations are made on the basis of medicinal herbs, then they give few side effects, and such remedies can be taken for a long time.The combination of 10 medicinal herbs acts in different directions.

Special exercises

In addition to the use of funds, methods can be used to treat a severe cough that help the respiratory system to cope more effectively with it. There is a whole range of exercises called postural drainage. It is carried out on the recommendation of a doctor and includes special breathing and drainage exercises to help the sputum discharge. Another method – percussion massage – improves blood circulation and facilitates the removal of phlegm from the bronchi.This adjunctive treatment is recommended for adults and especially children.

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Severe dry cough – treatment methods

Contents:

Coughing fits

Cough causes

Dry cough features

Dry cough diagnostics

Dry cough treatment

As a rule , cough is caused by various diseases of the respiratory system. The problem is that dry cough is difficult to treat, so doctors usually try to translate it into a cough with phlegm.For this purpose, the patient is prescribed medications for coughs or is offered to cure a cough with traditional medicine on natural products and herbs.

Causes of dry cough

Cough is a reflex of the body. Cough manifests itself at moments of irritation of the nerve endings in the mucous membrane of the respiratory system. The entire system, in turn, is divided into two sections – upper and lower. The upper includes the nasopharynx, pharynx, larynx and trachea, and the lower – bronchi and lungs.

An infection – bacterial or viral – can cause inflammation in any of these respiratory organs.
Protozoa can cause mucosal irritation and coughing. Depending on the underlying cause of a severe dry cough, your doctor will prescribe an appropriate treatment option. It would seem that everything is simple, but the causative agents of infectious diseases can be determined only after examining sputum, and with a dry cough, a person does not have it. What to do in such cases? Some doctors prescribe cough medicine without being sure of the cause of the cough.This can lead to the development of complications. A more correct approach is to transfer the cough to the wet stage.

Features of dry cough

Cough is dangerous because it serves as a signal of the presence of more serious inflammatory processes in the body. The symptoms of a dry cough depend on which organ of the respiratory system is affected. With inflammation of the pharynx, a dry cough is accompanied by discomfort in the throat and severe burning of the mucous membrane. Laryngitis (inflammation of the larynx) is characterized by a barking cough and a hoarse voice.If laryngitis is not treated, a severe cough can develop into bouts of choking. If these diseases are caused by fungi, the cough becomes chronic and prolonged.

In inflammatory processes in the trachea, cough is, among other things, accompanied by pain in the sternum. Inflammation of the bronchi and lungs (pneumonia) is characterized by a strong deaf cough, as well as dull pain. Pleurisy (inflammation of the serous membrane of the lungs) is characterized by a dry cough and severe pain.Sometimes the pain is so severe that patients try not to inhale too deeply. Tuberculosis in the initial stages can be recognized by a mild but persistent cough. Finally, the worst disease – lung cancer – manifests itself in the form of a chronic cough.

Diagnosis with dry cough

If a dry cough begins suddenly and is accompanied by an increase in body temperature, a runny nose and general weakness of the body, we can talk about acute respiratory diseases. In this case, the doctor checks the lungs for wheezing.If he does not find them, they try to transfer the dry cough to the wet stage to investigate the cause of the disease.

When the cough does not go away within a week, and the temperature does not subside, a series of tests should be done. A general blood test and fluorography are prescribed. With these procedures, you can establish tuberculosis, pneumonia and pleurisy. Based on the research results, the type of cough treatment is prescribed.

When the cough gets worse from day to day, but other symptoms of inflammation are not observed, this may indicate diseases of the respiratory system or lung cancer.To establish this or that diagnosis and pinpoint the cause of a severe dry cough, you should consult a doctor for a thorough examination.

Treatment of dry cough

Treatment is most effective if the causative agent of dry cough is known. Therefore, before starting cough treatment, it is recommended to accurately identify the fungus or virus that causes dry cough. The patient is first given special preparations for coughing, which facilitate the formation of phlegm in the respiratory system.After that, the sputum is taken for analysis.

In addition, sputum-forming agents help to remove pathogens from the body along with it. Other cough medicines are expectorants that make it easier to separate and remove phlegm from the bronchi.

