Cough, important in protecting the lungs, is a forceful expiration that can clear the airways of debris and secretions.
It may be voluntary or generated by reflex irritation of the nose, sinus, pharynx, larynx, trachea, bronchi, or bronchioles.
Classification of Cough
It may be classified on the basis of duration
- Productive (with sputum/mucus expectoration)
- Dry ( Very less or no expectoration)
Causes of Cough
May be either a normal physiological reflex or due to an underlying cause. It includes:
- Reactive airway disease
- Gastroesophageal reflux
- Air pollution
- Foreign body
- Angiotensin-converting enzyme inhibitor
- Psychogenic cough
- Psychogenic cough
- A major cause of cough is infection specially respiratory tract infection like common cold, bronchitis, pneumonia, pertussis, or tuberculosis.
- Acute cough i.e. cough less then 3 weeks is usually caused by common cold. It is also called as post infectious cough. This typically is a dry, non-productive that produces no phlegm. Symptoms may include tightness in the chest, and a tickle in the throat. This may often persist for weeks after an illness.
Reactive airway disease
- When our respiratory system reacts to some allergen is termed as reactive airway disease. Asthma is a common cause of chronic cough in adults and children. Coughing may be the only symptom the person has from their asthma, or asthma symptoms may also include wheezing, shortness of breath, and a tight feeling in their chest.
- Chronic bronchitis is defined clinically as a persistent cough that produces sputum (phlegm) and mucus, for at least three months in two consecutive years. It is the chronic inflammation of bronchus due to repeated exposure to some harmful agent often seen in chronic smokers.
- The tobacco smoke causes inflammation, secretion of mucus into the airway, and difficulty clearing that mucus out of the airways. Coughing helps clear those secretions out. May be treated by quitting smoking.
- Cough is not always associated with respiratory tract only it may be because of gastric disorder also like gastroesophageal reflux disease
- This occurs when acidic contents of the stomach come back up into the esophagus. This happens due to weakening or the valve at the lower end of the esophagus.
- Symptoms usually associated with GERD include heartburn, sour taste in the mouth, or a feeling of acid reflux in the chest, although, more than half of the people with cough from GERD don’t have any other symptoms.
- Air pollution is a major leading cause of many illnesses specially of respiratory system.
- Inhaling of tobacco smoke, particulate matter, irritant gases, and dampness in a home cause damage to the tissue.
- The human health effects of poor air quality are far reaching, but principally affect the body’s respiratory system and the cardiovascular system.
- Individual reactions to air pollutants depend on the type of pollutant a person is exposed to, the degree of exposure, the individual’s health status and genetics.
As we know cough is a protecting mechanism of the body to clear out the airways. A foreign body can sometimes be suspected, for example if the cough started suddenly when the patient was eating. Rarely cough can be triggered by dryness from mouth breathing or recurrent aspiration of food into the windpipe in people with swallowing difficulties.
Angiotensin-converting enzyme inhibitor
- Angiotensin II is formed from angiotensin I in the blood by the enzyme angiotensin converting enzyme (ACE). Angiotensin II is a very potent chemical produced by the body that primarily circulates in the blood. It causes the muscles surrounding blood vessels to contract, thereby narrowing the vessels. The narrowing of the vessels increases the pressure within the vessels causing increases in blood pressure.
- Angiotensin-converting enzyme (ACE) inhibitors are drugs used in diabetics, heart disease, and high blood pressure. In 10-25% of the people who take it, it can cause them to have a cough as a side effect. Cessation of ACE Inhibitor use is the only way to stop the cough.
- Such medicines for hypertension are very common in use such as ramipril and quinapril. There are cases of “cough of unknown origin” who had resolution with stopping the drug.
A psychogenic cough, “habit ” or “tic cough” may be the cause in the absence of a physical problem. However, other illnesses have to be ruled out before a firm diagnosis of psychogenic cough is made. Psychogenic cough is thought to be more common in children than in adults.
Some cases of chronic cough may be attributed to a sensory neuropathic disorder.
Diagnosis of Cough
The complete respiratory history includes onset, duration, and frequency of respiratory symptoms (cough, noisy breathing, work of breathing/exercise tolerance, nasal congestion, sputum production), swallowing function (especially in infants), and exposure to others with respiratory illness.
It is important to obtain information concerning the severity (hospitalizations, emergency department visits, missed school days) and pattern (acute, chronic, or intermittent) of symptoms. For infants, a feeding history should be obtained, including questions of coughing or choking with feeds. Family history should include questions about asthma and atopy, immune deficiencies. The environmental history queries exposure to smoke, pets, and pollutants. Travel history may also be relevant.
- Acute cough generally is associated with respiratory infections or irritant exposure (smoke) and subsides as the infection resolves or the exposure is eliminated.
- The characteristics of the coughs and the circumstances under which the it occurs help in determining the cause. Sudden onset after a choking episode suggests foreign body aspiration.
