RESPIRATORY DISORDERS – Cough
Cough (the barking sound of man) is a common problem that everyone often faces. Cough is a natural reflex expulsive defence mechanism of the body, for clearing excess secretions or mucous or inhaled irritants or toxins or foreign substance in the respiratory tract. Coughing protects the respiratory system by clearing or cleaning it voluntarily or involuntarily. As long as cough is helpful in getting rid of infectious material with the help of mucous from the airway, it should not be stopped. It is very important to remember that cough usually manifests in common cold, but it may be the initial manifestation of serious illness such as pulmonary hypertension, pneumonia, tuberculosis, heart failure or asthma.
Mechanism of cough
Normally, cough is an involuntary reflex, which is controlled by a complex interaction of nerve fibres. There are a lot of receptor sites situated in the nose, nasopharynx, larynx, auditory canal, trachea, pulmonary bronchus and pleura. They report about the excess mucous or foreign substance to the cough center which is located in the medulla of the brain for inducing cough. Receptors are sensitive to
- Touch of inhaled foreign body
- Excessive secretions or mucous in nose, throat, sinuses and lungs
- Irritant gases like nitric acid, sulphuric acid, ammonia
- Oedema or infection with pus in the airway
- Exposure to extreme hot or cold air
Usually, cough begins with a deep inspiration and closed glottis, which suddenly opens after gaining pressure from contraction of the diaphragm, abdomen muscles and respiratory muscles which compresses the lungs to let the trapped air out of the lungs with force. Hence, with an explosive throw of air, cough occurs. Sometimes, cough speed is measured as more than 100 km/per hour. Normally, people cough voluntarily once or twice during early morning or daytime to clear the throat or lungs, when uncomfortable.
Types of cough – Cough is mainly classified as:
- Productive cough – Also named as an effective cough since it brings secretions or mucous from the lungs. This type of cough is mostly acute in nature and often caused by bacterial or viral or fungal infection. This type of cough should not be suppressed or otherwise recurrent or constant infection will be there, since the purpose of the cough (to remove mucus) is suppressed.
- Non-productive cough – Also named as an ineffective cough since it won’t bring any secretions or mucous from the lungs. It is a dry, irritating cough without phlegm. Mostly, this type of cough is chronic in nature and caused by dry irritation or dust or smoke or fumes, or due to oedema and mild secretion in the resolving stage of illness. It may be also due to weakness of the muscles of respiration, thick viscid mucus and in diseases of the cilia which helps mucous transportation in the airway.
Cough can also be classified as:
- Acute – not more than three weeks’ duration – for example, infective coughs
- Chronic – more than three weeks’ duration – for example, smoker’s cough
- Dry cough – No mucous or secretions &
- Wet cough – with mucous or secretions
- Cough from chest and cough from throat – Productive or non-productive
- Paroxysmal cough – spasmodic and recurrent
- Bovine cough – soundless cough due to paralysis of larynx
- Psychogenic cough – self-conscious activity of the patient to draw attention
Causes of cough
A) Infection – by bacteria, virus (common cold), and fungus (Aspergillus infection)
B) External factors – by dust, cold, pollens, smoking and other environmental irritants. Also by drugs of hypertension and heart diseases (ACE inhibitors, beta blockers). Foreign body when enters pharynx, nose, larynx, trachea, bronchus, oesophagus
C) Internal factors – as diseases get progressive in
Sinuses – Postnasal drip
Heart- Congestive heart failure
Lung – Asthma, chronic bronchitis, cancer, emphysema, bronchiectasis, tuberculosis Pressure on lung due to a mass like mediastinal lymphadenopathy, aneurysm, thyromegaly
Ear – Otitis media, CSOM, impacted cerumen and foreign body
Stomach – Gastro oesophageal reflux
D) Psychogenic factors – habit of clearing mucous, for drawing attention, etc.
Symptoms of cough
Cough itself is a symptom – usually associated with sore throat, hoarseness, nose block, breathlessness, heartburn or chest pain, dizziness, disturbance in sleep, distress on exercise or running, sometimes even for laughing, restlessness, general bodyaches, urinary incontinence, haemoptysis, lack of concentration, stomachache, nausea, vomiting and swollen glands. It produces white/green/yellow/ discoloured or blood-stained phlegm.
Effects of cough -
- The anus will get tightly closed – so it may aggravate piles or fissure in the anus.
- Pressure in abdomen is increased – so hernia may occur in diaphragm or the muscle of the abdomen (umbilical hernia, incision hernia, etc.) or into the scrotal sac
- Due to pressure in chest – air emphysema may develop
- Due to violent cough, bursting type of headache may occur
Diagnosis is very important to cut short the course and spread of the underlying disease. Diagnosis can be made through the type of cough, sputum and presence of haemoptysis, pain, breathlessness, wheezing, etc.
Clinical examination of chest, nasal congestion, throat irritation for any pathology and auscultation of lung is very important to rule out rales, rhonchi, and wheezing
Cough can be diagnosed by knowing a person’s history, and characters of cough, as
Cough in smokers – suspect tobacco-induced bronchitis
Cough in infants – suspect congenital malformations
Cough (recurrent) in children – suspect primary complex
Cough with high-pitched sound in children – suspect whooping cough
Cough while working – suspect occupational environment
Cough at night (or after lying) with breathlessness and wheezing – asthma, heart failure
Sputum also gives a clue to diagnosis with quantity, consistency, colour, odour and thickness. Purulent sputum indicates pneumonia, bronchitis
Blood-stained indicates tuberculosis or pneumonia
Yellow or green sputum with odour indicates the presence of bacterias, leucocytes and pus.