Alternative medicine can also be used to treat severe coughs. A famous recipe is radish. You need to mix radish juice with honey and drink one teaspoon several times a day. However, if the patient’s cough persists and is accompanied by other complications, a doctor should be consulted.

Treatment of dry or wet cough in children without fever

Cough is a kind of protective mechanism that maintains airway patency. Any kind of cough should be regarded as a signal of the presence of a disease in the body that is not necessarily associated with the respiratory system.

The cause of the cough reflex can be viral, bacterial or allergic diseases, excessively polluted air, compression of the bronchi by a foreign body, tobacco smoking and airway infiltration.

Physiological coughing that occurs involuntarily during the day is considered a normal condition in which the body gets rid of excess mucus. Any other types of spastic exhalation must be regarded as a pathological process that requires correct diagnosis and treatment.

Varieties of cough

• Wet (productive) cough accompanied by profuse expectoration.
• Dry (unproductive) – the most exhausting and painful.If not treated correctly, it can lead to hoarseness or complete loss of voice.
• Acute cough appears suddenly and in most cases occurs with infectious diseases, as well as when a foreign object enters the respiratory tract.
• Prolonged is a continuation of an acute one and is characterized by wave-like bursts, usually at a certain time of the day.
• Chronic cough begins after a prolonged three-month period and is a complication after an untreated disease.
• Paroxysmal, convulsive bronchospasm may be a manifestation of an allergy. A tearful cough in a child is an alarming symptom, one of the first signs of whooping cough.
• “Barking” means inflammation of the larynx. A dangerous symptom of false croup in children, which can lead to suffocation.
• Hoarse or silent means vocal cord involvement;
• A wheezing cough indicates a varying degree of bronchial damage.

By the nature of the cough, its duration and accompanying symptoms, an experienced doctor determines the localization of the inflammatory process and makes the correct diagnosis.

Cough as the main symptom of the disease

Barely coughing, many make the mistake of trying to self-cure with antiviral drugs. But a cough can be a symptom of dangerous changes, which can only be diagnosed by a qualified specialist.

Major diseases accompanied by cough

1. Tracheitis occurs when inhaling cold air, the cough is hacking, painful, especially at night and in the morning.Much sputum leaves, the patient feels weak and chills.
2. Laryngitis and laryngotracheitis are characterized by a hoarse, barking cough, fever, and general weakness.
3. Acute bronchitis is accompanied by a moist, deep cough, shortness of breath, low fever and lethargy. In the chronic course of the disease, cough manifests itself in the morning and is the only symptom of the disease.
4. Pneumonia is characterized by muffled, moist cough, muscle and headache, fever.With croupous pneumonia, the cough is at first dry, but when sputum is released, it causes sharp pains behind the sternum. The patient’s condition is extremely serious.
5. Bronchial asthma may be accompanied by a suffocating cough with the discharge of viscous sputum and allergic reactions.
6. Sinusitis and rhinitis manifest themselves as a lingering, dry cough, especially at night.
7. Pharyngitis is characterized by dry cough, persistent sore throat and itching in the throat;
8. Tuberculosis is initially asymptomatic, then attacks of dry or wet cough appear, sputum may contain blood.At night, there is increased sweating, chills, constant high temperature.
9. Influenza conditions are almost always accompanied by first dry, then moist, barking cough.

Dry, very strong, debilitating cough can occur with various gastrointestinal diseases, as well as in the presence of parasites in the body.

Bronchospasm necessarily appears when the functioning of the respiratory system is impaired.

A sharp, ringing cough that passes during sleep may be due to psychosomatic disorders and stress.

Is a child’s cough a harmless symptom or a dangerous condition?

Viral and “colds” diseases that attack the fragile body of a child are often accompanied by a cough that goes away without a trace with the right treatment. Some conditions in which cough is the main symptom require immediate medical attention.

A frequent and weak cough can cause worms, as pinworm larvae develop in the lung tissue, irritating the respiratory tract.

If a foreign body enters the respiratory system, children develop a sharp cough, as a result of the lack of inhalation, the face turns blue, the baby may lose consciousness.

Symptoms of whooping cough, bronchial asthma, or neurological disease may include convulsive bronchospasm, resulting in vomiting or asphyxiation with loss of consciousness.

