Productive cough in the morning. Productive Morning Cough: Causes, Symptoms, and Treatment Options

24.08.197704.11.2021 by alexxlab

What are the common causes of a productive morning cough. How can you differentiate between acute and chronic coughs. What are the most effective treatments for a productive morning cough. When should you seek medical attention for a persistent cough.

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Understanding Productive Morning Coughs: An Overview

A productive morning cough, characterized by the expulsion of mucus or phlegm, is a common symptom experienced by many individuals. This type of cough often occurs upon waking and can be caused by various factors, ranging from temporary infections to chronic conditions. Understanding the nature of productive morning coughs is crucial for proper management and treatment.

What Defines a Productive Cough?

A productive cough, also known as a wet cough, is one that produces mucus or phlegm. This distinguishes it from a dry cough, which does not bring up any secretions. The presence of mucus in a productive cough can provide valuable information about the underlying cause of the cough.

Why Do Productive Coughs Often Occur in the Morning?

Productive coughs are often more pronounced in the morning due to the accumulation of mucus in the respiratory tract during sleep. When we lie flat, mucus can pool in the airways, leading to increased coughing upon waking as the body attempts to clear these secretions.

Common Causes of Productive Morning Coughs

Productive morning coughs can be attributed to various factors, ranging from short-term illnesses to chronic conditions. Identifying the underlying cause is essential for appropriate treatment and management.

Acute respiratory infections (e.g., common cold, flu)
Chronic obstructive pulmonary disease (COPD)
Bronchitis
Pneumonia
Postnasal drip
Gastroesophageal reflux disease (GERD)
Smoking or exposure to secondhand smoke
Environmental irritants

Acute vs. Chronic Productive Coughs

Productive coughs can be categorized as acute or chronic based on their duration. An acute cough typically lasts less than three weeks and is often associated with viral infections. Chronic coughs persist for more than eight weeks and may indicate an underlying condition requiring medical attention.

Symptoms Associated with Productive Morning Coughs

While a productive cough is a symptom itself, it often occurs alongside other signs that can help identify the underlying cause. Recognizing these associated symptoms is crucial for proper diagnosis and treatment.

Common Accompanying Symptoms

Chest congestion
Wheezing
Shortness of breath
Fatigue
Fever
Sore throat
Nasal congestion
Body aches

The color and consistency of the expelled mucus can also provide clues about the underlying condition. Clear or white mucus is often associated with viral infections or allergies, while yellow or green mucus may indicate a bacterial infection.

Diagnosing the Cause of a Productive Morning Cough

Accurately diagnosing the cause of a productive morning cough is essential for effective treatment. Healthcare providers use various methods to determine the underlying condition.

Diagnostic Approaches

Physical examination
Medical history review
Chest X-ray
Pulmonary function tests
Sputum culture
Blood tests
Allergy testing

In some cases, additional tests such as CT scans or bronchoscopy may be necessary to rule out more serious conditions or to get a clearer picture of the respiratory system.

Treatment Options for Productive Morning Coughs

The treatment for a productive morning cough depends on its underlying cause. While some cases may resolve on their own with time and home remedies, others may require medical intervention.

Home Remedies and Over-the-Counter Treatments

Staying hydrated to thin mucus
Using a humidifier to moisten the air
Elevating the head while sleeping
Avoiding irritants such as smoke and strong odors
Taking over-the-counter expectorants or cough suppressants
Using saline nasal sprays to relieve congestion

Medical Treatments

For more persistent or severe cases, medical treatments may include:

Antibiotics for bacterial infections
Inhaled corticosteroids for inflammatory conditions
Bronchodilators for conditions like asthma or COPD
Antihistamines or decongestants for allergy-related coughs
Proton pump inhibitors for GERD-related coughs

It’s important to consult a healthcare provider before starting any new medication, as some treatments may have side effects or interact with existing medications.

Preventing Productive Morning Coughs

While not all productive morning coughs can be prevented, there are steps you can take to reduce their frequency and severity.

Lifestyle Changes and Preventive Measures

Quitting smoking and avoiding secondhand smoke
Practicing good hygiene to prevent infections
Managing allergies and asthma effectively
Maintaining a healthy diet and exercise routine
Reducing exposure to environmental pollutants
Getting vaccinated against influenza and pneumococcal disease

By implementing these preventive measures, you can significantly reduce your risk of developing conditions that lead to productive morning coughs.

When to Seek Medical Attention for a Productive Morning Cough

While many productive morning coughs are benign and resolve on their own, certain symptoms warrant immediate medical attention.

Red Flags to Watch For

Coughing up blood
Severe chest pain or tightness
Difficulty breathing or shortness of breath
High fever (above 101°F or 38.3°C)
Cough persisting for more than three weeks
Unexplained weight loss
Fatigue or weakness

If you experience any of these symptoms, it’s crucial to consult a healthcare provider promptly for proper evaluation and treatment.

Special Considerations for Productive Coughs in Children

Productive coughs in children can be particularly concerning for parents and caregivers. Understanding the unique aspects of pediatric coughs is essential for proper management and knowing when to seek medical help.

Age-Specific Considerations

The approach to managing productive coughs in children varies depending on their age:

Infants (0-12 months): Coughs in this age group require careful monitoring as they can quickly lead to breathing difficulties.
Toddlers (1-3 years): Croup, characterized by a barking cough, is common in this age group.
School-age children (4-11 years): Asthma and allergies often emerge during these years, potentially causing chronic coughs.
Adolescents (12+ years): Smoking-related coughs may become a concern in this age group.

When to Seek Immediate Medical Attention for Children

Parents should seek immediate medical care if their child experiences:

Difficulty breathing or rapid breathing
Blue or purple discoloration of the face during coughing
High fever, especially in infants
Signs of dehydration
Lethargy or unusual drowsiness
Persistent vomiting after coughing

It’s always better to err on the side of caution when it comes to children’s health. If you’re unsure about the severity of your child’s cough, consult a pediatrician for guidance.

The Impact of Chronic Productive Coughs on Quality of Life

Chronic productive coughs, lasting more than eight weeks, can significantly impact an individual’s quality of life. Understanding these effects is crucial for both patients and healthcare providers in developing comprehensive management strategies.

Physical and Emotional Consequences

Chronic productive coughs can lead to various physical and emotional challenges, including:

Sleep disturbances and fatigue
Social embarrassment and isolation
Disruption of daily activities and work productivity
Anxiety and depression
Physical discomfort, including chest pain and muscle strain
Potential complications such as rib fractures or urinary incontinence

Coping Strategies for Chronic Cough Sufferers

Individuals dealing with chronic productive coughs can employ several strategies to improve their quality of life:

Adhering to prescribed treatment plans
Practicing stress reduction techniques
Joining support groups or seeking counseling
Making necessary lifestyle modifications
Communicating openly with family, friends, and colleagues about the condition

By addressing both the physical and emotional aspects of chronic productive coughs, patients can better manage their symptoms and maintain a higher quality of life.

Emerging Research and Future Treatments for Productive Coughs

The field of respiratory medicine is continually evolving, with ongoing research aimed at improving our understanding and treatment of productive coughs. Staying informed about these developments can provide hope and new options for those dealing with persistent cough issues.

Current Areas of Research

Scientists and medical professionals are exploring various avenues to enhance the diagnosis and treatment of productive coughs:

Genetic factors influencing cough sensitivity
Novel antitussive medications with fewer side effects
Advanced imaging techniques for more accurate diagnosis
The role of the microbiome in respiratory health
Personalized medicine approaches for cough management

Promising Future Treatments

Several innovative treatments are currently in development or early stages of clinical trials:

P2X3 receptor antagonists for chronic cough
Inhaled sodium channel blockers
Targeted immunotherapies for allergic coughs
Advanced mucus-thinning agents
AI-powered diagnostic tools for cough analysis

While these treatments are still in the research phase, they offer hope for more effective management of productive coughs in the future. Patients with persistent cough issues should stay in close contact with their healthcare providers to learn about new treatment options as they become available.

Coughs, Age 11 and Younger

Does your child have a cough?

How old are you?

Less than 3 months

3 to 11 months

12 months to less than 3 years

3 to 11 years

12 years or older

Are you male or female?

Why do we ask this question?

If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Has your child had surgery in the past 2 weeks?

Surgery can cause problems that make your child cough.

Yes

Surgery within past 2 weeks

Does your baby seem sick?

A sick baby probably will not be acting normally. For example, the baby may be much fussier than usual or not want to eat.

How sick do you think your baby is?

Extremely sick

Baby is very sick (limp and not responsive)

Sick

Baby is sick (sleepier than usual, not eating or drinking like usual)

Would you describe the breathing problem as severe, moderate, or mild?

Severe

Severe difficulty breathing

Moderate

Moderate difficulty breathing

Mild

Mild difficulty breathing

Has the coughing been so bad that it has made your baby vomit?

Yes

Vomiting after coughing spasm

Is your baby coughing up blood?

Would you describe the breathing problem as severe, moderate, or mild?

Severe

Severe difficulty breathing

Moderate

Moderate difficulty breathing

Mild

Mild difficulty breathing

Is your child’s ability to breathe:

Getting worse?

Breathing problems are getting worse

Staying about the same (not better or worse)?

Breathing problems are unchanged

Getting better?

Breathing problems are getting better

Is your child’s ability to breathe:

Quickly getting worse (within minutes or hours)?

Breathing problems are quickly worsening

Slowly getting worse (over days)?

Breathing problems are slowly worsening

Staying about the same (not better or worse)?

Breathing problems are unchanged

Getting better?

Breathing problems are getting better

Does your child have a chronic health problem that affects his or her breathing, such as asthma?

A breathing problem may be more of a concern if your child normally does not have breathing problems.

Yes

Has chronic breathing problems

Is the problem your child is having right now different than what you are used to?

Yes

Breathing problem is different than usual symptoms

Does your child make a harsh, high-pitched sound when he or she breathes in?

This often occurs with a loud cough that sounds like a barking seal.

Yes

Harsh, high-pitched sound when breathing

Do you think your baby has a fever?

Did you take a rectal temperature?

Taking a rectal temperature is the only way to be sure that a baby this age does not have a fever. If you don’t know the rectal temperature, it’s safest to assume the baby has a fever and needs to be seen by a doctor. Any problem that causes a fever at this age could be serious.

Yes

Rectal temperature taken

Is it 100.4°F (38°C) or higher?

Yes

Temperature at least 100.4°F (38°C)

When your child is coughing, does his or her face turn blue or purple?

Yes

Color changes to blue or purple when coughing

Is your baby eating less than usual?

Yes

Change in eating habits

Has your baby had a cough for more than 1 full day (24 hours)?

Yes

Cough for more than 24 hours

Cough for 24 hours or less

Do you think your child has a fever?

Did you take your child’s temperature?

How high is the fever? The answer may depend on how you took the temperature.

High: 104°F (40°C) or higher, oral

High fever: 104°F (40°C) or higher, oral

Moderate: 100.4°F (38°C) to 103.9°F (39.9°C), oral

Moderate fever: 100.4°F (38°C) to 103.9°F (39.9°C), oral

Mild: 100.3°F (37.9°C) or lower, oral

Mild fever: 100.3°F (37.9°C) or lower, oral

How high do you think the fever is?

Moderate

Feels fever is moderate

Mild or low

Feels fever is mild

How long has your child had a fever?

Less than 2 days (48 hours)

Fever for less than 2 days

From 2 days to less than 1 week

Fever for more than 2 days and less than 1 week

1 week or longer

Fever for 1 week or more

Does your child have a health problem or take medicine that weakens his or her immune system?

Yes

Disease or medicine that causes immune system problems

Does your child have shaking chills or very heavy sweating?

Shaking chills are a severe, intense form of shivering. Heavy sweating means that sweat is pouring off the child or soaking through his or her clothes.

Yes

Shaking chills or heavy sweating

Did the cough start after a recent choking episode?

The cough could mean that something is still stuck in the throat.

Is your child coughing up mucus, phlegm (say “flem”), or blood from the lungs?

This is called a productive cough. Mucus or blood draining down the throat from the nose because of a cold, a nosebleed, or allergies is not the same thing.

Yes

Coughing up sputum or blood

Is your child coughing up blood?

How much blood is there?

Thin streaks of blood

Streaks

More than just streaks

More than streaks

Has this been going on for more than 2 days?

Yes

Coughing up mucus for more than 2 days

Has the coughing been so bad that it has made your child vomit?

Yes

Vomiting after coughing spasm

Has your child had a cough for more than 2 weeks?

Yes

Cough for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of difficulty breathing can range from mild to severe. For example:

You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Symptoms of difficulty breathing in a baby or young child can range from mild to severe. For example:

The child may be breathing a little faster than usual (mild difficulty breathing), or the child may be having so much trouble that the nostrils are flaring and the belly is moving in and out with every breath (severe difficulty breathing).
The child may seem a little out of breath but is still able to eat or talk (mild difficulty breathing), or the child may be breathing so hard that he or she cannot eat or talk (severe difficulty breathing).

Severe trouble breathing means:

The child cannot eat or talk because he or she is breathing so hard.
The child’s nostrils are flaring and the belly is moving in and out with every breath.
The child seems to be tiring out.
The child seems very sleepy or confused.

Moderate trouble breathing means:

The child is breathing a lot faster than usual.
The child has to take breaks from eating or talking to breathe.
The nostrils flare or the belly moves in and out at times when the child breathes.

Mild trouble breathing means:

The child is breathing a little faster than usual.
The child seems a little out of breath but can still eat or talk.

You can use a small rubber bulb (called an aspirating bulb) to remove mucus from your baby’s nose or mouth when a cold or allergies make it hard for the baby to eat, sleep, or breathe.

To use the bulb:

Put a few saline nose drops in each side of the baby’s nose before you start.
Position the baby with his or her head tilted slightly back.
Squeeze the round base of the bulb.
Gently insert the tip of the bulb tightly inside the baby’s nose.
Release the bulb to remove (suction) mucus from the nose.

Don’t do this more than 5 or 6 times a day. Doing it too often can make the congestion worse and can also cause the lining of the nose to swell or bleed.

