COUGH

I have often been asked as to whether cough is good or bad for the person. Cough is a reflex action to clear the airways from mucus and other trapped irritants (like dust ad smoke). In itself, it is distressing, both for the child and their parents and carers, but I consider them beneficial to the body as it helps clearing the chest. It is the cause behind this cough which worries me more. Although most coughs are not serious and self-resolving but serious illnesses may present with a cough. Therefore instead of suppressing the cough using various commercially available cough syrups, it is important to look for the cause behind this cough.

Are there types of cough and could they help understand the problem behind?

Cough can be ‘dry’ which means it is tickly and does not produce any phlegm (sputum). On the other hand, a cough may be ‘wet’ or ‘chesty’ which means phlegm is produced along with cough. Although overlap is common, the rule of thumb is that a wet cough is more to worry about.

Sometimes cough may be associated with a ‘wheeze’ or ‘whistling’ from the chest, on other occasions, the cough may have ‘barking’ nature to it.

The nature of cough, it’s onset, timing, frequency and characteristics, may be helpful to guess the underlying cause.

Most coughs clear up within three weeks and don't require any treatment. For more persistent coughs, it's a good idea to see your GP so they can investigate the cause.

What causes a child to cough?

Almost any problems relating to the nose, throat, voice box, the airways and the lungs themselves can cause a child to cough. Below, I list some common causes for cough.

Common causes of a short-term (acute) cough include:

• An upper respiratory tract infection (URTI) that affects the throat, windpipe or sinuses – examples are a cold, flu, laryngitis, sinusitis or whooping cough
• A lower respiratory tract infection (LRTI) that affects your lungs or lower airways – examples are acute bronchitis or pneumonia
• Bronchiolitis – a mild respiratory tract infection that usually causes cold-like symptoms (rarely breathing and feeding difficulties)
• Croup – this causes a distinctive barking cough and a harsh sound known as stridor when the child breathes in (usually caused by a virus)
• Whooping cough (pertussis) – a serious illness caused by a bacteria with intense, hacking bouts of coughing, vomiting, and a "whoop" sound with each sharp intake of breath after coughing
• An allergy, such as allergic rhinitis or hay fever
• A flare-up of a long-term condition such as asthma or bronchitis
• Inhaled irritants (dust or smoke)
• Rarely, an acute cough may be the first sign of a health condition that causes a persistent cough like cystic fibrosis

Common causes of persistent (chronic) cough include:

• Asthma – this also usually causes other symptoms, such as wheezing, chest tightness and shortness of breath
• An ongoing exposure to an allergen
• Exposure to tobacco smoke
• A long-term respiratory tract infection, such as chronic bronchitis (inflammation of the airways)
• Tuberculosis – a serious infection of the lung
• Bronchiectasis – where the airways of the lungs become abnormally widened
• Postnasal drip – mucus dripping down the throat from the back of the nose, caused by a condition such as rhinitis or sinusitis
• Gastro-oesophageal reflux disease (GORD) – where the throat becomes irritated by leaking stomach acid
• Rarely, a persistent cough can be a symptom of a more serious condition, such as cystic fibrosis or interstitial lung disease (ILD)

When to see a doctor?

Most coughs are trivial and caused by simple viral infections and get better by spontaneously. Mostly, such viral coughs take a week or two to get better.

Red flags that should alert you to take your child to be seen by the doctor include:

• Cough for more than three weeks
• Cough is particularly severe or is getting worse
• Noisy breathing (wheeze and stridor)
• Coughing up blood (haemoptysis) or experience shortness of breath, breathing difficulties or chest pain
• Fever not settling soon
• Night sweats
• Presence of other worrying symptoms, like loss of appetite, unexplained weight loss, a persistent change in your voice, or lumps or swellings in neck

How do you treat cough?

As I had said before, it is more important to treat the cause of cough rather than the cough itself. Mild, short-term coughs does not ned any treatment as they are likely to be due to a viral infection that will get better on its own within a few weeks. Taking rest, drinking plenty of fluids, and taking painkillers such as paracetamol or ibuprofen may be helpful.

Medicines that claim to suppress cough or stop bringing up phlegm are not usually recommended. They may have other side effects. The Medicines and Healthcare products Regulatory Agency (MHRA) recommends that over-the-counter cough and cold medicines shouldn't be given to children under the age of six. Children aged 6 to 12 should only use them on the advice of a doctor or pharmacist.

A homemade remedy containing honey and lemon is likely to be just as useful and safer to take. Honey shouldn't be given to babies under the age of one because of the risk of infant botulism.

If a specific cause is identified, treating the underlying cause is very important and may help in earlier resolution of cough. For example, in asthma attacks, the cough would get better once inhalers to open the airways (bronchodilators) and steroids (to suppress the airway inflammation) are used.

More Information Link

NHS Inform

NHS Choices