Cough
Dr Wrishi Raphael
Its the time of year when we all start getting coughs. Most of the time the cough clears up within a few days, but if it doesnt, it could be the sign of something more ominous. While most coughs clear up within days, around 20 per cent become chronic and some may persist for a long time. Its important that any cough that has lasted for more than eight weeks is checked out by the family physician.
Here we will look at chronic coughs, their causes, and what treatment is available.
Most people find themselves with a cough for a part of the winter, but if it hangs around for days and weeks it is worth checking it out.
Post Nasal Drip Cough. It is one of the common varieties of cough during the change of seasons.
SYMPTOMS: Irritating, tickly or dry cough with a feeling of mucus or catarrh dripping down the throat.
The most clear symptom can feel like there is a lump in the throat, eased by continually clearing it.It may last for years and cause the throat to become sore and swollen.
CAUSE: The glands which line the nose and sinuses produce up to four pints of clear thin mucus a day. Little hairs in the sinuses usually brush mucus down the throat - this happens without us realising.
An allergy, hayfever or a cold can make mucus thick and sticky. Instead of draining normally, it drips down the throat, obstructing the airways, causing a coughing reflex.
TREATMENT: If its due to an allergy, such as an allergy to dust, a steroid nasal spray will ease the inflammation causing the drip.
If caused by sinusitis - acute inflammation of the sinuses - antibiotics can help. Applying drops of a specially prepared salt solution up the nose may provide relief.
History and Physical
The duration (chronic 3 months), onset, frequency, quality (dry vs. productive), sputum
characteristics, provoking/ relieving factors, recent changes must be noticed thoroughly.
Associated symptoms must also be checked which include: fever, dyspnea, (breathlessness) hemoptysis (blood in sputum), wheezing, chest pain, Post Natal Drip, rhinitis.
Important constitutional symptoms which may lead to a more definitive diagnosis include: fever, chills, fatigue, night sweats
The following risk factors are always making cough worse and they should be ruled out: smoking, occupation, exposure, family history of lung CA or other CA, TB status, recent travel.
Medications such as ACE inhibitors namely ramipril can cause dry cough.
Past Medical History include pathologies of the lung (asthma, Chronic Obstructive Pulmonary Disease, Cystic Fibrosis) or heart diseases (Congestive Heart Failure, Myocardial Infarction, arrhythmias), or any other chronic illness.
Vital signs must be monitored including oxygen saturation, respiratory exam, head, eyes, ears, nose , throat and precordial exam
Investigations
Guided by findings on history and physical
The following must be considered throat swab, CXR, Pulmonary Function Tests, tests to evaluate the upper gastrointestinal tract, sputum culture test for acid-fast bacilli (if Tubeculosis is
suspected).
The writer can be reached at: [email protected]