If you’re not sure if a child’s fever is high, moderate, or mild, think about these issues:

With a high fever:

The child feels very hot.
It is likely one of the highest fevers the child has ever had.

With a moderate fever:

The child feels warm or hot.
You are sure the child has a fever.

With a mild fever:

The child may feel a little warm.
You think the child might have a fever, but you’re not sure.

A baby that is extremely sick:

May be limp and floppy like a rag doll.
May not respond at all to being held, touched, or talked to.
May be hard to wake up.

A baby that is sick (but not extremely sick):

May be sleepier than usual.
May not eat or drink as much as usual.

Temperature varies a little depending on how you measure it. For children up to 11 years old, here are the ranges for high, moderate, and mild according to how you took the temperature.

Oral (by mouth), ear, or rectal temperature

High: 104° F (40° C) and higher
Moderate: 100.4° F (38° C) to 103.9° F (39.9° C)
Mild: 100.3° F (37.9° C) and lower

A forehead (temporal) scanner is usually 0.5° F (0.3° C) to 1° F (0.6° C) lower than an oral temperature.

Armpit (axillary) temperature

High: 103° F (39.5° C) and higher
Moderate: 99.4° F (37.4° C) to 102.9° F (39.4° C)
Mild: 99.3° F (37.3° C) and lower

Note: For children under 5 years old, rectal temperatures are the most accurate.

Symptoms of serious illness in a baby may include the following:

The baby is limp and floppy like a rag doll.
The baby doesn’t respond at all to being held, touched, or talked to.
The baby is hard to wake up.

Symptoms of serious illness may include:

A severe headache.
A stiff neck.
Mental changes, such as feeling confused or much less alert.
Extreme fatigue (to the point where it’s hard for you to function).
Shaking chills.

Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in children are:

Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
Steroid medicines, which are used to treat a variety of conditions.
Medicines taken after organ transplant.
Chemotherapy and radiation therapy for cancer.
Not having a spleen.

Sudden drooling and trouble swallowing can be signs of a serious problem called epiglottitis. This problem can happen at any age.

The epiglottis is a flap of tissue at the back of the throat that you can’t see when you look in the mouth. When you swallow, it closes to keep food and fluids out of the tube (trachea) that leads to the lungs. If the epiglottis becomes inflamed or infected, it can swell and quickly block the airway. This makes it very hard to breathe.

The symptoms start suddenly. A person with epiglottitis is likely to seem very sick, have a fever, drool, and have trouble breathing, swallowing, and making sounds. In the case of a child, you may notice the child trying to sit up and lean forward with his or her jaw forward, because it’s easier to breathe in this position.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don’t have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don’t have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Coughs, Age 12 and Older

Postoperative Problems

Cough and Sputum Production – Clinical Methods

Definition

A cough is a sudden, usually involuntary, expulsion of air from the lungs with a characteristic and easily recognizable sound. Although it is known as the most common symptom of respiratory disorders, it serves the functions of defending the respiratory tract against noxious substances and maintaining airway patency by removing excessive secretions from the air passages. Expectoration or sputum production is the act of coughing up and spitting out the material produced in the respiratory tract.

Technique

A careful history, the most helpful task in the evaluation of patients with cough, will suggest the diagnosis of its cause in most instances. If the cough is not a part of the patient’s presenting symptoms, its presence or absence should be determined by pointed questions not only directed to the patient but also to the spouse or other family members, as the patient may be unaware of a cough or may underestimate its frequency and duration. For example, it is not uncommon for patients with chronic bronchitis to be oblivious to their frequent coughing, while people around them are quite annoyed by it. Some patients may perceive their cough as “throat clearing.” Many times, the truth about the patient’s cough reveals itself to the observer during the interview and physical examination.

Once it is acknowledged that the patient has a cough, adequate information about its characteristics and circumstances should be obtained by appropriate questioning:

Was the onset of the cough sudden or insidious? What was its initiating event? Did it start as an isolated symptom or occur with or follow other symptoms?
How long has the cough been present? Is it persistent or episodic? Seasonal or perennial?
To determine the severity of the cough, ask: How frequent is a coughing spell? How long does each coughing spell last? What is its effect on daily activity or rest?
Is the cough productive or dry? Lack of expectoration does not necessarily indicate that the cough is dry, as many patients, particularly children and women, tend to swallow their sputum raised to the level of the pharynx. The sound of the cough would help in determining its productive or dry nature. Patients with sputum production should be asked about its frequency and description of the physical characteristics of the sputum including the amount (with each coughing spell and daily total), color, consistency, ease of its expectoration, taste, and smell.
Is the cough the only symptom, or is it associated with other respiratory or nonrespiratory symptoms? Inquiry should be specifically made about conditions known to cause the cough, particularly when it is chronic and persistent.
In addition to an accurate smoking history (see Chapter 40), ask: To what respiratory irritants is the patient exposed at home or at work? Is exposure accidental or intentional?
What are the precipitating or aggravating factors? What time of the day or night is the cough or sputum production worse? Does it happen in supine position, upon arising in the morning, with drinking or eating, with exercise, or with breathing cold or dry air? Does the cough awaken the patient from sleep?
Is there a past history (recent or old) of foreign body aspiration?
Has the pattern of the cough and the amount or other characteristics of the sputum changed recently?
Can the patient locate the site of origin of the cough or the sputum, such as from the throat or deeper in the chest?
Has the patient had a similar problem with coughing in the past?
Does the cough have easily recognizable characteristics, as in croup or whooping cough?

Basic Science

The dynamic effect of a cough is the creation of an airflow velocity, within a certain portion of the airway, intense enough to shear and dislodge the secretions accumulated on the mucosal surface. Although coughing may be entirely voluntary, it is usually a physiologic reflex. As such, it is mediated through a reflex arc made of sensory receptors, afferent nerve fibers, a center, efferent nerve fibers, and effector muscles.

Cough receptors are considered to be the rapidly adapting nerve endings, which are also known as irritant receptors. These nerve endings are more plentiful in the mucosa of the larynx, carina, trachea, and large bronchi, which are readily stimulated by mechanical or chemical irritants. These are the portions of the airways in which the cough is most effective in clearing the secretions. The cough receptors have also been demonstrated or suspected in other sites, including the pharynx, peripheral airways, and other intra- or extrathoracic sites such as pleura, ear canals, tympanic membrane, and even the stomach. The vagus is the most important afferent nerve, although the glossopharyngeal and trigeminal nerves may operate, depending on the receptors involved. A medullary cough center has been postulated with no proof of its precise anatomic location. This “center” is under the influence of the higher voluntary nerve centers, which may initiate or modify the cough. The efferent nerves are the vagi (recurrent laryngeals), the phrenic nerves, and the spinal motor nerves of the expiratory muscles.

The mechanical events involved in a typical cough are rapid successions of: (1) a fairly deep initial inspiration; (2) the tight closure of the glottis, reinforced by the supraglottic structures; (3) the quick and forceful contraction of the expiratory muscles; and (4) the sudden opening of the glottis while the contraction of the expiratory muscles continues. The very high intrapulmonary pressure generated during the last two phases results in a very rapid airflow from the lungs once the glottis is open. In addition, the pressure difference between the outside and the inside of the intrathoracic airways during phase 4 causes their dynamic compression and narrowing. The combination of a high airflow and airway narrowing results in the expulsion of an airstream with a linear velocity sometimes nearing the speed of sound. The blast of air thus produced is capable of expelling the secretions with a great force. The site and the extent of the dynamic compression are determined by the lung volumes. With large lung volumes, only the trachea and large bronchi are compressed; with smaller lung volumes, more distal airways are also narrowed. With each successive cough without an intervening inspiration, as seen in patients with chronic bronchitis, lung volumes become smaller, and the cough becomes effective also in removing secretions from more distal airways. With the ensuing deep inspiration, the cough restarts with larger lung volumes, and the cycle repeats itself.

The characteristic explosive sound of coughing results from the vibrations of the vocal cords, mucosal folds above and below the glottis, and the accumulated secretions. Variation in sounds of coughing is due to several factors, including the nature and quantity of secretions, anatomic differences and pathologic change of the larynx and other air passages, and the force of the cough. Vibrations of coughing also help in dislodging secretions from the airway walls.

The small amounts of tracheobronchial secretions normally produced are very effectively handled by the mucociliary clearance mechanism. These secretions are made up of water, dialyzable substances such as electrolytes and glucose, mucus glycoprotein, indigenous and transudated proteins, and lipids (surfactant). The mucous glands and goblet cells are the primary sources of the tracheobronchial mucus. By forming a thin blanket, the airway mucus covers the ciliated epithelium. Rhythmic vibrations of cilia propel it toward the pharynx from where it is swallowed, usually unnoticed. A proper balance between its formation and its clearance maintains a thin protective layer of mucus for trapping and removing the impurities of the inspired air while preventing the excessive accumulation of secretions. With an adequate function of the mucociliary escalator, the cough has no additional benefit in removing the amount of secretions formed under normal conditions. In pathologic states, however, when the mucociliary function is ineffective or insufficient because of the quantity or alteration of the physical properties of secretions, the cough becomes essential for airway clearance.

Although coughing is most effective when the excessive secretions are accumulated in the large, centrally located airways, it also plays an important role in clearing the peripheral airways in situations in which there is impaired mucociliary clearance, as in chronic bronchitis, cystic fibrosis, or primary ciliary dyskinesia (immotile cilia syndrome). A “milking” effect of coughing on peripheral airways has been suggested as a mechanism of its action in removing secretions from these sites. This requires coughing at low lung volumes when the secretions are squeezed out of the small airways toward more centrally located bronchi.

In addition to the mucus, the expectorated sputum may contain other endogenous or exogenous materials, including transudated or exudated fluids, various local or migrated cells, microorganisms, necrotic tissues or cells, aspirated vomitus, or other foreign particles. Gross appearance and other physical characteristics of the sputum are the result of its content of these and other materials. Mucous sputum is clear or translucent and viscous, containing only small numbers of microscopic elements. Purulent sputum is off-white, yellow or green, and opaque. It indicates the presence of large numbers of white blood cells, especially neutrophilic granulocytes. In asthmatics, the sputum may look purulent from the eosinophilic cells. Red coloration, uniform or streaky, is usually due to its mixture with blood. Carbon particles discolor the sputum gray (as in cigarette smokers) or black (as in coal miners or with smoke inhalation).

Clinical Significance

As a cardinal manifestation of respiratory diseases, coughing is one of the most common symptoms encountered in clinical medicine. Being a physiologic reflex, the cough also occurs without any demonstrable evidence of disease when triggered by the stimulation of the irritant receptors. Moreover, it may be a voluntary act or may result from nervous habit. Although the clinical significance of coughing in many instances is trivial, it may be an indication of a serious intrathoracic disease. Pathologic conditions causing the cough are usually the ones that irritate the airways, increase their irritability, result in their deformation, or increase the tracheobronchial secretions. These factors may operate singly or in various combinations. Sputum production with coughing occurs when the respiratory tract secretions are beyond the ability of the mucociliary mechanism to deal with them.

The most common cause of the acute cough of clinical significance is viral tracheobronchitis. The cough in this transient and self-limited condition is, at the beginning, nonproductive and quite annoying; later it becomes productive of mucous or mucopurulent sputum before it begins to subside. Inflammation of the respiratory tract mucosa, from infectious or noninfectious causes, results in hyper-reactivity of the cough receptors. This results from the alteration of the surface epithelium, making them more sensitive to the cough-producing effect of commonly occurring mild irritants such as cold air, respiratory pollutants, deep or fast respiration, and excessive use of the larynx. At times, the mechanical irritation of coughing itself brings about more coughing. Inflammation, in addition, increases the secretions. In acute viral respiratory tract infection, post-nasal drip may be another cause for triggering the cough. Other infectious, as well as noninfectious, diseases of upper or lower respiratory tract are known for their propensity in causing the cough as a part of their clinical manifestations ().

Table 38.1

Anatomic Classification of Causes of Cough.

A chronic cough, defined as a cough lasting for a minimum duration of 3 weeks, is usually indicative of structural changes in the respiratory tract or the persistence of other cough-stimulating factors. By far the most common cause of a chronic cough in developed nations is tobacco smoking, which is the most important factor in the etiology of chronic bronchitis. In this disease, the cough is productive of a fairly large amount of sputum that varies from mucous to mucopurulent. Patients with chronic bronchitis, well accustomed and often oblivious to their symptoms, become concerned when the characteristics of their cough and sputum production change. The most frequent cause for the change is the intercurrence of an infection; however, it may indicate the occurrence of a neoplasm.

Since the decline of tuberculosis in developed nations, lung cancer has become most feared among the people with a chronic cough. The cough in lung cancer may develop de novo when there is no underlying chronic bronchitis and may be its only manifestation. As chronic bronchitis and lung cancer are very uncommon among nonsmokers, a chronic persistent cough has a different significance in this population. Airway hyperreactivity, the hallmark of bronchial asthma, is a rather common condition in which the cough may be the predominant or even the sole manifestation. Patients with hyperreactive airways, without other manifestations of asthma, may have a chronic cough for as long as several years until the condition is suspected, accurately diagnosed, and properly treated. Chronic postnasal drip, a frequent symptom of allergic or nonallergic rhinitis and/or sinusitis, is implicated in many instances of a chronic cough. A sensation of secretions dripping down into the throat and the feeling of a need to clear the throat are very suggestive of this disorder.

The chronic cough may be a manifestation of many other pathologic conditions involving the intra- and extrathoracic organs (). Left-sided heart failure not only results in a cough with acute pulmonary edema but also may be a cause of a chronic nocturnal cough. Recurrent aspiration is another condition in which the cough characteristically occurs in a supine position. Foreign-body aspiration should always be considered in the differential diagnosis of the chronic cough. After the initial coughing or choking episode at the time of its aspiration, the cough may restart and continue long after the incident. Other, less common intraluminal or compressing lesions of the tracheobronchial tree, chronic inflammatory or fibrosing lung diseases, and extrapulmonary lesions may have cough as their predominant symptom. Tumors of the mediastinum, enlarged heart chambers, and pleural disease may manifest with cough. A psychogenic or intentional cough for personal gain should be seriously considered only when other causes are properly excluded. The angiotensin-converting enzyme inhibitors such as captopril and enalapril, used for the treatment of hypertension and congestive heart failure, are being increasingly recognized as a cause of a dry, annoying, and often incessant cough, which disappears only after the discontinuation of these agents.