Cough with pain
- Pain in head, face and maxillary tooth is sinusitis
- Burning pain in chest with sour eructation is gastro esophageal reflux
Cough with breathlessness – suspect asthma, bronchogenic carcinoma, heart failure
Cough with swelling (oedema) of legs – suspect congestive heart failure
Cough with heartburn and vomiting of acid substances- suspect gastro oesophageal reflux disease. This complaint often gets aggravated while lying down after a meal.
Cough with postnasal drip – suspect sinusitis
Cough with weight loss- suspect disease like lung cancer, tuberculosis
Cough with stridor (high-pitched respiratory sound) – suspect whooping cough, flabby epiglottis, laryngeal
or tracheal obstruction
Psychogenic cough – the diagnosing point is these patients won’t cough at night.
Investigations – If the cough persists for more than a week, do the following tests.
X-ray of chest – to rule out pneumonia or tuberculosis or pleurisy
Para-nasal sinuses – to rule out sinusitis
Microscopic examination of sputum – can reveal bacteria and white blood cells.
Endoscopy – to rule out oesophageal reflux, hiatus hernia, abdomen disorders, etc.
Bronchoscope and laryngoscopy to rule out pathology in bronchus and larynx
CT or MRI examination of the sinuses, adenoids, lungs and abdomen
Throat swab and culture – to find out infective bacteria
Prevention of cough
Ø Smoking & dust exposure
Ø Working in areas of noxious fumes or polluted air
Ø Cold food items
Ø Contact with infected persons or wear a protective mask
Ø Continuous usage of nasal decongestant sprays and cough syrups
Ø Rest in room with good ventilation
Ø Plenty of fluids – water, juices to dilute mucous for easy expulsion
Ø Frequent light and small meal to reduce vomiting in oesophageal reflux
Ø Steam inhalation to loosen the phlegm
Ø Vitamin C and zinc to shorten the duration of cold or disease
Management must start with diagnosing etiology and elimination. For patients with underlying diseases, treatment should first be based on treating the underlying disease. Usually in Allopathy, they treat Acute infection with antibiotics, anti inflammatory Asthmatic cough with bronchodilators Allergic cough with antihistamines.
Also there are two types of drugs used to treat cough:
Expectorant drugs – used to bring up mucous to clear
secretions from the airways. These medications help to thin bronchial secretions and make them looser and easier to cough up. Steam inhalation also helps make secretions looser and easier to cough up.
Suppressant drugs – if a cough is not useful in clearing the infectious materials in the airways, these drugs are used to suppress the cough. For example, these types of drugs are used in smokers, those with chronic bronchitis, postnasal drip, allergic cough and nose block. These drugs are codeine and narcotics which depresses the brain with adverse effects of drowsiness and nausea. These drugs are useful in dry, hacking cough which disturbs sleep.
Surgery is rarely needed except in extreme cases of pleurisy, bronchiectasis, cancer, etc.
Homeopathic approach – In Homeopathy, we treat patients (symptoms of the patients) and not the disease. Cough is only a symptom. Using inhaler or steroids often will only create dependency. Use of cough syrup as bronchodilators will also often suppress phlegm expulsion.
Cough is natural, protective phenomenon to protect the lung or throat from irritants. It comes to expel the phlegm or substance present in the lungs. If it is shut off temporarily with heavy doses of inhalers, steroids and bronchodilators, then you are barring the natural protection and elimination. So, phlegm will settle to the bottom of the lung and it has to be dehydrated or evaporated in the lung itself. Stopping cough instantly is like adding diseases with suppuration. Hence, there will also be chances of complication or re-infection which may be felt as continuous or repeated attacks of cold.
So, here is the reason for children who take cough syrup and nasal decongestants often or continuously to suffer from the cough and cold without any relief. In such cases, we must stop the cough syrup and treat the conditions.
Homeopathy follows the natural rule and takes effect in elimination of the phlegm and changes the circumstances which favour the production of phlegm. The underlying reason for any cough should be diagnosed first, followed by curing it permanently as Homeopathy does.
In Homeopathy, medicines are usually selected with the mode of onset and character of the disease, existing cause, allergies, thirst, sweat, shivering, mental restlessness, characteristic symptoms of patient, appetite, sleep and stool habit, etc, also with aggravating factors like time, period, how – while climbing stairs, at rest, at night or morning, change of temperature, humidity and altitude, smoking, fumes or irritants.
Some of the common medicines often used in complaints of cough are Aconite, Ars Alb, Ars iod, Anti-tart, Belladonna, Bryonia, Corallium, Rhus tox, Pulsatilla, Hepar sulph, Kali bich, Kali-mur, Senega, Silicea, Nat-sulph, Nux vom etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.
Dr. S. Chidambaranathan, BHMS, MD (Homeo)
24 E. New Mahalipatti Road
Tel: +91-452-233-8833 | +91-984-319-1011 (Mob)
(Disclaimer - The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)