Barking cough, hoarse voice, blue lips are dangerous symptoms indicating the development of false or diphtheria croup.

Dry, debilitating cough, fever and rashes on the skin and mucous membranes are the main symptoms of measles.

We treat cough. And what are we crippling?

Regardless of the disease, coughing is not the cause, but only a symptom. Therefore, fighting a cough, being unsure of its origin, is a thankless and hopeless occupation.

Inappropriate treatment, especially when it comes to a child, will not help, and in some cases will make the situation worse. For example, undetected bronchitis, in which only a cough was treated, can develop into pneumonia, fraught with serious complications.

Often, patients do not notice the stage when the cough becomes productive and continue to take unnecessary drugs, delaying full recovery for weeks.

It is very difficult, and sometimes impossible, to make the correct diagnosis on your own. Only a physician with experience and professional knowledge is able to distinguish an allergic reaction from an infectious disease requiring immediate and competent treatment.

Before receiving medical attention, the patient must be warmed and wrapped, but provide fresh air in the room.Coughing fits are relieved by a mixture of warm milk and Borjomi. In the absence of a gag reflex, you need to drink as much as possible.

At the first signs of coughing and the absence of fever in a child, it is necessary to make a hot foot bath with mustard, and then cover the baby with a warm blanket, and then consult a pediatrician the next day.

Differential diagnosis – the first step towards productive treatment

The most common reason for going to a doctor is a long and painful cough, when all possible traditional and folk remedies, which cure a cough, are powerless.

The qualified specialists of our clinic scrupulously collect anamnesis, which plays an important role in the diagnosis of the disease. The doctor takes into account the slightest nuances during the conversation with the patient, and then proceeds to diagnostic procedures:

• physical examination;
• X-ray and computed tomography of the chest;
• sputum examination;
• fibrobronchoscopy;
• ENT video endoscopy.

The most advanced diagnostic method is video endoscopy – a method that allows you to objectively assess the state of internal organs.Our doctors conduct video endoscopic examination of ENT organs and receive a detailed image, on the basis of which it is possible to identify and successfully fight many serious diseases.

The video endoscope also allows you to visually and safely monitor the dynamics of treatment at any time, which is especially important for small patients.

Do not tighten with a call for help!

90,000 How to treat a cough and how to do it correctly

Coughing is a reflex, not a disease in its own right.Reaction to an external stimulus in the form of a bacteria or infection that ARVI brings with it. What happens when a cough starts with a high fever, chills and snot? We begin in all possible and impossible ways to get rid of him and the very disease that led to the cough. But often we do not know how to do it correctly, delaying or aggravating the treatment. About what kind of cough happens and whether it is worth treating it at all, we talk about in this article.

Why does a cough occur?

If we describe a cough as a mechanical process, then this is our body’s attempts to get rid of infections and bacteria, dust, foreign body, phlegm.In fact, it is a self-defense and self-healing mechanism. In rare cases, cough is an independent disease and requires immediate treatment. More often it is an attached symptom of an existing disease or its complication. Experts do not recommend stopping it, because it helps the body cleanse itself, but it is possible and necessary to alleviate the condition and eliminate the source (in the nose, throat, nasopharynx, bronchi and trachea). If the reflex is suppressed, then the sputum will go deeper into the lungs, which can cause inflammation and serious complications.

Cough receptors are found not only along the respiratory tract, in the nasopharynx, trachea, bronchi and pleura. They are even in the ear canals, in the stomach and diaphragm, in the pericardium, so sometimes the reflex is triggered when you clean your ears with cotton swabs.