Characteristics of expectorated sputum often suggest the diagnosis of its cause. Chronic expectoration of large amounts of purulent and foul-smelling sputum is strongly suggestive of bronchiectasis. Sudden production of such a sputum in a febrile patient indicates a lung abscess. Rust-colored purulent sputum in pneumococcal pneumonia, currant jelly and sticky sputum in klebsiella pneumonia, and blood-tinged foamy sputum in pulmonary edema are other examples in which the diagnosis of the underlying disease is strongly suggested. A cough with the expectoration of blood (hemoptysis) is discussed in Chapter 39.

References

Curley FJ, Irwin RS, Pratter MR. et al. Cough and the common cold. Am Rev Respir Dis. 1988;138:305–11. [PubMed: 3057962]
Godfrey RC. Diseases causing cough. Eur J Respir Dis. 1980;61(Suppl 110):57–64. [PubMed: 6938392]
Grumet GW. Psychogenic coughing. Compr Psychiatry. 1987;28:28–34. [PubMed: 3802796]
Irwin RS, Corrao WM, Pratter MR. Chronic persistent cough in the adult: the spectrum and frequency of causes and outcome of specific therapy. Am Rev Respir Dis. 1981;123:413–17. [PubMed: 7224353]
*Irwin RS, Rosen MJ, Braman SS. Cough: a comprehensive review. Arch Intern Med. 1977;137:1186–91. [PubMed: 901087]
Leith DE. Cough. In: Brain JD, Proctor DF, Reid LM, eds. Respiratory Defense Mechanisms. New York: Marcel Dekker, 1977;545–92.
McCool FD, Leith DE. Pathophysiology of cough. Clin Chest Med. 1987;8:189–95. [PubMed: 3621873]
Poe RH, Harder RV, Israel RH, Kallay MC. Chronic persistent cough: experience in diagnosis and outcome using an anatomic diagnostic protocol. Chest. 1989;95:723–28. [PubMed: 2924600]
Widdicombe JG. Mechanism of cough and its regulation. Eur J Respir Dis. 1980;61(Suppl 110):11–20. [PubMed: 7011828]

When a cough may be more than just a cough

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As a person with any amount of life experience under your belt, you likely don’t need the term “cough” defined for you. You’ve probably experienced a recurring cough at least once in your life, if not countless times. Sometimes the cough goes away after a short time all by itself. Sometimes the cough is a symptom of an illness.

So, when should you worry about your child’s cough? What’s the difference between a “wet cough” and a “dry cough?”

Keith Hanson, MD, is a pediatric hospitalist at OSF HealthCare Children’s Hospital of Illinois in Peoria. His insights can help you identify the type of cough your child is experiencing, and what other symptoms to look for to help you know whether you should call your child’s pediatrician.

“A cough by itself is not very worrisome, really,” Dr. Hanson said. “But if it is accompanied by other symptoms of illness, it can help you identify when it’s time to call your child’s pediatrician.”

Wet vs. dry

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You’ve likely seen or heard the terms “wet cough” and “dry cough” used to help diagnose an illness. These terms describe two types of coughs with different causes.

Wet cough: Coughing up mucus from the airway makes the cough sound “wet,” as mucus shifts in the airway.
Dry cough: Also known as a hacking cough, this cough has a consistent tone because it is free from the sound of mucus. It is caused by irritation and inflammation of the airway.

Assessing the situation

“If your child has a cough but is running around the room, they’re probably fine,” Dr. Hanson said. “But if they’re coughing and feeling miserable, that is concerning.”

So how do you know if you should contact a doctor? Dr. Hanson suggests going through these questions, and if you answer “yes” to any of them, contact a physician.

Any other COVID-19 symptoms?

COVID-19 symptoms can be very similar to those of a common cold, including a cough. Know the symptoms of COVID-19, and if your child exhibits any of them, call their physician’s office. Find COVID-19 information and resources to help you know how to respond to a possible COVID-19 infection.

Does the cough stay bad or get worse after a week?

Even a cough by itself with no other symptoms should be checked out by a physician if it lasts longer than a week. It could still be nothing serious, but this is a good point at which it makes sense to see a physician for peace of mind.

Is it a deep cough from the chest, bringing up thicker yellow or green mucus?

This is a sign of a possible bacterial infection like pneumonia. Contact a physician for an appointment to get it checked out promptly.

Is it a loud cough that sounds like a seal bark and accompanied by high-pitched breathing?

This could be croup, and the cough can often be accompanied by stridor, a high-pitched breathing sound from the upper airway. Croup is a viral infection that causes some narrowing of the airway at the level of the vocal cords. This usually clears up, but severe cases can require hospitalization, so contact your child’s pediatrician immediately.

It’s important to have a physician for yourself and your children, so you have someone you trust with any health concerns. If you don’t already have a primary care provider, you can find one that fits the needs of you and your family here.

Cough | Cancer.Net

Coughing is a natural reflex. It clears your airways of irritants and protects your lungs. A cough can be due to a simple cold or allergies. But some coughs carry more serious risks. People with cancer may also develop a cough related to cancer or its treatment.

You may hear your health care provider describe your cough in different ways:

Productive. A productive cough brings up mucus. It is also called a wet cough.
Dry. A dry cough does not produce mucus.
Acute. A cough that starts suddenly and lasts less than 3 weeks. It is also called a short-term cough.
Persistent. A cough that lasts more than 8 weeks. It is also called a chronic cough.

Coughs that last a long time can cause serious problems by disrupting sleep. Severe persistent coughs can also cause vomiting, dizziness, headaches, loss of bladder control, and muscle strains. Other risks include rib fractures, especially for people with cancer that has spread to the bone.

Treating a persistent cough is an important part of your cancer care and treatment. This is called palliative care or supportive care. If you are receiving cancer treatment, you should let your health care team know about a cough that develops.

What causes a cough?

A cough can have many causes. Sometimes there may be more than 1 cause for people with cancer. Causes can include:

Certain types of cancer.

Cancer treatment.

Some types of chemotherapy, including bleomycin (available as a generic drug) and methotrexate (Rheumatrex, Trexall, Xatmep)
Some types of oral targeted therapy drugs, including osimertinib (Tagrisso) and everolimus (available as a generic drug)
Immunotherapy drugs, including pembrolizumab (Keytruda), that can cause inflammation of the lungs
Radiation therapy to the chest
Hormonal therapies, such as fulvestrant (Faslodex) and letrozole (Femara)

Other medication.

Nonsteroidal anti-inflammatory drugs (NSAIDS), used to reduce pain and inflammation
Angiotensin-converting enzyme (ACE) inhibitors, used to treat high blood pressure and heart disease
Midazolam (Versed), used to relax patients before medical procedures

Cancer-related side effects.

Other health conditions.

Chronic lung diseases, such as bronchiectasis or interstitial lung disease
Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis
Heart disease, including heart failure
Asthma
Acid reflux or gastroesophageal reflux disease (GERD)

Other common factors and illnesses.

Cigarette smoking or breathing secondhand smoke
Allergens, such as pollen, mold, and dust
Postnasal drip
Cold
Flu
Bronchitis, pneumonia, and COVID-19

How is a cough diagnosed and evaluated in people with cancer?

An occasional cough is usually not something to worry about. But you should let your health care provider know if you have a persistent cough or if your existing cough worsens.

It is especially important to tell your health care provider if you:

Cough up blood. If you cough up blood, you should call your health care team right away or go to the emergency room. This can be a sign that a cancer has spread to the lungs and it can be an emergency. There are many reasons why you might cough up blood that are not an emergency, including as a side effect of radiation therapy, but this symptom should be evaluated by your doctor or an emergency care provider as soon as possible.

Cough up colored mucus. Yellow, green, or foul-smelling mucus could be a sign of an infection. Common colds can cause colored mucus, but so can the flu, pneumonia, and bronchitis. These can be serious conditions for people with cancer that need immediate care. Learn more about when to call the doctor during your cancer treatment.

Experience other symptoms with your cough. Tell your doctor about any new or worsening symptoms like shortness of breath, chest pain, fever, heartburn, vomiting, roughness in your voice, trouble swallowing, a sore throat, or swelling in your feet.

To help learn the reason for your cough, your health care provider may ask you some of the following questions:

When did your cough start?
How long have you had this cough?
How often do you cough and how severely?
When does the cough occur?
Does anything make your cough better or worse?

Based on your answers, your health care provider may suggest one or more of the following tests:

Chest x-ray. This test takes a picture of the inside of your chest. This test cannot find all problems that can cause a cough, but it can help your health care team diagnose problems like pneumonia.

Computed tomography (CT or CAT) scan. This scan takes pictures of the inside of the body using x-rays and then combines these images into a detailed 3-dimensional image.

Lung function tests. These tests can show how well your lungs are working.

Blood tests. A blood test can show if you have an infection.

Heart tests. An electrocardiogram or echocardiogram may be necessary to see if your cough is caused by problems with your heart.

How is a cough treated and managed?

How your cough is treated depends on what is causing it. In general, it may be helpful to start tracking your cough at home, noting when and how often you cough, to help your doctor determine its cause. Learn more about symptom tracking.

Your cough may have a cause that is unrelated to your cancer. If this is the case, your health care provider can provide treatments to help. For example, such treatment may include antacids to treat acid reflux or steroids for asthma.

For a cough caused by a tumor, you may need chemotherapy, radiation therapy, or surgery. Talk with your health care team about which treatment is best for you.

For a cough with reversible causes, your health care provider will treat the cause of your cough. For fluid around the lungs (pleural effusion), you may need a procedure to remove the fluid. For an infection like pneumonia, you may need antibiotics.

In some cases, it is not possible to treat the cause of a cough or treating the cause will not be helpful. In those cases, you can treat the cough with medication.

Medications commonly used to treat or manage a cough include:

Mucus-loosening expectorants, such as guaifenesin
Cough suppressants, such as benzonatate, codeine, and dextromethorphan
Decongestants
Antihistamines

Some of these medications are available over-the-counter. Let your health care team know if you want to take any of these medications.

How to avoid making a cough worse

These tips can help you manage your cough:

Avoid smoking and breathing in secondhand smoke
Take a hot, steamy shower to loosen mucus
Stay hydrated, which makes mucus in the throat thinner
Mild exercise can help open your airways, but avoid very strenuous exercise
Avoid anything that triggers an allergic reaction in you
Avoid throat-irritating aerosol sprays, like hairspray, deodorant, fragrances, and cleaning products

You can also use cough drops, have a warm drink with honey, and use a humidifier if the air in your home is dry. Relaxation techniques, such as deep breathing, can also help with a cough.

Questions to ask the health care team

Could the cancer I have cause a cough?
When should I call you if I develop a cough?
How should I track my cough at home?
What treatments do you recommend for a persistent cough?
Are there things I can do at home to ease my cough?
When should I seek emergency medical care for a cough?

Related Resources

Dehydration

When Cancer Is Not Your Only Health Concern

Benefits of Quitting Tobacco Use

Health Risks of Secondhand Smoke

More Information

American Lung Association: Cough

Chronic cough in adults: what’s the diagnosis? | Differential diagnoses

Read this article to learn more about:

recognising the red flags associated with chronic cough
identifying the cause of chronic cough based on a patient’s presenting symptoms, examination, and diagnostic tests
treating and managing the different conditions associated with chronic cough.

Guidelines Learning

After reading this article, ‘ Test and reflect ’ on your updated knowledge with our multiple-choice questions. We estimate that this activity will take you 30 minutes—worth 0.5 CPD credits.

Chronic cough is one of the most common presentations seen in general practice, with the condition affecting between 10% and 20% of the population.^1,2 Chronic cough is defined as a cough lasting longer than 8 weeks and it can cause significant impairment to quality of life.³ There are numerous causes of chronic cough and a clear history is vital in guiding further management. Important risk factors include smoking and a history of atopy. Drug history is also important since a number of common drugs, such as angiotensin converting enzyme inhibitors, can precipitate cough.² Occupational and travel history are also important and should not be neglected.

Given the vast number of patients who present each year with cough symptoms, it is important to be able to differentiate a cough due to serious underlying pathology from more benign disease. Box 1 lists ‘red flags’ that would warrant prompt investigation and appropriate management.

Box 1: Red flag symptoms in chronic cough

Excessive sputum production (bronchiectasis)⁴
Systemic symptoms e.g. fever, sweats, and weight loss (lung carcinoma, or TB)^2,4
Haemoptysis (lung carcinoma or TB)^2,4
Significant associated dyspnoea (heart failure, COPD, pulmonary fibrosis, or inhaled foreign body).^2,4,5

Case 1

A 37-year-old woman presents with a 4-month history of a dry cough. The cough is worse at night, often causing her to wake up, and is more noticeable in cold weather. She has a history of hayfever and her brother had childhood asthma. She is a keen runner and has noticed that over the last few months she has found it more difficult to train than usual. She works as a high school teacher and is not on any regular medication. She has no known allergies, is a non-smoker, and has no pets. On examination she is well and her chest is clear. A peak flow reading gives a result of 65% of predicted value.

Diagnosis

Given the patient’s history, a diagnosis of asthma is high on the list of possible diagnoses. NICE Guideline (NG) 80 on Asthma: diagnosis, monitoring and chronic asthma management⁶ recommends that all patients with suspected asthma should be offered objective testing for the disease, rather than relying purely on a convincing history. Fractional exhaled nitric oxide (FeNO) testing should be carried out as first-line diagnostic testing, in conjunction with spirometry (see Box 2).⁶

Should tests result in an uncertain diagnosis, a 2–4-week period of serial measurement of peak flow may be helpful. Variability of more than 20% is regarded as diagnostic. Should a diagnosis of asthma still be in doubt, despite a convincing history and supportive clinical examination, direct bronchial challenge testing with histamine or methacholine can also be used to test for airway hyperactivity. Should these results be negative or inconclusive, an alternative diagnosis should be considered or the patient referred to secondary care. Interestingly, if direct bronchial challenge testing is unavailable, treating the patient as if they had asthma and monitoring improvement is appropriate.⁶

Box 2: Diagnosing asthma in adults aged 17 and over

⁶

Diagnose asthma in adults (aged 17 and over) if they have symptoms suggestive of asthma and:

a FeNO level of 40 ppb or more with either positive bronchodilator reversibility or positive peak flow variability or bronchial hyperreactivity, or
a FeNO level between 25 and 39 ppb and a positive bronchial challenge test, or
positive bronchodilator reversibility and positive peak flow variability irrespective of FeNO level.

