Cough is common upper respiratory complaint

There are many circulating irritants in the air atmosphere that easily access the respiratory chambers of the body and prompt people to cough or try to force out or prevent the entry of foreign materials into the lung cavity.

1416169057Dr-Joseph-Kamugisha
Dr Joseph Kamugisha

There are many circulating irritants in the air atmosphere that easily access the respiratory chambers of the body and prompt people to cough or try to force out or prevent the entry of foreign materials into the lung cavity.

Cough can be caused by an irritation or allergy from the environment. For example cough that result from aspiration of foreign objects into the lungs.

Sometimes cough can be chronic, the kind that does not resolve in a few days.

Chronic cough is usually a symptom of an underlying body illness. For example, cough caused by diseases like asthma, allergic rhinitis, sinus problems (for example sinus infection) and esophageal reflux of stomach contents.

Medics tend to request for chest X-ray to patients with cough. Chest films can give clear picture for the appearance of normal or abnormal lung parenchyma.

Various diseases can force people to cough so frequently. For example, asthma is a disease of airways that result in difficulty breath or shortness of breath commonly referred to as dyspnea.

Asthma patients can have various complaints but chronic cough is usually one of the major symptoms.

People with asthma need protection from air pollutants that can aggravate the disease such as cold air, exposure to air pollutants or pollen, smoke, or perfumes.

Gastro-esophageal reflux disease refers to backward flow of stomach acid and other contents into the esophagus. If stomach acid moves backward up the esophagus, reflexes result in spasm (contraction) of the airways that can cause shortness of breath and coughing.

In some instances, reflux can be so severe that substances can be aspirated into the lungs and cause similar symptoms as well as damage to lung tissue. In some individuals, no sensation of heartburn is felt and their only symptom may be cough.

Sinus problems and postnasal drip can also cause chronic cough. This condition can be difficult to detect. Sometimes CT scan of the sinuses is necessary for diagnosis. Post-nasal drip patients usually feel a tickle in their throat and this prompts frequent throat clearing.

Infections such as bronchitis or pneumonia can prompt people to cough. These infections can be caused by virus, bacteria or fungus. Cough caused by viral infections does not usually respond to antibiotics treatment.

Some anti-hypertensive medications such as enalapril (Vasotec), captopril (Capoten) can cause chronic cough. Angiotensin enzyme converting inhibitor drugs are very useful and important in the treatment of high blood pressure but can make you develop chronic cough.

It is, therefore, recommended that patients who take blood pressure medications such as the angiotensin converting enzyme inhibitors should talk to their doctors when to switch medications.

They should not stop their medicines on their own because a marked elevation in blood pressure can result from discontinuation. A newer generation of angiotensin converting inhibitors such as  valsartan (Diovan), losartan (Cozaar) can be alternatives that have less potential side effects to cause chronic cough.

Treatment

The treatment of cough is determined by the cause. However, patients may get symptomatic relief from the counter cough medicines.

Asthma; inhaled bronchodilators and inhaled steroids are given to decrease inflammation of the airways. In some cases, short-term oral steroid drugs are prescribed.

In Gastro esophageal reflux disease; you need to avoid foods that can elicit or increase the reflux and use medications such as cimetidine, ranitidine  to decrease stomach acidity.

Sinus problems and postnasal drip involves use of decongestants such as pseudoephedrine (Sudafed) or antihistamines such as diphenhydramine (Benadryl) that can improve symptoms of post-nasal drip.

Inhaled nasal steroids are effective in the treatment of allergic rhinitis – one of the common causes of cough. Other nasal inhalers like ipratropium bromide (Atrovent) can relieve post nasal drip.

Antibiotics may be prescribed if the cause is found to be a bacterial infection or involvement of the bacterial pathogen at some stage of the illness. For example, bacterial pneumonia or bronchitis can be treated with cephalosporins and azithromycin (Zithromax).

 If the pneumonia is close to the chest wall or inflammation of the surface of the lung, this tends to cause severe pain and you need analgesics to help calm the situation. Cough suppressants are used with caution in this situation because clearing the lung of infected mucus by cough can help clear the infection.

Most bronchitis in adults is from virus infection, so treatment is the same as that of the common cold that include adequate rest, fluids, analgesics, and humidification.

 Dr Joseph Kamugisha is an oncologist at Rwanda Military Hospital, Kanombe

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