Causes of cough

• Runny nose. Any degree, with viscous discharge or transparent mucous flow. The disease occurs due to the fact that mucus either stands in the nasopharynx, or flows down the back wall, which irritates the upper respiratory tract.It is enough to start the immediate treatment of the common cold. Washings with saline solutions, furacilin solution, Dolphin, Polidex or Isofra rinsing solution when discharge with signs of pus appears, Derinat immunomodulating drops, Pinosol plant drops based on eucalyptus, mint, pine oils are well suited.
• Viral infection. It develops in the same way and requires exclusively symptomatic treatment. The main feature is that it cannot be treated with antibiotics. It is accompanied by a runny nose, swollen mucous membranes, sore throat.If you do not have time to start treatment in time, the virus “descends” to the lower floors and passes to the bronchi as a complication, causing bronchitis, acute bronchitis, pneumonia. The cough in this case will be moist, with sputum coming off.
• Pneumonia. It develops either as a complication of an untreated and poorly tolerated cold, or as an independent disease of a viral nature. Pneumonia is often accompanied by high fever, weakness and shortness of breath, and fever. In this case, the cough may not appear immediately.So, if the symptoms of a common cold do not disappear after 3-5 days, the temperature persists, there is a painful cough, or it just begins to appear with sputum coming off, it is time to consult a specialist for antibiotics.
• Taking medications. Some medicines for high blood pressure can provoke a cough as a side effect. This happens often, but not for everyone.
• Smoking. Long-term smoking and exposure to the body of toxic chemical compounds of tobacco smoke lead to obstructive pulmonary disease, when the cough becomes chronic.The result of the disease is an irreversible reduction in airflow in the airways. Tissues suffer constant irritation, resulting in chronic tissue inflammation.
• Allergy. Asthma. An equal sign can be put between these concepts, because an allergic cough is akin to a mild form of asthma. In this case, the airways experience an immune response to the stimulus. People who experience hay fever in spring and autumn often suffer from allergic coughs. But it can also pose a real threat when it is a consequence of Quincke’s allergic edema.In this situation, it is important to seek medical help as soon as possible. Asthma, on the other hand, is a chronic somatic disease that has a similar allergic mechanism, when edema and bronchospasm occur. An asthmatic cough is characterized by wheezing, wheezing, difficult breathing, and a persistent feeling of congestion and tightness in the chest and shortness of breath. Bronchial obstruction is partially or completely reversible, spontaneously or under the influence of treatment.
• Serious lung pathology. They speak for themselves.Any violation of the integrity of this organ, such as tumors, can lead to coughing. If a suspicious, persistent cough appears, it is important to undergo a complete medical examination and take action as soon as possible.

How to choose cough medicine

In order to choose the right cough medicine, it is important to first understand its nature. The selection of drugs is carried out taking into account the following circumstances:

1. type of cough – productive / dry
2. presence / absence of sputum;
3. The cause of the cough is ENT disease, allergy, etc.

Dry cough treatment

What is a dry cough? It is also called unproductive. It is characterized by a significant difficulty in the discharge of sputum, its meager amount or none at all when coughing. At this stage, treatment will focus on making the cough productive and promoting the liquefaction and discharge of sputum. The important point is not to suppress the reflex, otherwise thick and viscous sputum that could not leave the lungs and bronchi will cause serious complications.

How to treat: sinecod preparations, linkas, herbion syrup, doctor Mom syrup.

A nebulizer for inhalation with medications will help get rid of dry cough and make it productive. This procedure is very effective in treating dry coughs. The action of the drugs introduced into the body with the help of the device will begin faster and the drug will enter the focus exactly. Basically, suitable for a nebulizer: saline, the combined use of saline and medicinal solutions (Berodual, Pulmicort – on the recommendation of a specialist)

Sputum cough treatment

If the cough was initially sputum or dry changed to productive, it is important to dilute the phlegm in order to facilitate and accelerate its excretion.Such drugs are aimed at the earliest possible excretion of sputum, the removal of the inflammatory process in the respiratory tract.

At this stage, expectorants, bronchodilators are needed.

• Acetylcysteine ​​- this substance effectively liquefies mucous secretions, has an anti-inflammatory effect. Acetylcysteine-based drugs are most often used to treat dry cough, no more than 7 days. How to treat: ACC, Fluimucil, Vicks Active
• Ambroxol is an effective substance that is used in the treatment of dry cough. How to treat: Lazolvan, Ambrobene, Ambroxol, Flavamed.
• Carbocisteine ​​- means with it improve the elasticity of the viscous secretion, accelerate the period of its discharge, convert dry cough into wet one. How to treat: Libexin; Fluditek; Bronchobos; Fluifort.
• Bromhexine – in addition to the sputum-thinning action, it has a weak secretomotor effect. How to treat: Bromhexine; Bronhosan; Solvin.