© NICE 2017 Asthma: diagnosis, monitoring and chronic asthma management. Available from www.nice.org.uk/ng80 All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication. See www.nice.org.uk/re-using-our-content/uk-open-content-licence for further details.

Management

Given that the patient is having persistent symptoms and waking up at night several times a week, it is reasonable to start her on a low-dose inhaled corticosteroid (ICS) along with a short-acting beta₂ -agonist (SABA).⁶ A review 4–8 weeks later would be appropriate to monitor symptoms. Adding a leukotriene receptor antagonist (LTRA), followed by the introduction of a long-acting beta₂ -agonist (LABA), are the next appropriate steps. Should symptom control be difficult to achieve on low-dose ICS plus a LTRA and/or a LABA, the dose of ICS can be carefully titrated upwards.⁶

Outcome

The patient’s FeNO and spirometry tests confirmed a diagnosis of asthma. She was treated with a low-dose ICS and an as-required short-acting beta₂ -agonist. Within 4 weeks her symptoms had markedly improved. She only required salbutamol when running in cold weather, and her nocturnal cough had completely gone. She attends for asthma reviews regularly and is aware of when to seek help should her symptoms deteriorate.

Case 2

A 48-year-old man presents to the surgery with a 9-week history of a dry cough. He has noticed that the cough is worse after eating, but can occur at any time of the day. He spent the weekend doing DIY which required much bending over, and his cough became much more noticeable. He describes mild dyspepsia after eating, which started approximately 4 months ago. Examination is unremarkable other than mild epigastric tenderness on palpation and a BMI of 38 kg/m².

Diagnosis

Gastro-oesophageal reflux disease (GORD) is a well-recognised cause of chronic cough. Although other symptoms of GORD may be present, these may be mild or even absent in up to 75% of cases.⁷ The mechanisms behind GORD-induced cough are thought to be a result of either microaspiration of gastric contents and/or a vagally mediated oesophageal-tracheobronchial reflex.^7,8 Food intake, as well as a number of medications (such as non-steroidal anti-inflammatory drugs and theophylline), can aggravate GORD, as can posture including lying supine.⁷

Management

Given the clinical suspicion of GORD, in the absence of any red flag symptoms, an initial 4-week course of a proton pump inhibitor (PPI) can be offered.⁹ Lifestyle advice regarding weight loss is also appropriate for patients with a BMI over 25 kg/m².⁹ If symptoms persist, the patient should be tested for Helicobacter pylori infection with a breath test or a stool antigen test, after a 2-week washout period from the PPI.⁹

Outcome

The patient returned for a review appointment 1 month later and reported that his cough had improved significantly. He still experienced a mild cough after heavy meals but otherwise felt much better. He had intentionally lost half a stone in weight and aimed to continue his healthy lifestyle. Because of the ongoing presence of mild symptoms, he was tested for H. pylori; test results were positive so triple therapy (a PPI, amoxicillin, and either clarithromycin or metronidazole⁹) was prescribed. Following treatment his symptoms resolved.

Case 3

A 39-year-old IT consultant attends with an irritating cough, which has been present on and off for 4 months. For the past 6 weeks it has been occurring on a daily basis and he is concerned he may have an underlying serious pathology. On further questioning, the cough is largely non-productive other than first thing in the morning when he expectorates sputum. His partner has noticed that he appears to be constantly clearing his throat and he has noticed the sensation of something dripping down the back of his throat. The symptoms started after a cold but have persisted since then. He is an ex-smoker, having stopped 6 years ago. He drinks moderate amounts of alcohol and has mild hay fever.

Diagnosis

This patient’s symptoms are characteristic of postnasal drip (PND). Postnasal drip, or upper airway cough syndrome as it is also known, is the drainage of secretions from the nose or paranasal sinuses into the pharynx. Multiple studies have suggested that it is the most common cause for a chronic cough.¹⁰ Postnasal drip is largely diagnosed by a typical history of the sensation of having something drip down into the throat, nasal discharge, frequent throat clearing, and cough;¹⁰ however, it can be diagnostically challenging as there are no objective tests for it and no way to quantify the amount of PND.

The differential diagnoses of PND include all other causes of rhinitis, such as allergic rhinitis, bacterial sinusitis, allergic fungal sinusitis, rhinitis due to anatomic sinonasal abnormalities, rhinitis due to physical or chemical irritants, occupational rhinitis, rhinitis medicamentosa, and rhinitis of pregnancy. A careful history can help differentiate between these various aetiologies.^11,12 The issues of PND are further complicated by the fact that GORD can often co-exist with or mimic PND.¹²

In this case a full examination would be advised. There may be a nasal quality to the voice because of concomitant nasal blockage and congestion, and there may be hoarseness of the voice. Physical examination of the pharynx is often unremarkable, although a ‘cobblestoning’ appearance of the mucosa and draining secretions may be observed.¹³ Given the patient’s history of smoking and presence of chronic cough, a baseline chest radiograph would be recommended as per British Thoracic Society guidance.²

Management

Treatment of postnasal drip with a trial of topical corticosteroids is not only therapeutic but, given the difficulties in confirming the syndrome, can be of diagnostic importance. The patient should be warned that resolution of symptoms can take several weeks and occasionally months.¹² Anecdotally, many clinicians will try a number of topical corticosteroids should the first-line option fail to improve symptoms. If there is a history of potential allergy, non-sedating antihistamines can be used in addition to a topical corticosteroid.¹² Care should be taken with decongestants because of the risk of rebound symptoms and rhinitis medicamentosa with prolonged use.¹⁴

Outcome

The patient was given 1-month trial of a low-dose over-the-counter topical steroid. He presented 4 weeks later complaining that his symptoms had failed to improve. He was switched to an alternative nasal spray and good compliance was urged. He presented 6 weeks later delighted that his symptoms had settled and both the cough and clearing of his throat had improved. He continued the topical treatment for a total of 3 months before ceasing medication altogether.

Case 4

A 72-year-old woman presents with a 6-month history of chronic dry cough and increasing breathlessness. She has been treated periodically for chest infections over the past few months. Her breathlessness is beginning to make walking upstairs or on an incline difficult. She does not think she has lost any weight and is not on any regular medications. She has never smoked and is a retired GP receptionist. On examination she has bibasal inspiratory crackles. A chest X-ray is arranged, which is abnormal.

Diagnosis

This woman may have underlying pulmonary fibrosis. Pulmonary fibrosis may be secondary to a wide range of diseases; however, one of the most common types is idiopathic which affects approximately 10 per 100,000 people in the UK each year.^15,16 Idiopathic pulmonary fibrosis rarely affects people under the age of 45 years and typically presents with breathlessness on exertion, a dry cough, bilateral inspiratory crackles, and clubbing of the fingers. Patients can also exhibit non-specific constitutional symptoms such as myalgia, fatigue, or weight loss. In the later stages of disease, cyanosis and features of right heart failure commonly occur.¹⁷ Given this patient’s history and abnormal chest radiograph, a high-resolution computed tomography of her chest is arranged, revealing a typical honeycombing appearance typical of idiopathic pulmonary fibrosis.¹⁸ She has baseline spirometry at the practice, which reveals a restrictive pattern, and so is referred to the respiratory multidisciplinary team.

Management

Following the patient’s diagnosis, her future management and prognosis should be sensitively discussed. It is important to explain that, other than lung transplantation, there is no cure for the disease and medication is often ineffective. The median survival for idiopathic pulmonary fibrosis in the UK is approximately 3 years, although up to 20% of people survive for 5 years or more. For this reason good palliative care, even at an early stage, is vital in the management of pulmonary fibrosis.¹⁹ The respiratory team arranged for this patient to start pulmonary rehabilitation with regular review on a 6-monthly basis.²⁰

Outcome

About 1 year after the patient’s diagnosis her health started to deteriorate more rapidly and her spirometry and gas exchange dropped. Home oxygen was initiated and a sensitive discussion about the poor outcomes associated with both mechanical ventilation and resuscitation was had with the patient and her family. She continued to decline rapidly and full palliative care support was provided. She died at home 6 months later.

Conclusion

Chronic cough is a common symptom encountered in general practice. A full history and examination will help to identify the possible causes of cough. Further investigations in the form of lung function tests, testing for the presence of H pylori, chest radiography, and trials of medicines such as PPIs and topical corticosteroids are used to confirm the diagnosis. Treatment and management can be instigated in primary care but patients may need referral to secondary care if test results are inconclusive or if diagnosis reveals conditions such as idiopathic pulmonary fibrosis, which require specialist management.

Dr Jessica Garner

GP, Worcester

Guidelines Learning

After reading this article, ‘ Test and reflect ’ on your updated knowledge with our multiple-choice questions. We estimate that this activity will take you 30 minutes—worth 0.5 CPD credits.

References

Song W, Chang Y, Faruqi S et al. Defining chronic cough: a systematic review of the epidemiological literature. Allergy Asthma Immunol Res 2016; 8 (2): 146–155.
Morice A, McGarvey L, Pavord I. BTS Guidelines. Recommendations for the management of cough in adults. Thorax 2006; 61 (Suppl I): i1–i24.
Gibson P, Wang G, McGarvey L et al. Treatment of unexplained chronic cough: CHEST Guideline and Expert Panel Report. Chest 2016; 149 (1): 27–44.
Barraclough K. Chronic cough in adults. BMJ 2009; 338: 1267–1269.
Bain A, Barthos A, Hoffstein V, Batt J. Foreign-body aspiration in the adult: presentation and management. Can Respir J 2013; 20 (6): e98–e99.
NICE. Asthma: diagnosis, monitoring and chronic asthma management. NICE Guideline 80. NICE, 2017. Available at: www.nice.org.uk/ng80
Fontana G, Pistolesi M. Cough. 3: chronic cough and gastro-oesophageal reflux. Thorax 2003; 58 (12): 1092–1095.
Sekizawa S, Ishikawa T, Sant’Ambrogio F, Sant’Ambrogio G. Vagal esophageal receptors in anesthetized dogs: mechanical and chemical responsiveness. J Appl Physiol 1999; 86 (4): 1231–1235.
NICE. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Clinical Guideline 184. NICE, 2014 (last updated 2014). Available at: www.nice.org.uk/cg184
Pratter M. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest 2006; 129 (1 Suppl): 63S–71S.
Quillen D, Feller D. Diagnosing rhinitis: allergic vs nonallergic. Am Family Physician 2006; 73 (9): 1583–1590.
Sylvester D, Karkos P, Vaughan C et al. Chronic cough, reflux, postnasal drip syndrome, and the otolaryngologist. Int J Otolaryngol 2012; 564852.
Chung K, Mazzone S. Postnasal drip (rhinosinusitis, upper airway cough syndrome). In: Brodus V, Mason R, Ernst J et al. Murray and Nadel’s textbook of respiratory medicine. 6th edition. Philadephia: Elsevier, 2016: 497–514.
Pinto J, Jeswani S. Rhinitis in the geriatric population. Allergy Asthma Clin Immunol 2010; 6 (1): 10.
British Lung Foundation website. Idiopathic pulmonary fibrosis statistics. www.blf.org.uk/support-for-you/idiopathic-pulmonary-fibrosis-ipf/statistics (accessed 1 March 2018).
Wilson M, Wynn T. Pulmonary fibrosis: pathogenesis, etiology and regulation. Mucosal Immunology. 2009; 2 (2): 103–121.
Kim D, Collard H, King T. Classification and natural history of the idiopathic interstitial pneumonias. Proc Am Thorac Soc 2006; 3 (4): 285–292.
Devaraj A. Imaging: how to recognise idiopathic pulmonary fibrosis. Eur Respir Rev 2014; 23 (132): 215–219.
NICE. Idiopathic pulmonary fibrosis in adults. Quality Standard 79. NICE, 2015. Available at: www.nice.org.uk/qs79
NICE. Idiopathic pulmonary fibrosis in adults: diagnosis and management. Clinical Guideline 163. NICE, 2013 (last updated 2017). Available at: www.nice.org.uk/cg163

Is It Asthma or COPD? – Asthma Health Center

Asthma and chronic obstructive pulmonary disease, or COPD, share many symptoms and even certain treatments, but understanding the differences between the two conditions is the key to taking control of the health of your lungs.

“COPD” is an umbrella term for a group of lung diseases including chronic bronchitis and emphysema — diseases that block airflow as you exhale and make it progressively harder to breathe.

Asthma is also chronic, marked by an inflammation and narrowing of the airways. Both conditions could cause trouble breathing. So what’s the answer?

Asthma and COPD: The Similarities and Differences

“They are both lung diseases and affect the airways, and they have similar symptoms, including cough, shortness of breath, wheezing, and chest tightening,” said David A. Beuther, MD, chief medical information officer at National Jewish Health in Denver and an assistant professor in the division of pulmonary, critical care, and sleep medicine at the University of Colorado Denver School of Medicine.

One differentiating characteristic of COPD is that a morning cough is often “productive,” meaning you produce mucus or phlegm.

Asthma and COPD are both diagnosed with a simple lung function test known as spirometry, and the treatments are also similar. But the severity of your breathing problems and how responsive they are to treatment remain the best ways to determine whether it is asthma or COPD that is causing your symptoms.

“The main difference is that the lung function decline with asthma is more reversible,” Dr. Beuther said. “There are much more severe lung function abnormalities in the COPD crowd than the asthma crowd. People with COPD have more chronic symptoms. They cough up mucus and phlegm even on a good day, where an asthmatic may have periods of time where they feel fine and then experience a flare.”

The reasons for flares may also differ. Asthma attacks may occur in response to known triggers, such as allergens or exercise. COPD exacerbations usually follow respiratory ills, such as the flu or the common cold.

