Cough: identify it correctly to better treat it

Cough: identify it correctly to better treat it

A common symptom, cough results from diverse and varied causes, and can reflect both benign and more serious pathologies. This is why it should not be neglected. Overview of its manifestations and treatments with Dr. Frédéric Le Guillou, pulmonologist.

What is cough and what is its mechanism of occurrence?

Cough is a noise, due to the expulsion of air through the upper airways, which occurs during contraction of the respiratory muscles (diaphragm, intercostal muscles). This natural defense reflex helps eliminate mucus and irritants from the respiratory tract (throat, trachea, bronchi).

The evacuation of these secretions thus helps to breathe better: the respiratory tract is freed of any unwanted foreign bodies and the lungs are protected against inhaled particles. “When the mucous membranes are attacked, the receptors located in the mucous membrane of the trachea and bronchi trigger a reflex contraction of the respiratory muscles. This is the case, for example, in the presence of a foreign body which obstructs the larynx., notes Dr Frédéric Le Guillou, pulmonologist, allergist and president of the Santé respiratory Europe association. What you need to understand is that cough is not an illness. “On the contrary, it is a phenomenon that we must know how to respectcontinues the specialist. However, it can reflect an illness, a respiratory infection or an allergy: and in this case, it is a symptom to be taken seriously.

Many illnesses can in fact cause an acute cough: flu, colds, bronchitis, pneumonia, asthma, respiratory allergies, heart problems in the elderly, etc. Chronic cough is also often linked to smoking and chronic bronchitis. In all cases, it remains a very frequent reason for consultation.

What are the different types of coughs?

There are two types of cough, which differ in nature:

  • Dry cough (called non-productive): irritative, without expectoration (phlegm), the person expels nothing.
  • Fatty cough (called “productive”): it produces blood or sputum (also called phlegm). This can be clear, yellow, green or bloody; and are made up of mucus, debris and cells ejected from the lungs.

It is also important to differentiate between:

  • A sharp cough : which lasts less than three weeks.
  • And a chronic cough : which lasts beyond eight weeks and can appear during the day, at night, at bedtime, continuously, be associated with effort or other symptoms.

What are its manifestations?

Coughing can be a painful symptom to bear, especially when it lasts. By coughing too much or if the cough is very strong, the phenomenon can cause elongation of the rib muscles or cartilage, and cause chest pain (on inspiration, during movement or when coughing).

When it persists, cough can be exhausting, especially if it occurs in fits at night and interferes with sleep. “Chronic cough can also develop slowly over several years: this is the case, for example, in smokers who sometimes do not always realize the importance of the evolution of this symptom.observes Dr Frédéric Guillou.

What can be the causes of cough?

Cough is a common symptom in adults but even more so in children, in whom the peak frequency is observed at the age of 6 years. Due to their immature immune system, they are in fact more sensitive to attacks on the respiratory tract than adults.

Most of the time, cough is a symptom reflecting irritation of the throat, trachea, bronchi or sometimes the ears.

Frequently associated with nasal congestion, acute cough often comes from a viral infection (sometimes bacterial) such as: nasopharyngitis, a cold, sinusitis, sore throat, flu, bronchitis, bronchiolitis, pneumonia, whooping cough, Covid-19… It can also occur in the event of a misdirection, to help expel the ingested foreign body. Pieces of food, coins, marbles, beads can therefore put a person’s life in danger, especially in children.

“Two thirds of chronic coughs are not of respiratory or pulmonary origin”, reveals Dr Frédéric Le Guillou. When the cough is chronic, it is therefore appropriate to suspect a more serious pathology such as: asthma, chronic obstructive pulmonary disease (COPD or chronic bronchitis), gastroesophageal reflux disease (GERD), posterior rhinorrhea, an allergy, a dry syndrome or Gougerot Sjögren syndrome, heart problems, a polyp located on a vocal cord, on the trachea or bronchi.… Tobacco is another important cause of long-term cough, just like cannabis or sprays (including including household) which contain irritants. Air pollution, certain medications (such as ACE inhibitors – ACE inhibitors, treatment of high blood pressure; or beta blockers, certain eye drops, particularly in the treatment of glaucoma) can also explain it.

Among the other etiologies are finally bronchopulmonary and ENT cancers, pulmonary embolism, tuberculosis, cystic fibrosis, heart failure, mycotic infections in the lungs, pleurisy, pneumothorax, diseases due to asbestos…

How to recognize cough and associate it with a pathology that needs to be treated?

“The mechanism of occurrence of the cough and its presentation are essential to make the diagnosisexplains the pulmonologist. Is the cough isolated or accompanied by symptoms (sputum, fever, weight loss, etc.)? Is it dry or productive? Does it occur during the day, at night, during exercise, during the grass pollen season (seasonal depending on certain pollen exposures)? Is it calmed or aggravated by a particular position? Is there associated shortness of breath or chest pain? These are the questions that must be answered to guide the diagnosis.”.

What to do to calm a cough?

If the cough (whether dry or oily) does not present alarming or aggravating symptoms, there is no point in going to the doctor. “Viral coughs resolve spontaneously within 7 days and do not require treatment.specifies Dr Frédéric Le Guillou.

However, a few actions can relieve irritation: hydrate well by drinking water, elevate your head with pillows in the event of a nighttime cough, humidify your home and workplace with a humidifier or a wet cloth placed on a radiator, avoid irritants (perfumes, aerosols, essential oils, etc.) likely to trigger coughing fits, cover up and stay warm, rest, etc.

As for natural remedies, turn to honey, whose softening properties will be appreciated: you can consume it directly or as a herbal tea, combined with a little lemon juice. Herbal infusions (thyme, marshmallow root, hibiscus, star anise, mallow flowers for example) can also relieve your dry cough fits. “Menthol lozenges (not eucalyptus) can also provide relief, notes the doctor. Also be careful with essential oils which can be irritating and make coughs worse. Their use requires precautions and the advice of a specialist“.

Finally, avoid smoking or exposing yourself to smoke, and be sure to ventilate your home regularly.

An update on cough medicines

Little, if not ineffective, cough medicines should be avoided, particularly in children under two years of age, the elderly, pregnant women or people suffering from chronic bronchial disease for whom they can be harmful.

On a wet cough, they risk aggravating the problem and delaying healing. “Remember that wet coughs are useful coughs, because they clear the airways and contribute to healing., underlines the pulmonologist. A medication that helps thin the mucus is preferable in this case.

On a dry cough, they can mask a more serious pathology and lead to a delay in medical diagnosis.

In any case, they should not be taken for more than a few days.

Remember that cough is a natural defense mechanism of our body, it disappears on its own within a few days, once the infection is overcome. If this is not the case and other worsening symptoms set in, talk to a doctor. Don’t take any risks if you are pregnant either: do not take any medication without your doctor’s advice.

What to do with a cough that lasts?

A sharp cough, without associated signs, may take a few days to disappear. If it is an upper respiratory infection (URTI), characterized by nasal congestion and sore throat, the cough should resolve on its own once the infection has been stopped.

On the other hand, a cough that persists for more than two months, without an obvious cause, should lead you to consult a doctor (general practitioner first, pulmonologist secondly; unless there is a sign of rhinitis and sinus damage, in which case it is best to see an ENT doctor). Complications may indeed appear, such as throat irritation and insomnia if the nighttime cough is severe.

When to worry?

“A cough that lasts is not normal and should prompt you to see a doctor. Consult if it persists beyond eight weeks or earlier, if the cough worsens or is accompanied by associated signs that are bothersome on a daily basis”, invites Dr Frédéric Guillou. In case of associated emergency signs (fever, difficulty breathing, pain…