Treatment of allergic cough

With an allergic reaction, the cough is spasmodic, dry and productive.Sometimes it breaks down to “barking”, maybe with a small amount of phlegm. It occurs upon contact with an allergen, with prolonged exposure, in a sluggish state it can develop into asthma. Such a cough can be protracted and misleading, provoking useless medication. It is important to understand the nature of the cough and start treatment on time. To eliminate allergic cough, antihistamines are suitable: erius, zirtek, tsetrin, telfast.

How to quickly cure a cough at home

Folk recipes and “grandmother’s” advice can also provide the body with significant support in getting rid of cough.To get rid of the trouble quickly at home, it is important to follow several rules: do not use all the means and immediately, in the hope of a quick recovery from the disease, know the measure and possible individual reactions.

• Herbal decoctions and inhalations. Pine buds are an excellent proven remedy that helps to quickly get rid of a cough at home. Take the broth should be 1/3 cup 3 times a day with meals. Store the ready-made infusion in the refrigerator.Duration of admission can be up to 2-3 weeks.

• A couple of boiled potatoes or rice. They soften the respiratory tract, and the substances in the vapors help relieve swelling and inflammation.
• Onions with honey are an effective antitussive remedy at home. It is very important to pay attention to honey in this drug. If there is a tendency to allergies, especially to bee products, it is better to put this recipe aside. Pass the onion through a meat grinder or beat in a blender in mashed potatoes, add honey and eat 2 teaspoons 3-4 times a day.And this is provided that you love onions and do not plan to leave the house.
• Honey with milk and soda. An important nuance – the temperature of milk should not exceed 60 degrees, because all the useful substances of honey simply lose their properties and are destroyed at higher temperatures.
• Honey with ginger and garlic. perhaps the most courageous thrill-seeker will decide on such a drug, but having made up his mind, he will definitely not regret it. Ginger and garlic are known for their valuable anti-inflammatory, antibacterial, and immune-boosting properties.In the form of a warm tincture, such a remedy can quickly put you on your feet and shorten the duration of the cough.
• Essential oils also speed up the cough relief process. Inhalation with essential oils has a softening effect on the respiratory tract. Not recommended for children, because they can get burned. It is better for children to use a special device – a nebulizer.
• Good old mustard plasters are not only an excellent cough remedy at home, but also a remedy for hypothermia and muscle pain.An important condition is the absence of increased body temperature. Mustard plasters are contraindicated for children under 3 years old. Adults can apply for 15-30 minutes. It is undesirable to leave the mustard plaster on the body for longer, so as not to burn.

Be healthy!

Causes of cough without fever

The human respiratory system is designed so that when foreign bodies (even microscopic sizes) get into it, spasm occurs and, as a result, cough.Thus, our body tries to cleanse itself of everything that can harm it. Cough can also occur with inflammation of the lining of the airways. Air pollution from various industrial emissions and exhaust gases leads to the fact that most urban residents complain of coughing and other breathing problems. Additional exposure to dust, bacterial spores, pollen and chemicals further exacerbates the situation.

A cough, which is accompanied by a fever, often indicates the development of an infectious disease, colds or other ailments in the body.In this case, many go to the doctor to start treatment. However, a cough without fever is not always given enough attention. But such a condition may indicate the presence of serious health problems.

Causes of cough without fever in adults

Smoker’s cough . This is one of the most common occurrences. Inhalation of nicotine and hot smoke can irritate the respiratory tract mucosa.Moreover, there are about 300 harmful compounds in cigarette smoke that irritate the respiratory tract – these substances can cause a dry cough without fever. At the same time, prolonged exposure to the respiratory tract of the components of tobacco smoke can cause the development of an inflammatory reaction of the bronchi, as a result of which sputum is formed, and subsequently a wet cough without fever may occur. Allergy. Thousands of irritants are in the air and on the usual things.This is animal hair, dust, and mold. Often, an allergy to one of them is accompanied by a cough without fever.

Incorrect or incomplete treatment. Cough without fever can be caused by incomplete cure of an infectious disease or a simple cold. Likewise, the airways try to clear the remaining phlegm.

Certain diseases. A severe cough without fever may also indicate the presence of serious pathologies.These include lung cancer, tuberculosis, emphysema, and chronic bronchitis. If you find yourself showing symptoms of these diseases, see your doctor immediately.