Another differential is that asthma may strike in childhood, although it can develop at any age. While the risks for COPD may begin to develop with childhood or teen smoking, COPD is usually diagnosed later in life among current and former smokers — once they’re in their mid-forties.

“Long-standing asthma is a risk for COPD, but typically we say it’s one or the other,” said Beuther. “Some people look like they have both, but the treatment doesn’t change, so you are essentially treating both anyway. If the symptoms are reversible, it is likely asthma.”

Len Horovitz, MD, an internist and pulmonologist at Lenox Hill Hospital in New York City, agreed. “You do spirometry and give medications to open the breathing tubes. If it reverses somewhat but not totally, that suggests more COPD than asthma. It may take time to figure it out,” said Dr. Horovitz.

There is also the possibility of overlapping conditions; so much so that, according to a report published in the journal Allergy, Asthma & Immunology Research, it makes sense to develop treatments that target the processes involved in both.

7 Possible Reasons Why You’re Coughing

Feel like you’ve been coughing for-ev-er? The truth is, the average cough lasts 18 days (what the what?), and while it’s the season for passing germs, there’s lots of other reasons you could be hacking up a lung. Ahead, your 101 class on distinguishing between the most common types of coughs and how long they generally last.

1. The Common Cold or Flu (One to Two Weeks)
If you’re dealing with a wet cough, in addition to symptoms like a runny nose, sore throat, headache, sneezing, or fever (can you hear the nasal medication commercial playing in your head yet?), odds are you’ve picked up one of winter’s two favorite bugs—the cold or flu, says Kathrin Nicolacakis, M.D., a pulmonologist at the Cleveland Clinic. You’ll see a slew of combo cough and cold meds on the pharmacy shelf with different cough suppressants or expectorants to clear or quiet your lungs, but check with your pharmacist before medicating with one of those heavy-hitters. It’s safer to treat symptoms one by one to reduce your risk of drug interactions, and you should only use a cough suppressant at night if you’re missing out on sleep, since clearing the lungs is usually a good thing.

2. Bronchitis (A Few Days to a Few Weeks)
It’s the barky, hacking cough that quickly turns you into office enemy numero uno. Bronchitis (an inflammation of the bronchial tubes) often starts out as a mild cold and then develops into that nasty, sometimes painful, wet cough that won’t quit (and brings up lovely phlegm in shades of brown, green, and yellow). Treatment is usually rest and warm fluids to break up the mucus clinging to your lungs or an inhaler to help open your airways. “If the bronchitis is caused by a bacterial infection, you’ll need antibiotics to clear things up,” says Nicolacakis.

3. Pneumonia (A Few Weeks to a Month)
When the air sacs in your lungs become infected (either because of a virus, bacteria, or fungi), you may be sidelined with mild to severe symptoms including a phlegmy or dry cough, fever, and shortness of breath. Other trademark signs: coughing up discolored mucus from your lungs and having zero energy, says Nicolacakis. Older adults or young kids may need a hospital stay for medical attention. A chest x-ray is usually ordered to diagnose the infection, and a course of antibiotics (if it’s bacterial) can clear the bugs—and cough—out of your lungs.

4. Post-Nasal Drip (Chronic)
People with PND can usually feel mucus from their sinuses sliding down the back of their throat, which triggers a wet cough (typically at night, when you’re kicked back) and a nauseous stomach in the a.m. from the booger flow. “For some people, it’s obvious this is happening, and they have other allergy symptoms like sneezing or an itchy nose—while others only show more subtle signs,” says Nicolacakis. Antihistamines or a nasal steroid (both available OTC) can help clear the sinuses, and it’s a good idea to turn on a humidifier at night, especially in the winter, since dryness can exacerbate the problem.

5. Asthma (Chronic)
When the airways narrow and swell, breathing becomes tough (think: wheezing and chest tightness), and a dry cough can come out. “Your lungs have better airflow during the daytime and late afternoon, so this kind of a cough typically happens at night or in the morning,” says Nicolacakis. Docs typically diagnose asthma through breathing or lung function tests and use inhaled steroids or a drug called albuterol to prevent and treat symptoms.

6. Gastroesophageal Reflux Disease (Chronic)
Acids that travel from your stomach back up to the esophagus (hello, heartburn) may also trigger a dry cough. (It’ll usually come out after eating a big meal or in the mornings and evenings when you’re lying down and acid can flow more freely.) A select few people can actually develop the cough without any other obvious heartburn symptoms, which can make it tricky to diagnose unless a doc sends a camera down your throat. If you or your M.D. think GERD could be behind all that throat-clearing and hacking, tweaking your eating habits (i.e. limiting fatty or spicy foods, booze, and caffeine) can help, as well as acid reflux meds.

7. Less Likely: COPD, Lung Cancer or Chronic Heart Disease
If you’ve got a super stubborn cough that’s not responding to treatment (we’re talking two to three months or longer), it’s a good idea to see your doc to rule out some of the more rare, scary causes of chronic hacking like COPD (chronic obstructive pulmonary disorder, usually caused by smoking or other inhaled irritants), lung cancer, or even heart problems. “Women, especially, don’t think as much about cardiac problems, so if you have a family history of heart disease or you’ve got other risk factors like high blood pressure, you definitely want to see a doctor,” says Nicolacakis.

Kristen Dold
Kristen Dold is a freelance writer based in Chicago.

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Cough – SCCH

Cough is perhaps the most common problem parents face. Very often, a cough, even if it sounds scary, has a harmless cause and goes away on its own. Sometimes coughing is a serious symptom. Let’s try to figure out how to behave when a child has a cough and when to start sounding the alarm.

What is a cough?

Cough is a manifestation of a protective reflex, which is designed to clear the airways. During a cough thrust, air abruptly leaves the lungs and forces out everything that interferes with breathing – phlegm and foreign bodies.If you think about the mechanism of coughing, it becomes clear that it is not always necessary to “suppress” it.

What causes and how does a cough occur?

The most common cause of cough is a viral infection. Viruses can cause damage to the respiratory tract at different levels – from the nose (with a common cold) to the bronchi, bronchioles and lungs, and cough is a common symptom in all these diseases. For example, sore throat and nasal discharge running down the back of the throat irritate the mucous membrane of the upper respiratory tract and stimulate the cough reflex.Due to irritation of the mucous membrane of the pharynx, a dry, hacking cough occurs, which will surely pass without treatment, but in the acute period it can be quite frequent and painful and even disrupt the night’s sleep. A runny nose and discharge along the back of the pharynx provoke a wet cough, while the child begins to cough when changing body position, especially in the morning and at night when he gets up, lies down, or turns over. If the virus infects the mucous membrane of the larynx, a false croup develops, that is, edema and, as a result, a narrowing of the lumen of the larynx, which is accompanied by a “barking” cough, hoarseness and a characteristic noisy inhalation (so-called stridor).With inflammation of the bronchi, bronchioles and alveoli – bronchitis, bronchiolitis and pneumonia, respectively – phlegm accumulates in the lumen of the respiratory tract, swelling of the mucous membrane occurs, as a result of which cough and shortness of breath appear. Unlike viral bronchitis and bronchiolitis, pneumonia is more often caused by bacteria and, in addition to coughing and shortness of breath, is accompanied by fever. In bronchial asthma, bronchial spasm and the accumulation of thick sputum in them occur after contact with an allergen, which also provokes a cough.

When should an ambulance be called for a child with a cough?

It is necessary to call an ambulance if the child has the following symptoms along with a cough:

It is very difficult for the child to breathe: you see that the child is breathing with difficulty, it is difficult for him to speak (or scream, if we are talking about an infant) due to difficulty in breathing, the child has “grunting” or “moaning” breathing;

90,023 the child has lost consciousness and / or stopped breathing;

the child’s lips turned blue.

If there are no severe symptoms, but the child’s condition is worrisome, see a doctor. An important sign of trouble is the child’s appearance – if he is lethargic, looks sick, and if you cannot get his attention and catch his eye. Shortness of breath, that is, rapid breathing, accompanied by the effort of the respiratory muscles and the retraction of the intercostal spaces and the jugular fossa (depressions above the sternum), is a sign that indicates damage to the lower respiratory tract. If you notice shortness of breath in your child, be sure to consult your doctor.An increase in body temperature, especially a fever above 39 – 40 ° C, also requires that the child be examined by a doctor, since cough and fever can be symptoms of pneumonia.

Special treatment should be given to children of the first months of life, because in small children, serious illnesses can be erased, and the condition can worsen suddenly. In case of fever (that is, if the rectal temperature in a child is> 38 ° C) in children under three months of age, it is imperative to see a doctor.

Should a yellow or greenish sputum color be alarming?

Yellow or green sputum does not always indicate a bacterial infection.In viral bronchitis and bronchiolitis, the yellow-green color of sputum is due to the fact that the cells of the mucous membrane of the respiratory tract, which have been damaged by the virus, enter the sputum. As a new mucous membrane forms, the desquamated cells come out with phlegm, so there is no need to be scared if the child coughs up yellow or even greenish phlegm, as in most cases this is a normal manifestation of a viral infection that does not require antibiotics.

What if my child coughs at night?

Most often, a nocturnal cough is associated with the fact that when the child lies in bed, discharge from the nose and paranasal sinuses flows down the throat and causes a cough reflex.When a child rolls over in bed or gets up from a horizontal to an upright position, a coughing fit occurs. In such cases, the doctor will prescribe topical treatment for the child to reduce the runny nose and, as a result, reduce the cough.

Night cough also occurs with pathology of the lower respiratory tract. Therefore, if your child is worried about a nocturnal cough, consult a doctor.

What if a child has a cough before vomiting?

If your child has a paroxysmal cough prior to vomiting, see a pediatrician as this may be a symptom of whooping cough.Whooping cough is especially dangerous for babies in the first months of life. Sometimes whooping cough develops even in children who were vaccinated against it, but a long time has passed since the last revaccination.

Prolonged cough

It is not uncommon for a prolonged cough to be caused by several consecutive viral infections. The child does not have time to recover from one infection and picks up another. In this case, the cough can last for several weeks and greatly frighten the parents, although the reason for it is trivial.

However, a long-term cough can be associated with allergies, including bronchial asthma, as well as with whooping cough and other diseases of the respiratory tract and ENT organs (chronic cough can even be due to sulfur plugs in the ears!), Therefore, in the case of prolonged cough, consult your doctor.

How to treat a cough?

A cough can have many causes and treatment is different for each case. Show your child to the doctor to understand what the cough is about and how to help the child.

If the cough is accompanied by sputum production (wet, productive cough), sputum production should be stimulated to facilitate coughing. Give your child more drinks (for example, apple juice or warm chicken broth can be given if age-appropriate and not allergic to these foods). If the air in the children’s bedroom is dry, install a humidifier.

You can combat unproductive (dry) coughs by reducing irritation to the upper respiratory tract. Give your child a drink of water or apple juice to help soften coughs and calm the airways to help with a coughing fit.Avoid sodas or citrus drinks, as they can irritate the inflamed mucous membranes. If the child tolerates honey, try giving it. Cough drops can be sucked for children over 6 years of age. If a cough interferes with sleep, going to kindergarten and school, see your doctor, he will prescribe an antitussive agent.

Steam in the bathroom can help with a coughing fit. Go to the bathroom, close the door, turn on the hot shower and wait a few minutes.After the bathroom is filled with steam, go there with your child, sit for about 20 minutes. Try reading a book or playing with your child in order to distract him.

Smoking at home is strictly prohibited! This contributes to frequent respiratory infections in the child and aggravates their course.

Medicines such as antibiotics and inhalation with bronchodilators, anti-inflammatory and mucolytic drugs are prescribed only by a doctor and are not required in every case.

90,000 causes and treatment. Morning cough with phlegm in a child

Cough is the first thing that parents usually notice when a baby gets sick. At first, a cough is alarming, then it scares, and finally, if it lasts for a long time, it begins to irritate. And the pediatrician can try on the baby all the remedies available at the local pharmacy, and he will cough as if nothing had happened. What to do, how to cure a cough?

Why can’t a doctor help a child who coughs for a long time? Quite simply – doctors are blindfolded more often than you might think.This is certainly bad, but it is a fact. Each doctor can only treat what he sees or hears. The pediatrician can listen to the lungs, but he cannot look at the throat and nose with high quality, the ENT can look, but he will not listen to the lungs; the neurologist will knock on the knee with a hammer, ask to grin, but will not look down the throat, let alone listen.

It turns out that a doctor who can immediately exclude all possible causes of cough simply does not exist. This means that you yourself will have to look for a doctor who will immediately make the correct diagnosis and prescribe the correct treatment.If we talk absolutely precisely, then the parents themselves will have to decide which specialist to go to in order to spend as little time as possible looking for the cause of the cough. But for this, again, you have to learn a little. Let’s start … well, at least with what a cough is.

What is cough

Cough is a symptom. Whatever happens in the respiratory tract, whatever gets there, our body tries to get rid of it absolutely the same way – throw it out with a sharp exhalation.Such a sharp exhalation is called a cough.

The main task if you hear a cough is to understand what your baby’s body wants to get rid of. Because a cough can cause accumulation of phlegm in the airways, swelling of the mucous membranes of the airways, and finally, just the command to immediately clear the airways, for some reason regularly coming from the brain (doctors call it a pathological cough reflex).

In all these cases, the cough will be different. How, then, can we suggest its cause? It’s very simple – by sound.And then you and I can at least correctly complain to the doctor. And this is already something.

Productive cough

He is wet, he is cough with phlegm

How it looks. The child is coughing loudly, you can even hear something gurgling inside him when he coughs. Usually sonority gradually increases, after which the cough stops – “sputum leaves”.

Moist morning cough. The child coughs only a few times and only in the morning.After the sputum has passed, the cough stops until the next morning. The most likely reason for such a cough is the expectoration of mucus, which accumulates somewhere quite shallow – in the throat and nasopharynx.

What to do . See an ENT doctor and ask him to carefully examine the child’s nose, throat and especially the nasopharynx – using a special nasopharyngeal mirror. And after the inspection – be sure! – ask if he saw mucus in the nasopharynx or mucus running down the back of the pharynx.Because this very mucus is the cause of the cough.

