Practical advice from allergist Pramod Kelkar, MD
Cough, cough, cough. That maddening cough that never goes away. The cough that makes people in the grocery store cover their carts as they speed past you. The cough that hammers a classroom of students trying to take a test or learn a new concept. Why do we cough? What can we do about it
Minnesota allergist Pramod Kelkar, MD, chair of the American Academy of Allergy, Asthma & Immunology Cough Committee, answers our cough questions.
AAT: What are the different causes of coughs?
Dr. Kelkar: Coughing is a reflex and usually happens involuntarily; it’s your body’s natural reaction to an irritated airway. Often, it is a symptom of an underlying disease. For instance, chronic “it-won’t-go-away” coughing can indicate that asthma, allergies or GERD (gastroesophageal reflux disease) is out of control.
Coughing is also the body’s way of clearing mucus in the airways or getting rid of foreign materials such as allergens, irritating pollutants or secondhand smoke that enter the respiratory tract (the nose, throat, larynx, sinuses or lungs).
Physicians divide coughs into three categories:
- Acute cough is a cough that lasts less than 2-3 weeks. Most often it is caused by the common cold or other upper respiratory tract viral infections, bronchitis, pneumonia, allergies, asthma or sinusitis.
- Subacute cough is a cough that lasts from 3 to 8 weeks. It is often caused by the same diseases that cause acute cough but becomes more serious if not treated.
- Chronic cough is a cough that lasts longer than 8 weeks (or 4 weeks in children). The three most common causes of chronic cough are postnasal drip/drainage, asthma and GERD.
AAT: Can you tell what’s causing a cough by how it sounds or feels?
Dr. Kelkar: Not really. Figuring out the exact cause of cough can be challenging. Whooping cough will obviously have whooping sound in most cases (but not always!). Barking or honking cough in children can sometimes be from habit (again, not always). In adults, the types of cough do not give a specific indication about a specific diagnosis.
That’s why it’s important to consider all symptoms. For example, allergies are associated with nose and sinus problems; asthma can produce chest tightness, wheezing and shortness of breath; and GERD often causes heartburn and a sour taste in the mouth. Having said that, it is important to keep in mind that all these diseases can occur with cough as the only symptom and multiple conditions can occur in the same patient (such as asthma and GERD).
AAT: When should patients see a doctor about a cough?
Dr. Kelkar: Cough in children less than 6 months old must always be evaluated. In other children, any wet cough or coughing while feeding should be checked by a physician.
Many cold- and virus-related coughs go away within a couple of weeks. If a cough lasts more than 2 weeks, however, you should see your healthcare provider.
For patients of all ages, seek medical help as soon as possible if you experience any of the following:
- coughing up blood or yellow-green sputum/phlegm
- a temperature higher than 101 degrees F
- losing weight
- night sweats
- feeling short of breath and tight in the chest
- no relief from over-the-counter medications or other medicines
- coughing all night long
- coughing that changes in character or becomes worse/deeper
- coughing accompanied by a high-pitched sound or stridor while inhaling
AAT: What type of physician should patients see for a cough?
Dr. Kelkar: Common types of acute and subacute cough can be treated initially by any healthcare professional. If the cough lasts more than 4 weeks, however, your physician may suggest you consult a specialist, such as an allergist. Trained to treat upper and lower respiratory disorders, allergists can be an important part of your healthcare team, guiding patients to specific testing, referrals and a comprehensive treatment plan.
AAT: What should you expect at your visit with a healthcare provider?
Dr. Kelkar: First of all, your provider will gather information from you, like how long you’ve had the cough, how it started, what triggers it, accompanying symptoms, when the cough occurs, whether there is fever, and whether there is any phlegm/ sputum and what color it is. This will be followed by a detailed physical examination to detect signs of any underlying disease such as swelling in your nose, drainage on the back of your throat from allergies, or wheezing from asthma.