Gastroesophageal reflux disease. This term refers to heartburn. In this case, a cough without fever is a minor symptom and is accompanied by chest pain and wheezing.

Problems with the cardiovascular system. People who have heart failure and high blood pressure and who are taking ACE inhibitors may complain of coughing fits without fever.

Causes of cough without fever in children

Anatomical features. Short-term cough without fever in children in the first year of life is considered normal. Since airways continue to form after birth, coughing may be a natural response to mucus and food debris. Babies cannot swallow saliva, so they cough it up.

Reaction to allergens. As with adults, a cough without fever in children may occur due to allergies to dust, hair, and other irritants.In addition, even excessively dry indoor air contributes to its development.

Bronchial asthma. This disease often develops during childhood. The most common cause of an attack of bronchial asthma is the ingestion of an allergen into the child’s body. A cough without fever can be a clear sign of the development of bronchial asthma, so you should consult a doctor for a correct diagnosis.

Chronic diseases. Tracheitis, bronchitis, pharyngitis and other ailments are often manifested by a cough without fever. Seizures can also occur with biliary dyskinesia or reflux disease.

Infections. ARVI, adenoids, tonsillitis and sinusitis are not always accompanied by an increase in temperature. With such diseases, coughing occurs due to the ingress of mucus from the nose into the throat, and the body is simply trying to get rid of it. A cough without fever can also be due to infection with worms.

Treatment of cough without fever

The list of causes of a cough without fever is endless, because each individual case is always individual. For an accurate diagnosis, you should consult a doctor. In this case, you can start cough treatment on time without fever and avoid complications. It should be noted that complex therapy is often prescribed, because this ailment, as a rule, is a consequence of a more serious disease.Drugs that are used to treat cough without fever can be grouped into the following groups:

In addition, inhalations with medicinal substances and solutions can be used. When coughing without fever, they help moisturize the mucous membrane, reduce airway swelling, and get rid of phlegm. Among the general recommendations, humidification of the room where the patient is located, walks in the fresh air, and abundant warm drinks are often noted.

90,000 How to stop a child’s coughing attack at night and during the day

Cough is a defense reaction of the body, which is activated in response to the presence of an irritant (dust, sputum, foreign object) in the respiratory tract.Cough thrusts (strong exhalation through the mouth) help push the irritant out and thus restore normal breathing. Let’s look at the types of coughs, talk about the causes of coughing attacks in a child and figure out how to alleviate the condition.

Reasons

Most often, a cough is one of the symptoms of a viral or bacterial respiratory infection. In this case, it is also accompanied by nasal congestion, runny nose, headache, weakness, and fever.

However, the cough may have other reasons:

• Respiratory tract diseases – bronchitis, pneumonia, asthma.
• Diseases of the gastrointestinal tract (the contents of the stomach enter the respiratory tract and irritate the mucous membranes).
• Heart disease.
• Allergy.
• Foreign body in the respiratory system (crumbs, small objects).
• Dry dusty air.
• Strong odor (eg paint, poor quality plastics, chemicals).
• Worms.

If a child is coughing, but at the same time he has no other signs of a cold, it is necessary to see a specialist as soon as possible to find out the cause of this condition.

Types of cough in children

Species are distinguished according to several criteria:

1. Productivity. A wet cough (productive) is accompanied by sputum, as opposed to a dry (unproductive). However, keep in mind that if the sputum is too viscous, its discharge is difficult, then wet is easy to confuse with dry.
2. Strength. According to this parameter, coughing, light, strong cough is distinguished.
3. Duration (number of episodes, their frequency).An episodic cough is short-lived (2-3 coughs), manifests itself several times a day. A short-term is called an attack – it is sudden, sharp, short-lived, and causes a lot of discomfort. A persistent cough is also emitted.
4. Duration. This is the period during which the cough is observed. It can be acute (lasts less than 20 days), subacute (3–8 weeks), protracted or chronic (more than 2 months).
5. Time of day. The greatest discomfort when coughing with ARVI is delivered in the morning (as soon as the child wakes up and changes body position, that is, gets out of bed), as well as at night (in the supine position).Nighttime coughing fits in a child are especially exhausting, as they interfere with proper sleep. Daytime and evening attacks are typical for bronchitis, pneumonia (intensify in the evening).