But what will happen if the ENT doctor says that everything is clean in the nose or in the nasopharynx? It’s okay – this is exactly the same symptom as the presence of mucus. Then you and I can only ask if the doctor saw irritation or redness on the back of the pharynx. And if it is, then our path lies with you to another doctor – to a gastroenterologist.

Why? Because mucus can accumulate in the throat after a night, not only because it flows down from above – in the same way, it can come from below, from the stomach.When the child lies, the gastric contents can enter the esophagus, and through it (albeit in small quantities) to reach the back of the pharynx. In children under one year old, such a thing is called regurgitation, in older children – reflux esophagitis. Why such a name? Yes, because reflux is a movement in the opposite direction, and esophagitis is because the esophagus suffers from such a movement in the first place. Well, if we know that the child is not doing well with the gastrointestinal tract, it is all the more necessary to go to a gastroenterologist. Because in fact, a very common cause of coughing is just reflux esophagitis.

Summing up: a wet morning cough is the coughing up of mucus that has accumulated overnight in the child’s nasopharynx and pharynx. Such mucus can flow either from above – from the nose (this is to the ENT) or from below – from the stomach. With this you need to go to a gastroenterologist. If you first turned to the pediatrician and found out that the lungs are clean, the problem should be looked for in the nose or in the stomach, but not giving the baby cough syrups will still not help.

What to do if a child coughs

The child coughs wet all day. What does this mean? That there is a lot of phlegm and it accumulates constantly. But where and how to be with her? The answer is simple – if there is a lot of sputum, it means that the child has active inflammation. If there is a plus to this and the temperature – everything is clear. If there is no temperature, this does not mean at all that there is no inflammation. It remains only to find its hearth.

What to do. First of all – take a blood test. It will not only show the presence of inflammation (this is important when there is no temperature), but also tell the doctor what kind of inflammation is it – whether it is caused by viruses or bacteria.

Now the second question: which doctor should I show the child to? In this case, it is better to leave the ENT doctor for later, and first show the child to the pediatrician. Why? Because the most unpleasant situation, which is manifested by the discharge of a large amount of sputum with a cough, is pneumonia. So at first it will be better for the child to listen to the lungs. And if the doctor at the same time hears wheezing, and then, after looking at the blood test, prescribes antibiotics, it is best not to argue – with pneumonia, you know, they are not joking.However, with bronchitis too.

But if the pediatrician says that the lungs are clean, then there is a direct road to the ENT doctor. Because a large amount of sputum (or rather purulent discharge) occurs with sinusitis, sinusitis or ethmoiditis. This is also very unpleasant, besides, pus and cough can be the only symptoms – if the nose breathes freely, then the baby simply will not have any headache.

Summing up: if a child coughs all day or around the clock, it means that a lot of sputum is secreted, it means that the child has active inflammation somewhere – either in the lungs or in the paranasal sinuses.It is necessary to establish the nature of this inflammation (do a blood test) and first exclude the most unpleasant (bronchitis or pneumonia) with the help of a pediatrician. And only if the pediatrician says that the lungs are clean, go to the ENT doctor. But in either case, the case may end up taking antibiotics. Be prepared for this.

cough syrups do not help everyone, some children are generally allergic to them, someone to herbs, someone to chemistry in the composition … we left the syrups, do inhalation with a nebulizer, bought for a small one, and now we use everyone if anyone gets sick.We chose between an inhaler and a nebulizer, stopped at the latter (because they can not only treat acute respiratory infections, but also bronchitis), we have Bee Well WN-115, in the form of a steam locomotive, there is a nozzle for children and adults, it can work for almost half an hour without interruption.

2013-09-22, Milania88

I also bought my baby a bi nebulizer in the form of a locomotive) otherwise we were tortured by these endless ARVI and bronchitis. The doctor advised us a nebulizer, explained that the medicine enters the respiratory tract directly in the form of an aerosol.Very helpful, suitable for adults too.

2013-10-09, Kira80

I take different medicines myself. according to the situation, but besides Gedelix I am afraid to give my son something .. there is at least a natural composition, nothing superfluous. and in most drugs it is alcohol, then preservatives, then a bunch of herbs, then you will not understand what you were allergic to if an attack occurs …

2018-05-13, Tamara

Oh, these ARVIs …. today we went to the children’s clinic, where all the children without exception, they cough, then sneeze, even though they do not go.But we need to, we haven’t been since the summer, we need to take directions for analyzes and that’s all. The main thing is to get sick, otherwise we will have to get our locomotive off the shelf again …

2013-10-11, Milania88

We are being treated with bronchobosus, it perfectly removes all phlegm and therefore the child recovers twice as fast

2017-09-13, AlsuSitdikova

My daughter also had a cough, then I began to temper her and she has not been sick anymore for 4 years.

2012-10-06, galushkaM

Total 10 reviews Read all reviews.

90,000 Cough. what to do, how to help?

E.M. OVSYANNIKOVA , MD, DSc, M.B. SHABAT , O.V. KARASHTINA , T.Yu. STOIKO , Polyclinic of OJSC “Gazprom”, Moscow , N.A. KOROVINA , MD, Department of Pediatrics, Russian Medical Academy of Postgraduate Education, Moscow

The main characteristics of the main diseases occurring with a cough symptom are given, modern approaches to the choice of antitussive therapy in children are considered.

The respiratory tract has several physiological defense mechanisms, these include endogenous surfactant, mucociliary clearance. Cough is an auxiliary mechanism for cleansing the airways.

Cough is a complex reflex defense mechanism aimed at removing both foreign substances from the respiratory tract from the inhaled air and mucus formed in the respiratory tract.

The cough is based on a complex protective reflex aimed at removing foreign substances from the respiratory tract that come with the inhaled air and mucus that accumulates in the respiratory tract. Excitation of several groups of sensory receptors, such as n.vagus, located in the airways, and pleural receptors leads to the transmission of nerve impulses to the cough center of the medulla oblongata. Due to the activation of the cough center and with the participation of the reticular formation, a response is formed in the form of a cough.Cough occurs as a result of a complexly coordinated contraction of the muscles of the larynx, bronchi, chest, diaphragm and abdomen [1].

Cough, playing an auxiliary role in various diseases, can be an important symptom that helps in the diagnosis.

With a cough symptom, the doctor will have to answer the following questions:

Why did the cough occur and what is its cause?
Is it associated with bronchopulmonary disease or is it due to extrapulmonary causes?
What are the leading pathogenetic mechanisms and associated symptoms?
Should a patient’s cough be treated? What treatment is advisable?

The main diagnostic guidelines in the presence of cough [1, 2]:

duration of cough (up to 3 months.or more than 3 months),
contact with irritants,
prior respiratory tract infection,
signs of allergy (medicinal, food, etc.)
nasal discharge,
heartburn and belching,
heart disease,
extrapulmonary malignant tumors,
fever,
sputum separation and its nature.

A detailed description of the cough symptom in combination with anamnestic data, the results of clinical and additional examinations greatly facilitates the diagnostic search.

Cough can be a manifestation of inflammatory processes of both the upper (oronosopharynx, larynx) and lower (trachea, bronchi) parts of the respiratory tract, as well as lung tissue and pleura [2-4] ( tab. 1 ).

Table 1.Diagnostic measures for coughing

Life history
Medical history
Objective examination
Otorhinolaryngologist consultation
Rg cells
Blood for antibodies to Ch. pneumonia, Micoplasma pneumonia, Pneumocistae, helminths
Tomography
Bronchoscopy
Esophagogastroscopy
Spirometry
Allergic tests

Often the occurrence of cough in children is associated with acute rhinitis or nasopharyngitis .Nasal congestion in these conditions leads to difficulty in nasal breathing. Breathing through the mouth is accompanied by drying of the pharyngeal mucosa. The latter, along with the flow of mucus along the back of the pharynx, leads to a cough. Increased cough usually occurs at night and in the morning. Chronic diseases of the nasopharynx (adenoiditis, recurrent nasopharyngitis) can also be accompanied by a cough.

With laryngitis, true and false croup cough may be one of the first symptoms of these diseases.The cough is usually dry and rough (“barking”). Often, cough is combined with aphonia and hoarseness of the voice, which result from a sharp swelling of the vocal cords and laryngeal mucosa.

Cough in the initial period acute bronchitis and tracheobronchitis is usually dry and intrusive. With tracheobronchitis, the cough may be accompanied by a feeling of pressure or chest pain. In the second week of the disease, cough with these diseases, as a rule, becomes productive, there is a tendency to decrease its intensity and frequency.

With obstructive bronchitis cough at the beginning of the disease can also be dry, and then gradually becomes wet. The duration and intensity of the cough depends on the etiology and nature of the inflammatory process. If the causative agent of bronchitis is the RS virus, influenza virus, parainfluenza, enterovirus, then the cough stops by 10-14 days from the onset of the disease. With bronchitis caused by adenovirus and intracellular pathogens (chlamydia, mycoplasma), the cough is longer, persistent, with sputum difficult to separate.Moreover, it can be observed for 3-4 weeks. and more. A long-lasting cough requires the exclusion of not only diseases of an infectious and inflammatory genesis, but also conditions such as a foreign body and chronic aspiration syndrome.

Foreign body in the airways is characterized by the sudden development of a coughing attack, often with cyanosis and asphyxia. In the future, the attacks are periodically renewed. At the same time, the cough is frequent, dry, painful, not bringing relief and often exhausting the child.

Chronic aspiration of food occurs with tracheoesophageal fistula, gastroesophageal reflux stage 3, as well as with organic lesions of the central nervous system (bulbar or pseudobulbar disorders). A characteristic feature of these pathological conditions is the occurrence of attacks of suffocation, cyanosis, accompanied by an attack of severe coughing during or immediately after eating.

In acute pneumonia , as in bronchitis, the nature of the cough changes depending on the stage of the disease.At the onset of the disease, the cough is dry. The dry cough period is usually 3-5 days. Gradually, the cough becomes moist with a small amount of sputum. Cough in uncomplicated pneumonia can occur within 14-18 days. When involved in the inflammatory process of the pleura, the cough becomes painful, superficial.

Cough is a persistent symptom chronic nonspecific lung diseases (COPD). The intensity of cough in these diseases is closely correlated with the volume of lung tissue damage.So, with a lesion within the segments of one lobe, cough during the period of remission is rare and inconstant. At the same time, cough is usually noted in the morning, with a slight separation of sputum. In some cases, with the defeat of 1-2 pulmonary segments, cough occurs only with an exacerbation of the inflammatory process. Widespread lesions cause a more persistent cough, sometimes with a significant amount of phlegm.

In the pulmonary form cystic fibrosis cough is one of the main symptoms of the disease.In this case, the nature of the cough varies depending on the stage of the disease and the degree of damage to the bronchopulmonary system. In the initial stage of cystic fibrosis with minimal functional impairment, the cough is unstable, occurs mainly in the morning, accompanied by the discharge of a small amount of sputum. However, excessive viscosity of sputum makes it difficult to evacuate and is accompanied by a decrease in local immunity. This leads to bacterial colonization of the bronchial tree, the development of inflammation with regular edema and infiltration of the bronchial wall.At the same time, the cough becomes constant, painful, paroxysmal and unproductive.

At bronchial asthma in the pre-attack period, sore throat and dry paroxysmal cough may occur. During an attack, the patient is worried about a cough with difficult, viscous and viscous sputum. In the post-attack period of bronchial asthma, there is a wet cough with the release of light mucous sputum.

Cough is one of the permanent signs of malformations of the trachea and bronchi.The group of such defects includes Munier-Kuhn syndrome (tracheobronchodilation), tracheobronchomalacia, Williams-Campbell syndrome, bronchomalacia. The cough in these diseases is constant, moist, with the release of a large amount of sputum.

For Kartagener’s syndrome – a congenital disease characterized by combined defects of internal organs, sinusorinopathies, frequent reverse arrangement of organs, signs of chronic inflammation of the bronchopulmonary system are also characteristic.The development of the inflammatory process is associated with dysfunction of the ciliated epithelium of the bronchi, which leads to a violation of mucociliary clearance. Bronchopulmonary changes in Kartagener’s syndrome are accompanied by a constant cough with hard-to-separate mucous or mucopurulent sputum.

Parasitic lung diseases in children are diagnosed relatively rarely. Lung lesions are observed with the invasion of parasites, for which a person is both the final and intermediate host.The lungs can be affected transiently (with ascariasis, echinococcosis) or serve as the site of the final localization of the parasite (with paragonimiasis). The defeat of the respiratory system is manifested by a cough, as a result of which a yellowish mucous sputum is released, often mixed with blood.

Immunodeficiency states in children are often accompanied by the development of chronic inflammatory processes in the bronchopulmonary system with a constant wet cough and discharge of a large amount of purulent sputum.Of course, not all conditions were listed above that are relevant to discuss when a child coughs.

In case of a cough symptom, it is necessary to conduct a comprehensive examination of the child and pay attention to the following data:

– The presence of a burdened history of diseases of the bronchopulmonary system and atopy (the presence of bronchial asthma, pollinosis, respiratory allergies) in the child and in relatives.
– When analyzing the anamnesis of the disease, the data of the epidemiological history, the “vaccination” of the child (incl.including the presence of BCG and DTP), the frequency and duration of diseases of the respiratory system in general.
– During an objective examination, attention is drawn to the nature of breathing, the frequency of breathing, the presence of shortness of breath and wheezing.
– Consultation with an otolaryngologist is necessary to exclude the pathology of ENT organs (otitis media, sinusitis, pharyngitis).
– Rg chest to exclude pathology in the lungs.
– Study of saliva by PCR and blood by enzyme immunoassay to detect antigens and antibodies to Ch.pneumoniae, Micoplasma pneumoniae, Pneumocistae, helminthic invasion, which can act as an etiological factor in the lesion of the respiratory tract and clinically manifest as a symptom of cough.
– Tomography to exclude the pathology of the bronchopulmonary system, which is not detected according to the data of standard X-ray examination (malformation, a specific process in the lungs, etc.) (Fig. 1 ).