- Morning attacks may be due to the accumulation of excessive secretions during the night from sinusitis, allergic rhinitis, or bronchial infection. Nighttime coughing is a hallmark of asthma and can also be caused by gastroesophageal reflux disease.
- Cough exacerbated by lying flat may be due to postnasal drip, sinusitis, allergic rhinitis, or reflux. Recurrent coughing with exercise is suggestive of exercise-induced asthma/bronchospasm.
- Paroxysmal cough suggests pertussis or foreign body aspiration. A repetitive, staccato cough occurs in chlamydial infections in infants. A harsh, brassy, seal-like cough suggests croup, tracheomalacia, or psychogenic (habit) cough.
- The last, which is most common in teenagers, disappears during sleep. Younger children can develop a throat-clearing habit, which also disappears during sleep.
Cough – Homeopathy Treatment & Homeopathic Remedies
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The homeopathic remedies for constipation given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a homeopathic remedy for cough. To study any of the following remedies in more detail, please visit our Materia Medica section. None of these homeopathic medicine should be taken without professional advice.
- Rumex crispus
- Antimonium tartaricum
- Kali bichromicum
- Sticta pulmonaria
The cough of Phosphorus arises from irritation in the trachea. It is made worse by talking or using the voice; in fact, any change in breathing. It is at first dry and tight and then with expectoration of tenacious purulent mucus. It is worse from a change to cold air, the chest feels dry, and the cough sounds and there is a constriction across the upper part of the chest. Continued hoarsensess with a distressing, dry cough. It is also a remedy for stomach or hepatic coughs, anaemic coughs, and in reflex coughs.
This remedy has a dry cough from tickling in the supra-sternal fossa. It is a laryngo-tracheal cough which is teasing and persistent, and is aggravated by cold air. The patient has to cover the head with the bedclothes and breathe warm air for relief. Deep inspiration aggravates it. It suits incessant fatiguing fatiguing coughs, with soreness behind the sternum, and much tough mucus in the larynx which cannot be hawked up. It suits the night coughs of consumptives where there are sharp, stitching pains through the lungs in the early stages.
The cough of Bryonia is generally dry and concussive. It seems to come from the region of the stomach, and is preceded by a tickling in the epigastrium. During the attack the patient holds the sides of the chest with his hands, as the sough not only shakes the chest, but also hurts distant parts of the body. It is induced also by coming from the open air into a warm room and is accompanied by bursting headache. The expectoration is scanty, tough and sometimes bloody.
This remedy suits a hard, barking, ringing, metallic sounding cough, which is worse from deep breathing and excitement, often arousing the patient out of sleep with a suffocative feeling. There is usually no expectoration; it suits, therefore, oftentimes the dry , racking cough of chronic bronchitis. Sambucus. Useful in suffocative coughs of children where there is rough wheezing with great dyspnoea; patient can only breathe with the mouth wide open.
The cough of this remedy is dry, nervous and spasmodic, occurs at night and ceases after sitting up. This is characteristic of the drug; it may compel the patient to sit up, but no relief is obtained. This remedy has a tormenting dry cough, worse lying down, and worse in the evening and at night. Speaking or laughing also aggravates. The irritation is in the trachea or upper bronchi.
This is one of our best remedies in dry and humid coughs following inflammation. It is especially useful in the pre-tubercular stage of phthisis. It is usually a dry cough excited by tickling in the larynx and upper chest. The expectoration is rust colored and the breath may be offensive. Again, it may have a loose cough, but the secretion of mucus is expectorated with great difficulty, here being like Kali bichromicum.
With this remedy the cough sounds loose and the patient feels sure that the next spell will raise the mucus; but it does not, no phlegm is raised. There is drowsiness accompanying the cough and the dyspnoea increases. The characteristic then are the loose cough, the rattling in the chest and the absence of expectoration. It is a convulsive, concussive cough, attended with copious secretion of mucus. It is worse at night and in bed. The expectoration when present is either lemon-yellow or blood streaked. As with Antimonium tartaricum, the chest seems full of mucus, but does not yield to coughing.
This remedy has a constant metallic barking and its great characteristic is the presence of a thick tenacious mucus, which is exceedingly difficult to expectorate. It corresponds well to coughs following measles and to wearisome morning coughs where there is the difficult expectoration. These symptoms distinguish the remedy, together with its amelioration at night in bed.
It is indicated in harsh, racking, incessant, “unprofitable ” coughs of spasmodic type. It is particularly adapted to neurotic, rheumatic, and gouty individuals. It is more valuable in sub-acute and chronic cases. It is most suitable to old age. It allays irritation, soothes irritable tissues, removes hyper-sensitive conditions of the respiratory mucous membrane and promotes sleep.
Lachesis has dry, spasmodic, in suffocative fits, tickling at night. There is but little secretion and much sensitiveness, worse from pressure on the larynx, after sleep and in the open air. The mucus cannot be brought up it will stick there. Useful in the harassing coughs accompanying organic diseases of the heart.
Davidson s Essentials of Medicine 2nd Edition
Hall – Guyton and Hall Textbook of Medical Physiology 13th Edition 2016