How to stop a coughing fit in a child?

It is important to determine the type – dry or wet, as the elimination mechanism is different for each.

What to do in case of a dry cough in a child?

In this case, the actions of the parent should be aimed at moisturizing the mucous membrane.To do this, you need:

1. Rinse the child’s nose with saline.
2. Humidify the room air. You can use a humidifier or place a wet towel on the battery. The room needs to be ventilated.
3. Move the child to the bathroom while the nursery is ventilated. You should turn on the water and let the child sit next to it: the air in a small room will humidify faster, which means it will become easier faster.
4. Inhale with saline or mineral water.Medicines should not be used on their own – they should be prescribed by a doctor.

How to calm a wet cough in a child?

In such a situation, it is important to help the sputum discharge. For this:

1. The child is placed on his stomach and given a gentle massage (tapping).
2. Then the child needs to be seated – the sputum will pass more easily.
3. Clears mucus from the nose.

General recommendations

A plentiful warm drink will help moisturize the mucous membranes.Non-acidic drinks – water, fruit drink, compote, tea – can easily cope with this task. In addition, a warm drink washes away microorganisms from the mucous membrane of the throat. Hot and sour drinks are not used: they will only aggravate irritation of the mucous membrane.

Another quick way to calm an attack is to rub your back and chest with warming agents. Warming rubbing restores blood circulation in the bronchi, relieves swelling of the airways, which makes breathing easier. An effective remedy for this is badger fat, but conventional ointments based on it are not recommended for young children.Breathe ^® warming gel is suitable for a child from 1 year old (you can learn more about the product here). In addition to badger fat, it contains essential oils (mint, eucalyptus, lavender, fir) with anti-inflammatory action. When the vapors are inhaled, essential oils disinfect the respiratory tract, strengthen the immune system.

Can drugs be used?

For the treatment of cough, expectorants and antitussives are used.However, their application has many nuances. For example, you cannot combine these drugs. You can not take antitussives with a wet cough, for some chronic diseases, because then mucus will accumulate in the lungs and bronchi, which can worsen the child’s condition. And expectorants are not used in the evening or at night, as they can intensify the attack. Therefore, only a doctor should prescribe medicines for coughing.

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How to cure a cough – Lifehacker

Experts from the British National Health Service (NHS) say ^{: in most cases, the cough goes away on its own within a maximum of 3-4 weeks.The help of a doctor is usually not needed. And if you are irritated by a dry throat and an uncontrollable desire to cough, it is enough to use warm drinks: compote, fruit drink, tea with lemon.}

However, not all types of cough respond equally well to home treatment. It is worth figuring out if you can really handle the problem yourself.

What is a cough and where does it come from

Doctors divide ^{coughs into two fundamentally different types: acute and chronic.}

Acute cough

This type of discomfort begins suddenly and usually lasts no more than 2-3 weeks. The most common causes of it are colds, flu, or acute bronchitis. But this cough can ^{be a symptom of more serious infections. For example, whooping cough or pneumonia, as well as life-threatening conditions such as pulmonary embolism, pneumothorax, or congestive heart failure.}

Sometimes an acute cough lasts up to 8 weeks ^{, becoming less frequent and quieter.}

Chronic cough

Talk about if symptoms persist for more than 8 weeks ^{. Experts from the authoritative American medical organization Cleveland Clinic list the five most common causes of this condition:}

1. Chronic obstructive pulmonary disease (COPD). This term denotes a whole group of diseases, the most famous of which are pulmonary emphysema and chronic bronchitis. Patients often have both of these pathologies at once.With COPD, it becomes difficult to breathe and the problem progresses over time.
2. Gastroesophageal reflux disease (GERD). This is a condition in which stomach acid regularly enters the esophagus, irritating the walls of the esophagus and causing heartburn.
3. Allergies, chronic colds and sinus infections. In this case, mucus, which constantly flows down the back of the throat, becomes the cause of the prolonged cough.
4. Asthma. With it, the airways become inflamed and swollen, so a person regularly experiences a lack of air and a desire to cough.
5. Taking certain medications. For example, ACE inhibitors – these drugs are prescribed for hypertension, heart and kidney failure.