Figure 1.
Clinical case
Additional survey data
X-ray examination of the chest (with persistent cough and subfebrile condition in a child observed with pneumonia).
According to Rg data, there are no infiltrative shadows.
According to CT data, the pulmonary pattern is significantly deformed on both sides; on the right, in the region of the apex of the lung, a rounded area of compaction with a “track” is determined. Primary tuberculosis complex on the right. Thanks to this method, a diagnosis of tuberculosis was made and specific therapy was prescribed.

Esophagogastroscopy to exclude gastroesophageal insufficiency, which may cause microaspiration of stomach contents.
Spirometry to assess the function of external respiration.
Allergy tests to assess the child’s allergic status and determine the role of allergies in the genesis of cough.

Analysis of the characteristics of cough and examination data help in each specific case to determine the diagnosis and differentiate approach to the appointment of therapy.

Acute pathology of the respiratory system in 70-90% of cases is accompanied by a cough symptom.Acute cough in acute pathology, as a rule, is dry, frequent, sharp and unproductive. This cough disrupts the patient’s quality of life.

In some cases, the cough loses its physiological expediency and not only does not contribute to the resolution of the pathological process in the respiratory system, but also leads to the development of complications. An agonizing, obsessive, unproductive “dry” cough, combined with chest pain, shortness of breath, requires the use of antitussives [6].

In young children, as well as children with a pronounced gag reflex, a high risk of aspiration, expectorant drugs are contraindicated, which increase the volume of secretion and especially enhance the gag and cough reflexes. And for the purposeful suppression of unproductive cough caused by irritation of the mucous membrane of the respiratory tract (for example, with whooping cough), on the contrary, it is possible to use antitussive non-narcotic drugs of central action.

The centrally acting drugs, which have the least number of side reactions and effectively eliminate dry cough, include non-narcotic drugs based on citrate butamirate, which are not inferior in efficiency to codeine-containing ones, but at the same time do not have a depressing effect on the respiratory center and do not cause addiction.These drugs are well tolerated by children, stopping dry cough attacks from the first use. The antitussive action begins 30 minutes after taking the drug, the maximum effect occurs in an hour and a half.

Indications for the use of citrate butamirate preparations are dry, irritating, painful cough, which is observed in acute laryngitis, tracheitis, bronchitis, with influenza, ARVI, as well as cough and pain with dry pleurisy.

Some citrate butamirate preparations are allowed for children from 2 months of age, the duration of therapy is 3-4 days.

The drugs are prescribed before meals. It should be emphasized that, subject to the recommended dosage regimens of butamirate, citrate is characterized by good tolerance and a high safety profile, having not only an antitussive, but also a moderate anti-inflammatory effect, and also promotes moderate bronchodilation.

These drugs are rapidly and completely absorbed when taken orally. The half-life of citrate butamirate in the form of a syrup is 6 hours.When the drug is reappointed, its concentration in the blood remains linear and no cumulation is observed. Citrate butamirate metabolites also have antitussive activity. In general, high therapeutic efficacy and tolerability of such drugs were noted in the treatment of unproductive cough in children with various infections of the respiratory tract (whooping cough, chlamydia, mycoplasmosis, etc.), as well as when used to suppress the cough reflex in the pre- and postoperative period during surgical interventions and bronchoscopy [6].

The correct approach, rational choice of therapy and timely inclusion of antitussive drugs in the complex therapy of respiratory diseases accompanied by cough significantly increases the effectiveness of basic treatment and improves the patient’s quality of life with dry obsessive cough [7].

Literature

1. Korovina N.A. et al. Cough in children. A guide for doctors. M .: 2000.
2. Mizernitsky Yu.L., Melnikova I.M. Muclitic and expectorant pharmacotherapy for lung diseases in children.Problem and solution. M. 2013.
3. Chuchalin A.G. et al. Cough. Ryazan, 2002.
4. Anokhina E.V., Solovieva I.L. The use of antitussive drugs in pediatrics. M. Consilium Medicum. Application. 2002.
5. Dulfano MJ, Adler KB. Phisical properties of sputum. Amer. Rev. Resp. Dis. 1975, 112: 341.
6. Federal guidelines for doctors on the use of drugs (formulary system). Issue XIII. M :. Echo, 2013.
7. Samsygina G.A. Antitussives in pediatrics. M. Consilium Medicum. Application. 2002.

Source: Medical Council, No. 6, 2015

Cough with phlegm – causes, diseases, diagnosis, prevention and treatment – Likar24

A cough accompanied by sputum when coughing up is also called a productive cough. Moreover, its character, as well as the amount of mucus secreted, as well as its color and consistency, can change. This symptom can disturb the patient at any time of the day.

It is believed that a cough with sputum comes, so to speak, “from the inside of the chest”, since it is usually localized in the region of the lungs, bronchi. It can be unproductive, that is, with a rare and insignificant discharge of sputum, when the mucus in the respiratory tract is too viscous. But as the disease progresses, he becomes more productive. A wet cough is usually not debilitating, painful.

Sputum is a secret in the form of mucus, which is formed in the cells of the epithelium (in other words, the mucous membrane) of the bronchi, trachea, bronchioles.Fragments of bacteria, epithelial cells and other components can join it. The phlegm moves through the bronchi, then mixes with saliva from the nose. Normally, it should be transparent, stand out in small quantities. Accumulating in the lower respiratory tract, it irritates the receptors, causing a cough reflex and going out through the mouth.

It is important to understand that the coughing mechanism is by its nature protective, mainly it is aimed at removing foreign particles from the respiratory tract that accidentally got there.In the case of inflammation of the upper respiratory tract, the sensitivity of the mucous membrane increases, even the flow of air during breathing begins to irritate it. And if the inflammation from the upper respiratory tract drops below (into the trachea and bronchi), then the cough changes and becomes not dry, but moist.

Responding to the existing inflammation, the cells of the bronchial mucosa are increasingly producing mucus in order to remove the source of irritation. As a rule, sputum with foreign particles enclosed in it is first picked up by the villi of the ciliated epithelium, and they move the mucus up, directly to the pharynx.However, due to inflammation, some of the cells of the ciliated epithelium die, but the rest do not work as actively. As a result, the secreted secretion does not leave the respiratory tract, but stagnates in the bronchi. Plus, dead cells of the epithelium and the immune system, as well as microbes, join it. As a result, the secreted secretion thickens and thick, rather viscous sputum is formed. When changing position of the body, it greatly irritates the respiratory tract, causing a wet cough.

Moreover, in children, this situation is aggravated by the fact that their airways are still quite narrow, and the muscles of the sternum are weak.Therefore, it is much more difficult for them to clear their throat than for adults. And the mucus itself in children is formed much more viscous, this makes it even more difficult for its discharge.

Classification

Cough is usually classified according to:

in nature – unproductive and productive;
duration – episodic, short-term, paroxysmal or constant;
current – acute, chronic.

It can also occur mainly in the morning or at night, depending on the cause for which it is caused.It differs in other features (wheezing, shortness of breath, barking cough) and pain (with tracheitis).

A cough is considered acute if it lasts less than three months. Its main causes are infections, toxic and mechanical influences. If a patient suffers from a cough with phlegm for more than 3 months, then it is considered a chronic form. Its causes are more varied: bronchopulmonary diseases, extrapulmonary pathology, side effects of drugs.

Usually, a severe cough with phlegm in a child is a sign of acute inflammation due to a cold.That is, the inflammation descended into the bronchi or further into the bronchioles and alveoli. In the worst case scenario, a wet cough is a sign of pneumonia.

For adult patients, a symptom such as coughing up sputum has the following causes:

Nasopharyngeal flow. One of the most common causes of chronic cough. The mucus from the paranasal sinuses flows down the throat, and when it reaches the vocal cords, it causes irritation and as a result – a wet cough.Exacerbations are especially noticeable at night due to the horizontal position of the body. In the morning, there may be an upset stomach, again due to mucus trapped in it.
Smoking. A huge amount of mucus is formed in the lungs of every person who smokes, and the body tries to get rid of it in every possible way, provoking a cough for this.
Upper or lower respiratory tract infections. Various viral, fungal, or bacterial infections cause coughing. As a result, a common cold causes complications (tracheitis, bronchitis, etc.). But at the same time, the accumulation of sputum is rarely the only manifestation of the disease. The accompanying symptoms are as follows: fever, cough, runny nose, etc.
Bronchial asthma. The reaction of the bronchi to a variety of allergens.
Abscess (purulent focus) of the lung or bronchiectasis. If there is an abscess in the lung, then it is possible to separate its purulent contents with a cough.
Benign and malignant neoplasms of the lungs, trachea, bronchi of the larynx.They are always accompanied by the formation of a rather thick phlegm with a fetid odor.
Tuberculosis. A characteristic feature is blood in the sputum.
Inflammation of the lungs and pleurisy, chronic bronchitis. With inflammation of the lung tissue, thick and foamy sputum is formed. Additional symptoms: high fever, chest pain.
Ingestion of a foreign body directly into the respiratory tract. They cause irritation and coughing.
Gastroesophageal reflux, gastritis and esophagitis.That is, the contents of the stomach and esophagus are thrown back into the throat, while irritating the mucous membrane. As a result, there is a chronic inflammation of the larynx, throat with sputum secretion.
Certain diseases of the cardiovascular system (postinfarction cardiosclerosis, tumors, congenital defects, etc.).
Taking ACE inhibitors. These drugs are commonly used to lower blood pressure. However, having fulfilled their function, they cause the body to produce a substance called bradykinin, which can stimulate coughing.

What is dangerous?

Cough is dangerous because when secretion is difficult to pass, it serves as an excellent environment for the growth and subsequent reproduction of microbes. As a result, the bacterial flora can join the inflammatory process, which was initially caused by respiratory viruses. Usually, the development of a secondary bacterial infection is considered by doctors as a complication of the current illness. Among the key bacterial complications of ARVI, accompanied by cough, purulent bronchitis and pneumonia should be distinguished, which are fatal.

Indirect symptoms indicating the development of secondary complications are: an increase in sputum volume, a repeated wave of temperature rise, deterioration of health, purulent sputum and its greenish-yellow tint.

First, the doctor collects an anamnesis and conducts an objective examination: determines the type of cough, provoking and suppressing circumstances, concomitant symptoms. Then, if necessary, a chest X-ray is taken and blood oxygenation is determined (i.e.e. pulse oximetry, gasometry). Sometimes an examination of the circulatory system (ECG, echocardiography, etc.) and respiration (chest CT, bronchoscopy, functional tests – spirometry) may be required. Also, the doctor can direct the patient to undergo a microbiological and cytological examination of sputum. Allergy tests, esophageal pH measurement and upper gastrointestinal endoscopy are sometimes needed.

Key diseases in which coughing up sputum appears:

Bronchitis.In this case, the sputum can be opaque, most often acute bronchitis is of a viral nature.
ARI, ARVI, whooping cough. As a rule, these diseases have additional symptoms: sore throat, fever, runny nose, etc.
Pneumonia (including croupous). Characterized by acute cough and colorless or bloody sputum. Additional symptoms: fever, fatigue, shortness of breath, chills. The cough may not appear immediately, sometimes the infection in the lungs can be so dense that only after a few days of treatment a secret begins to separate.
Bronchial asthma and other chronic diseases of the bronchi, trachea or larynx. Bronchial asthma has an infectious-allergic nature, in this case, the secretory function of the lung mucosa increases. Most often this is a reaction of the bronchi to various allergens. Additional symptoms: choking, wheezing in the sternum.
Gastroesophageal reflux disease. This is also a common cause of chronic cough, which is associated with irritation of the vocal cords due to the return of gastric juice into the esophagus.In this case, a wet cough worsens immediately after a heavy meal or at night / in the morning due to the horizontal position of the body.
Chronic obstructive pulmonary disease. Usually, the airway is affected after a long period of smoking or inhaling small particles such as dust.
Cancer of the lungs, trachea, bronchi or larynx. Oncology of the lungs is one of the most dangerous; the survival rate over 5 years is recorded in only 17% of patients. However, coughing is quite rarely the only symptom of lung cancer, usually also observed: weight loss, fatigue, coughing up blood, chest pain.

Also, a cough with sputum can occur due to diphtheria and tuberculosis (blood appears in the sputum).

If you have a cough with sputum, you need to contact a physician or pulmonologist. Sometimes an examination by an otolaryngologist may be required.

Prevention of the development of cough, first of all, is based on the prevention of the development of diseases of the bronchopulmonary system, their timely treatment. Also, preventive measures for the accumulation of sputum are: strengthening the immune system, staying in the fresh air, an active lifestyle, healthy eating, rejection of bad habits, adherence to the daily regimen, and a stable emotional state.

90,000 The head physician of the hospital in Kommunarka described a cough with COVID-19 :: Society :: RBK

Denis Protsenko

(Photo: Valery Sharifulin / TASS)

The head physician of the infectious diseases hospital in Kommunarka Denis Protsenko told how to determine the cough that appears with COVID-19.The doctor said this in an interview with Rossiyskaya Gazeta.

“This cough has a special intonation. Not deep harsh, but such as it were superficial, “- said Protsenko. He added that with coronavirus, the patient has a feeling of persistent perspiration.

Protsenko noted that he would not confuse “covid cough” with anything, because he had already learned to define it.

Problems in Pfizer trials.The most relevant information about COVID on November 3

In May, the head physician of the hospital said that skin rashes were found in patients with coronavirus infection. “First of all, rashes on the skin of the hands and abdomen,” said Protsenko. Doctors in Kommunarka noted such symptoms in most patients.

Severe shortness of breath

Shortness of breath is a common problem that makes it necessary to see a doctor ¹.It occurs against the background of various conditions and diseases, including rare ones, such as Pompe disease. This hereditary pathology can manifest itself at any age. In Pompe disease, there is a deficiency of an enzyme that breaks down glycogen. It accumulates in the constituent cells of the body, lysosomes, which leads to their destruction ².

The disease is manifested by progressive muscle weakness, especially the muscles of the legs, increasing shortness of breath on exertion, shortness of breath when walking, fatigue, changes in posture ².But more often, severe shortness of breath becomes a symptom of more common pathologies. Why does it arise and which doctor should I contact when it appears?

What is shortness of breath?

