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Health Matters
By Virginia Lester, RN, MSN, ARNP

We all cough from time to time. A cough can signal a health condition that may be serious. On the other hand, a cough once in a while is normal and healthy because it helps to clear mucus and other substances from our airways. It is the cough that hangs on for three or more weeks that is of concern and should be taken seriously. 

 According to the most recent guidelines from the American College of Chest Physicians, a cough can be divided into three categories based upon duration:

• Acute cough, lasting less than three weeks.
• Subacute cough, lasting between three and eight weeks.
• Chronic cough, lasting more than eight weeks.

The acute cough usually accompanies other acute illness symptoms such as viral upper respiratory infections, “the common cold.”

Symptoms are usually self-limiting and often do not require therapy.
Although chronic cough is usually not serious, it can be associated with a variety of unpleasant effects, including physical exhaustion, self consciousness, insomnia, headache, dizziness, muscle strain, hoarseness, excessive perspiration and leakage of urine during coughing. Additionally, a chronic cough is a cause of worry that something more serious is wrong. In most cases, more than 95 percent, the underlying cause can be identified and successfully treated.
 The most common causes of chronic cough are postnasal drip (also called upper airway cough syndrome), asthma or cough variant asthma, and gastroeophageal reflux disease (GERD).

Upper airway cough syndrome has several different causes: Allergic and non-allergic rhinitis (postnasal drip), acute tonsillitis and sinusitis. Secretions from the nose chronically drip into the back of the throat, causing inflammation, thus triggering a cough. Identifying and treating any allergic cause or infection should be the first step in treatment. The allergic cough can most often be managed with an antihistamine-decongestant that can be purchased over the counter. If symptoms do not begin to subside within one week, your health care provider should be contacted to determine if an antibiotic or other prescription medication will be necessary.

The asthmatic cough generally requires medical evaluation and the use of several prescriptions medications.

The cough due to GERD generally responds to several life style changes and possible medication. 

• Avoid foods that cause “heartburn” such as fatty foods, chocolate and excessive alcohol.
• Stop smoking.
• Eat three meals per day and eliminate snacking.
• Avoid meals at least two hours before going to bed.
• Elevate the head of the bed (either on blocks or with the aid of a wedge pillow).
• Add prescription medication as needed.

Other causes of cough, approximately 5 percent of cases, are caused by respiratory infections, medications, bronchitis, eosinophilic (allergic/inflammatory) bronchitis and lung cancer. A chronic cough should not be ignored. The cause needs to be identified and appropriate treatment followed. If you have concerns, please do not hesitate to come in to the clinic for an evaluation.