Cough

DEFINITION

Cough is non-productive (dry cough) if there is minimal clear-white or no phlegm (sputum)
Cough is productive (wet cough) if there is yellow, green, or brown phlegm (sputum)

General Information

Cough is a very common symptom. It is the fifth most common reason for visits to physicians.
Smokers may have a chronic cough, especially in the morning.

Why We Cough - A cough has two important functions:

It serves to clear the airways of infection, mucus, foreign bodies, and other irritants.
It protects against aspiration of oral and stomach contents.

Common Causes

Most common cause: postnasal drip syndrome from a cold, from allergic rhinitis, or from sinusitis.
Other common causes: asthma, bronchitis, pneumonia, gastroesophageal reflux, smoking.

See More Appropriate Topic (instead of this one) If

You are coughing because of an ASTHMA ATTACK
You have a COMMON COLD
Any CHEST PAIN
EARACHE is your main concern

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

Passed out (fainted)
Severe difficulty breathing (e.g., struggling for each breath, unable to speak)
Lips or face are blue
Wheezing or coughing started suddenly after medicine, an allergic food or bee sting
Difficulty breathing after exposure to flames, smoke, or fumes

Call Your Doctor Now (night or day) If

You feel weak or very sick
Chest pain (EXCEPTION: mild chest pain lasting only a few seconds that occurs only when coughing)
Difficulty breathing
Wheezing is present
Coughing up blood and more than a few streaks
Fever of 103° F (39.4° C) or higher
Fever of 100.5° F (38.1° C) or higher and you
- Are over 60 years of age OR
- Have diabetes mellitus or a weakened immune system (e.g., HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy) OR
- Are bedridden (e.g., nursing home patient, stroke, chronic illness, recovering from surgery)
Increasing ankle swelling

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

You think you need to be seen
Sinus pain or pressure (around cheekbone or eyes)
Fever present for more than 3 days
Earache is present

Call Your Doctor During Weekday Office Hours If

You have other questions or concerns
Coughing up blood
Coughing has kept you home from school or work for 3 or more days
Nasal discharge lasts more than 10 days
Fever returns after being gone for more than 24 hours
Symptoms of nasal allergy are also present (e.g., itchy eyes, clear nasal discharge, postnasal drip)
Taking an ACE Inhibitor medication (Including: benazepril/LOTENSIN, captopril/CAPOTEN, enalapril/VASOTEC, lisinopril/ZESTRIL)
Exposure to TB (Tuberculosis)
Cough lasts more than three weeks

Self Care at Home If

Cough with no complications and you don't think you need to be seen

HOME CARE ADVICE FOR COUGH

Mild Coughs: Use cough drops.
Cough Medications: In cough and cold medications, there is either a "cough suppressant" to reduce the cough or a "cough expectorant" to thin thick phlegm. Some medications contain both a cough suppressant and an expectorant. Generally, medications containing a cough suppressant should be avoided if you are coughing up phlegm.
Cough Suppression Medications:
- The most common cough suppressant in over-the-counter cough medications is dextromethorphan (DM). An example is Robitussin DM.
- Do not try to suppress coughs that produce mucus and phlegm. Cough suppression medications are best used in the late stages of a respiratory infection when the cough is dry and hacking.
- Read the package instructions thoroughly on all medications that you take.
- Special notes about dextromethorphan. Some recent research suggests that dextromethorphan is no better than placebo at reducing a cough. However, there is no over-the-counter medicine that works better than DM and generally DM has no side effects. It should also be noted that dextromethorphan has become a drug of abuse. This problem has been seen most commonly in adolescents. Overdose symptoms can range from giggling, euphoria, to hallucinations or coma.
Cough Expectorant Medications:
- To loosen and cough up thick phlegm, you can try using a cough medication that contains guaifenesin (e.g., plain Robitussin).
- Breathing in the mist from a steamy shower probably works even better. It moistens and helps loosen up the phlegm.
Coughing Spasms:
- Drink warm fluids. Inhale warm mist (Reason: both relax the airway and loosen up the phlegm).
- Suck on cough drops or hard candy to coat the irritated throat.
Hydration: Drink plenty of liquids (6-8 glasses of water daily). If the air in your home is dry, use a humidifier
Avoid Tobacco Smoke: Smoking or being exposed to smoke makes coughs much worse.
Fever Medication: For fever relief, take acetaminophen every 4-6 hours (Adults 650 mg) OR ibuprofen every 6-8 hours (Adults 400 mg).
- Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
- Do not take acetaminophen if you have liver disease.
- Read the package instructions thoroughly on all medications that you take.
Expected Course: Viral bronchitis causes a cough that lasts 1 to 3 weeks. Sometimes you may cough up lots of phlegm (sputum, mucus). The mucus can normally be white, gray, yellow or green.
Call Your Doctor If:
- Difficulty breathing
- Cough lasts more than 3 weeks
- You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 9/21/2007

Last Revised: 9/21/2007

Content Set: Adult HouseCalls Online