The term “shortness of breath” (or dyspnea) is understood as a complex of inhomogeneous sensations of difficulty breathing or respiratory discomfort, having different intensities ¹.

Dyspnea is very common: 50% of patients admitted to the hospital complain of it, and about 25% of patients who see a doctor on an outpatient basis in polyclinics ¹.

People who experience discomfort during breathing describe their condition as severe tightness in the chest, a feeling of lack of air, shortness of breath, suffocation. Sometimes shortness of breath occurs in a healthy person who is experiencing very strenuous physical activity, exposed to extreme temperatures or located at high altitudes. In other cases, shortness of breath is a sign of health problems ³.

According to the study, in 75% of cases, shortness of breath is caused by diseases of the lungs and heart ¹.

Common causes of shortness of breath: lung disease

The most common respiratory diseases in which this symptom appears are asthma, pneumonia and chronic obstructive pulmonary disease (COPD).

Bronchial asthma is a chronic inflammatory disease of the respiratory tract, the main manifestation of which is episodic attacks of suffocation, wheezing, a feeling of tightness in the chest and cough. The severity of sensations depends on the severity of the disease: with mild obstruction (“congestion”) of the airways, there is a feeling of tightness in the chest, in advanced cases the patient needs to make an effort to inhale ^4.5.

Asthma symptoms appear and disappear spontaneously or after treatment with airway dilators. The disease can develop at any age and cause shortness of breath in children and adults ⁴.

A common cause of severe shortness of breath is acute infectious pneumonia, or pneumonia, which develops more often due to a bacterial infection. With pneumonia, dyspnea occurs in combination with fever (above 38 ° C), cough, sweating, weakness ⁶.

Dyspnea is also a symptom of chronic obstructive pulmonary disease (COPD). This inflammatory airway disease usually develops in smokers. Patients experience prolonged shortness of breath and a productive wet cough, which are exacerbated after exercise ⁵.

Other causes of dyspnea

Dyspnea during light exertion, without exertion, as well as during heavy physical exertion can be a sign of a number of other diseases:

respiratory tract diseases – lung cancer, tuberculosis, pulmonary hypertension, pulmonary fibrosis ⁵;
heart disease – ischemic heart disease, chronic heart failure, myocardial infarction, heart rhythm disturbance; dyspnea in such cases may be accompanied by palpitations, chest pain ⁷;
Pulmonary embolism – a potentially life-threatening disease, the manifestations of which can range from gradually developing symptoms to fulminant catastrophe ⁸;
carbon monoxide poisoning – shortness of breath is accompanied by cough, hoarseness, sore throat ⁹;
anemia – in such cases, shortness of breath appears during exercise, and in severe cases, at rest (dyspnea while lying down) ¹⁰;
psychiatric disorders, in particular anxiety, panic attacks ⁴;
some rare hereditary diseases, for example, Pompe disease ² and other pathologies.

During pregnancy, shortness of breath, tachycardia (increased heart rate) may be a sign of iron deficiency anemia or other pathologies ¹¹.

Alarms

Shortness of breath can be a symptom of health-threatening and even life-threatening diseases that require immediate medical attention. Alarming signs, upon the appearance of which it is appropriate to call an ambulance ²:

severe shortness of breath that came on suddenly;
shortness of breath is accompanied by chest pain, fainting, nausea, blue lips or nails, changes in mental activity.

These symptoms may indicate the development of an acute condition – myocardial infarction or pulmonary embolism, therefore it is impossible to hesitate in such cases ².

Which doctor should I contact?

Since shortness of breath can be associated with a wide variety of diseases, it is first and foremost appropriate to consult a general practitioner or pediatrician if a child has a problem. Based on the history, description of the problem, physical examination, the doctor will be able to make an assumption why shortness of breath has arisen, and refer the patient to narrow specialists – a pulmonologist, cardiologist, hematologist, psychiatrist and others.Depending on the disease identified, the doctor prescribes a treatment regimen.

References

Martynenko T. I. et al. Optimization of early nosological verification of dyspnea of pulmonary or cardiac origin // Pulmonology – 2014. – No. 1. – P. 27-31.
Shortness of breath. Mayo clinic (date of treatment 07/16/2019). URL: https://www.mayoclinic.org/ symptoms / shortness-of-breath / basics / definition / sym-20050890 .
Princely NP Bronchial asthma: diagnostic difficulties // Practical pulmonology – 2011. – № 1.
Chikina S. Yu. Principles of dyspnea assessment in the practice of a pulmonologist // Practical Pulmonology – 2006. – No. 2.
Tatochenko V.K. et al. Pneumonia // Pediatric Pharmacology – 2006. – T. 3. – No. 4.
Poltavskaya MG et al. Chronic shortness of breath in cardiac patients: prevalence and etiology // Clinical Medicine – 2007. – V. 85.- No. 6. – P. 37-42.
Polozova E.V., Shilov V.V., Kuznetsov O.A. The main clinical manifestations of respiratory system damage in acute severe carbon monoxide poisoning complicated by thermochemical damage to the respiratory tract // Efferent therapy – 2009. – V. 15. – No. 3-4. – S. 35-39.
Avdeev S. N. Thromboembolism of the pulmonary arteries // Practical Pulmonology – 2009. – No. 3.
Savenko I. A. et al. Clinical pharmacology of drugs for the treatment of anemia in the educational process // International Journal of Experimental Education – 2013.- No. 8. – S. 132-134.
Nemerov E. V. et al. Analysis of clinical cases with dyspnea syndrome // Siberian Medical Journal (Tomsk) – 2013. – T. 28. – No. 2.
Mravyan S.R., Protopopova T.A. Diagnostics and treatment of cardiovascular diseases during pregnancy – 2010.

GZEA.PD.18.09.0435j

reasons for his visit after sleep

Children often cough after a night’s sleep. Sometimes the attacks are so severe that the parents become anxious.However, most often they disappear quickly enough. Therefore, there is no need to immediately try to apply any treatment. Watch your baby for a few hours after waking up.
There are cases when a child’s cough in the morning has a physiological basis and does not require special measures. If he feels well during the day and does not show any signs of illness, then there is no cause for concern. Perhaps the baby was just sleeping in a stuffy or insufficiently ventilated room.In these situations, mucus accumulates in the airways, which is secreted in the morning.

Causes of morning cough in children

When a child has a morning cough, the causes can be very different. If they are of a physiological nature, then the attack occurs only after a night’s sleep, and then it does not recur. There is no need to fight with it, since it has a reflex nature and helps to cleanse the bronchi.

If it does not disappear, but additional symptoms of a respiratory or other internal disease are noted, then you should urgently consult a pediatrician.

It is especially important if the cough does not disappear after getting out of bed, but torments the child all day or even at night. Such signs indicate an inflammatory or infectious process and only a doctor can determine where his focus is.

In this case, the parents of the baby need to be attentive. If the causes of cough have a physiological basis, then independent attempts to get rid of it can only harm the child.

In cases where there is any pathology, it is worth calling a doctor.If there is even the slightest doubt, then it is better to play it safe and not leave the little patient without medical assistance.

Physiological cough

This type of seizure does not mean that something unfavorable happens to the children.

It usually indicates that:

The child prefers to sleep lying on his back, therefore bronchial secretions and saliva accumulate in his airways;
after waking up, he immediately changes posture, which causes irritation with sputum of the mucous membrane of the trachea;
in the process of evening breastfeeding, a little milk remains in the baby’s throat, which flows into the respiratory tract at night;
his teeth began to erupt;
there is too much dust in the room and it got into the child’s bronchi at night;
an infection has recently been transferred, after treatment of which residual effects are observed;

90,023 children attract attention, etc.

These causes irritation of the inner lining of the respiratory tract, increased production of sputum, increased salivation or reflex manifestations of coughing.

The main signs that we are not talking about any disease is that the attack goes away soon after the child wakes up, its manifestations are short-lived, and the temperature remains normal. During the day, with physiological reasons for the development of cough, the baby usually feels good and does not hurt anything.

Symptoms of pathological cough

Often, a morning fit of coughing indicates the onset of the disease. How to distinguish such a symptom from a physiological one?

Especially need to be alert if it is accompanied by fever, runny nose or a sharp deterioration in health. Such symptoms primarily indicate infection with influenza or acute respiratory infections.
If, after waking up at night, the child, along with a cough, secretes mucus with an unpleasant odor, and the attacks resume during the day, then reflux esophagitis may be present.It occurs when, due to the pathology of the esophagus or other diseases, gastric juice enters the throat and greatly irritates its mucous membrane.
Attacks of dry, strong cough with a whistling sound, especially if it sounds like barking, directly indicate whooping cough.
If there is an increased body temperature and pain in the side, then, most likely, pneumonia has begun.
A paroxysmal dry cough with a small amount of sputum often occurs with bronchitis or asthma.In these cases, wheezing and loops in the chest are often heard in a small patient.
If a child has a moist cough in the morning, with a lot of mucus, especially if it is green or brownish, this is a characteristic sign of an abscess or the development of pleurisy.
With helminthic infestation, cough is its first symptom. Seizures usually occur immediately after waking up. They are explained by the presence of an allergic reaction in the body and intoxication with the waste products of helminths.

Dry cough in the morning

This type of cough is most often observed when the following diseases occur:

ARVI;

90,023 whooping cough;

bronchitis;
tracheitis;
pharyngitis;
laryngitis;
pneumonia;
false croup;

90,023 pleurisy;

sore throat;
emphysema;
neoplasm in the throat or lungs, etc.

Such diseases are accompanied by a barking cough, sore throat, chest or side, wheezing, difficulty breathing, fever, aching joints.

To establish an accurate diagnosis, it is necessary to identify the presence or absence of sputum.

If a lot of mucus leaves, then we are talking about other infectious or inflammatory pathologies. Therefore, you need to carefully monitor the symptoms in order to describe them in detail to the visiting doctor.

You should not start treatment on your own, as you can provoke serious complications. All drugs for the treatment of dry cough can only be prescribed by a specialist.

Wet

The most common cause of a wet cough in children exclusively in the morning is rhinitis posterior.This is an inflammation of the back of the nose that produces excess mucus. During sleep, it accumulates in the back of the throat. When the baby wakes up and changes position, there is a natural reflex to cough up her.

In addition to rhinitis, a wet cough in the morning may indicate:

Influenza;
ORZ;
bronchitis;
sinusitis;
pharyngitis;
tracheitis;
pneumonia, etc.

A large accumulation of sputum can lead to partial or complete blockage of the bronchial lumen and suffocation

The above diseases are characterized by the presence of paroxysmal severe cough, sputum production of an unnatural color and odor, pain in the chest and side from the affected lung, congestion in the chest and nose. A significant increase in temperature and a severe runny nose are also usually observed.

In such cases, you cannot do without the help of a doctor, since a productive cough rarely goes away by itself.

Diagnostics

If the child’s condition is satisfactory, then it is necessary to come to an appointment at the children’s clinic.

If the baby is feeling very bad, then you need to call a doctor at home. He will provide first aid, and then a complete examination of the body will be required to clarify the diagnosis.

Required studies include:

Clinical blood test;
biochemical blood test;
sputum analysis;
general urinalysis;

90,023 throat and nasal swab;

fluorography;
bronchoscopy;
panel of allergens, etc.p.

These studies are enough to identify the causative agent of the infection and select antibiotics to combat it. They will make it possible to determine the state of the baby’s respiratory system and the presence of inflammation in his body.

Treatment

Therapy is always based on the root cause of the cough and is aimed at eliminating it. If the cough is dry, the doctor prescribes the following remedies:

Antihistamines. Prescribed for allergies. The first generation drugs (Tavegil, Suprastin, Pipolfen) are very fast acting and are designed to relieve acute conditions.Second-generation antihistamines are not used (they have a strong toxic effect on the heart). Third-generation drugs (Citrine and its derivatives) act more slowly, but have a mild effect and minimal side effects.
Bronchodilators. This includes Berodual, Salbutamol. Preparations of this group are necessary for the rapid removal of puffiness and spasm of the bronchi.
Antitussive. Codelac Neo, Pantaus, Sinekod, Omnitus. If a dry cough is caused not by phlegm, but by irritation of the receptors, which is characteristic of measles and whooping cough, antitussives of this group are prescribed.
Anti-inflammatory drugs. Ketorolac, Nise. Shown for infectious lesions of the lung tissue. effectively relieve inflammation.
Anesthetics (indicated for diseases of the throat, relieve pain).
Antacids. Rutacid, Gastal. Used for reflux.

In case of the development of a wet version of the cough, medications are usually prescribed:

Mucolytics. Acetylcysteine, ACC, Vicks Active, fluimucil.Powerful drugs for thinning viscous phlegm. It is recommended to drink more liquid for the best effect.
Expectorants. This includes Bromhexine, Lazolvan. Medicines promote the early discharge of sputum from the bronchi (if it is sufficiently liquid).
Antibiotics. Fluoroquinolones (considered the most effective), Aminopenecillins, Cephalosporins, Macrolides (narrow-use antibiotics specifically against bronchitis and pneumonia). Used for bacterial coughs.The mechanism of action is different. Some destroy bacterial cells, provoking their death, others violate their DNA, making reproduction impossible.
Corticosteroids. Pulmicort, Flixotide, Berotek, Benacort. They are used only in a hospital with severe bronchitis, bronchial asthma and COPD.

At the end of the acute period, physiotherapy and breathing exercises are indicated. The specific procedures are selected by the attending physician. Self-medication is unacceptable.

Let’s summarize

It should be understood that, on the one hand, morning cough in children is a common reflex reaction to foreign matter entering the respiratory tract.Then an attack is a positive sign that helps to facilitate breathing.

But a cough is also possible, indicating the development of the disease. It can be dry or wet. In case of suspicion of a pathological process, urgent medical attention is required.

Only a doctor is able to establish why a child developed a cough in the morning after sleep, identify its causes, and determine the method of treatment.

It is necessary to call a specialist immediately if:

Seizures are very pronounced;
nausea and vomiting develops;
there is a suspicion of a foreign object entering the respiratory tract;
there is a high fever;
general weakness is noted;
there are signs of intoxication;
dehydration occurs;
cough worse at night;
previously diagnosed with allergies.