But these are not all reasons. Chronic coughs sometimes manifest themselves and other conditions, such as tuberculosis, cystic fibrosis, heart disease, and lung tumors. Also, symptoms can be psychogenic, that is, caused by stress.

When to see a doctor

You should go to a doctor immediately ^{if your cough has become chronic.This is necessary for the doctor to rule out the most dangerous diseases – the same COPD, tuberculosis or lung cancer.}

Acute cough is considered less dangerous. However, there are symptoms that indicate that you need urgent medical attention. Consult a physician or even dial 103 if ^:

• you are constantly and heavily coughing and the situation is getting worse;
• you obviously feel bad: there is not enough air, dizzy, dark in the eyes;
• chest pain appeared; 90 024
• difficulty breathing;
• The lateral side of the neck, in the region of the lymph nodes, looks very swollen and hurts when touched.

It is also important to see a doctor as soon as possible if you begin to lose weight dramatically against the background of persistent coughing. Or if you have a weakened immune system, say after chemotherapy or as a consequence of diabetes.

How the doctor will treat the cough

First, the doctor will try to establish its cause. To do this, he will conduct an examination, ask you about the symptoms, prescribe an examination – a blood test, an X-ray or an ultrasound of the chest.

If any medical condition is found, you will be referred to a specialist, such as a pulmonologist, allergist, or oncologist.When you heal or correct the underlying disorder, the cough will go away on its own.

Approximately one in five patients cannot find the cause of chronic cough ^{. In this case, therapy is only symptomatic.}

If you have an acute form and no danger signs, treatment is not required. Rest and plenty of warm drinks are enough. In some cases, your doctor may recommend medication to make you feel better ^:

• Antitussives.These are drugs that suppress the cough center in the brain and suppress the reflex. These drugs contain codeine, dextromethorphan or other active ingredients (there are many of them). They are prescribed for dry coughs when there is no phlegm.
• Expectorants (mucolytics). They help to thin phlegm and get rid of it, moving it along the respiratory tract. This group includes medicines with herbal extracts, as well as ambroxol, acetylcysteine. They are prescribed for a wet cough, when there is sputum, but it is not possible to completely clear the throat.

How to Relieve Coughs at Home

This is what ^{experts from the American Medical Research Center Mayo Clinic recommend.}

Eat a spoonful of honey or add it to warm tea

A spoonful of honey at night is a proven remedy that really ^{helps to calm coughs and get a good night’s sleep.}

Just don’t give honey to small children. For at least a year, the product is banned: due to the peculiarities of the intestinal microflora, babies may develop a severe form of botulism.

Try lozenges

When you suck lozenges, salivation increases. Saliva and frequent swallowing will help moisturize your throat and relieve irritation, which will make you cough less.

Keep an eye on the humidity in the room

This is also an important factor in helping to reduce throat irritation. The ideal room humidity is 40-60%.

Avoid tobacco smoke

Smoking, including passive smoking – when you have to inhale other people’s cigarette smoke, irritates the throat.

Why you shouldn’t self-medicate with anti-cough drugs

Often in the pharmacy you can hear: “Advise something for cough.” Usually, in such cases, pharmacists offer the two types of drugs already mentioned above: mucolytics and antitussives. However, using them is a bad decision. For two reasons.

1. These drugs do not cure

There is no ^{convincing evidence that taking these drugs will shorten the duration of the illness or alleviate its acute manifestation.}

Antitussives and mucolytics can only slightly alleviate the condition – just like rest, humid air and plenty of drink do.

2. These drugs can harm

Imagine that someone decided that he has a dry (but in fact does not) cough with ARVI, and took a pill. The cough stopped, but sputum stopped coming out along with it, even if there was not much of it. The mucus remained in the respiratory tract, bacteria began to multiply in it. This means that the risk of bronchitis and pneumonia increased.

Or another case: with a wet version, a person began to take expectorants. They made the sputum runny, its amount increased, which means that the cough became more frequent and more difficult.

Both antitussives and expectorants can be used as symptomatic therapy while the doctor is looking for the cause of the painful condition. However, it is unacceptable to assign them to yourself on your own ^.

This story was originally published in October 2018.