Some patients may require an x-ray or specialized tests based on the suspected cause of the cough: skin prick tests for allergies, breathing tests and spirometry for asthma, or imaging study (CAT scans) for sinuses. Your healthcare provider may refer you to an appropriate specialist like an allergist or pulmonologist for some of these tests.
AAT: What medications might a physician prescribe for coughing?
Dr. Kelkar: Your physician will diagnose and treat the cause of your cough, not just the cough itself. Sometimes, your physician will recommend trying a particular medication to see if it’s effective before doing expensive and invasive testing.
For instance, allergies can be treated by oral antihistamines, corticosteroid nose sprays and allergy shots. Asthma can be treated with bronchodilator inhalers and inhaled corticosteroids and by avoiding allergens and irritants that cause symptoms. (Asthma patients who need daily medications for their breathing symptoms should see an allergist to identify specific allergies.) GERD requires medications as well as a change in diet and lifestyle such as avoiding caffeinated beverages, alcohol, acidic fruit juices, chocolate and smoking and not lying down immediately after a meal.
AAT: Are there issues with chronic cough that are specific to children?
Dr. Kelkar: Coughing in children may occur from a variety of causes, some of which are specific to children, including croup, bronchiolitis, RSV infection, a tic-disorder manifesting as a dry cough, and exposure to cigarette smoke from parents/caregivers. Sometimes a foreign body such as a toy or a food item will get stuck in a child’s airway and cause a cough that goes on for days or weeks before it is detected.
Because young children cannot communicate in detail, it is challenging to treat coughs at home without a physician’s guidance. Parents and caregivers should talk with their healthcare team before using over-the-counter medications in children and not give more than the label recommends. Parents should also watch their children for signs of respiratory distress between coughing spells, especially if the child has asthma.
To repeat, any child with a cough should see a physician if:
- the child is less than six months old
- the cough is sounds wet and mucousy
- the child is coughing at night
AAT: Will any over-the-counter (OTC) medicines help with cough?
Dr. Kelkar: Two types of cough medications are available without
prescription: antitussives and expectorants. Antitussives (such as dextromethorphan) help suppress cough by blocking the cough reflex. Expectorants or mucolytics (such as guaifenesin) help thin mucus so the cough can get rid of thick accumulations. Some medications combine these two products. However, recent guidelines from the American College of Chest Physicians say that OTC cough medicines don’t work very well and can be dangerous for children.
The Food and Drug Administration (FDA) now says cough and cold medicines should not be used in children under the age of 4.
Cough and cold medicines can be dangerous for people of all ages if used incorrectly. While pharmacies now restrict the sale of cold medicines that contain pseudoephedrine or ephedrine, which can be used to make methamphetamine, experts also warn that dextromethorphan is a problem. Numerous studies by The Partnership for a Drug-Free America and others show increasing numbers of young people are using this easily available cough suppressant to get high (www.drugfree.org/Parent/Resources/ Cough_Medicine_Abuse).
AAT: Are there any “home remedies” patients can use to relieve cough symptoms until they can see a doctor?
Dr. Kelkar: Home treatments can be tried but should never take the place of consulting your healthcare provider. Some things that might help you feel better include:
- drinking adequate hot/warm liquids, which can soothe the throat, help keep the body hydrated and thin mucus
- using a cool mist humidifier in the patient’s room
- avoiding carbonated or citrus drinks, which can sometimes irritate the throat and lead to more coughing
- following asthma medication regimens and action plans, as well as monitoring progress
- using cough drops to soothe sore throats (for older children and adults only; they are a choking hazard for young children)
Talk with your physician before using any herbal remedies. Although some herbs are harmless, it is better to consult your doctor before trying them out. n
Pramod Kelkar, MD, chairs the American Academy of Allergy, Asthma and Immunology Cough Committee. He is a graduate of the Mayo Clinic and is in private practice at Allergy and Asthma Care, PA, in Maple Grove, Minnesota.
First published: Allergy & Asthma Today, Winter 2007
Updated February 2009