CLEAR YOUR COUGH, BREATHE EASY AGAIN:

Cough is a frequent cause for a patient to visit a doctor. Though it is often self limiting and harmless sometimes, it can be distressing and might be due to a serious lung disease for which a pulmonologist or a lung specialist is consulted.

CATEGORIES OF COUGH:

Depending on the time of onset of cough, it can be divided into three categories.

1. Acute cough: when cough lasts for less than three weeks. example: common cold, flu.

2. Sub acute cough: Cough lasting for three to eight weeks .

3. Chronic cough: Cough lasting for more than eight weeks.

A PULMONOLOGIST should be consulted if cough is associated with some symptoms which are called 'RED FLAGS IN A COUGH'.

1. Coughing up blood.

2. Associated with difficulty in breathing.

3. Associated with chest pain.

4. Associated with wheeze or noisy breathing.

5. Associated with ankle swelling, fever, weight loss, night sweats.

6. Any cough lasting for more than eight weeks.

KNOW ABOUT THE CAUSES OF COUGH:

The cause can be anything as simple as WAX IN THE EAR or as serious as PNEUMONIA or LUNG CANCER.

Common causes are:

1. Post nasal drip or upper airway cough syndrome (PNDS /UACS): It is due to secretions pooling at back of throat causing a sensation of liquid dripping into throat. It is caused by acute or chronic sinus problem or allergies.

2. Asthma: Asthma can sometimes present as cough as the only symptom. It is called as Cough Variant Asthma. It typically gets worse with exercise, cold air, exposure to fumes etc.

3. Chronic bronchitis or COPD is common in smokers or those exposed to biomass fuel or air pollution.

4. Infections like ' Viral / Bacterial pneumonia or TB can cause persistent cough.

5. Post infectious cough: Respiratory infections, especially Viral, can cause persistent cough which may take weeks or months to resolve.

6. Lung Cancer: Seen in high risk individuals like smokers, elderly, persons exposed to radiation.

7. GERD: Gastroesophageal reflex due to lax sphincter muscle in lower foregut (esophagus) may cause cough which gets worse after meals.

8. Interstitial lung diseases(ILD), Bronchiectasis, Aspired foreign body into airways (nuts and seeds) , use of certain drugs for high blood pressure or heart disease can also cause persistent cough .

A PULMONOLOGIST'S Approach to a case of persistent cough includes:

1.Full history including time of onset, triggers, medications ,risk factors like peptic ulcer disease, smoking and allergies.

2. After clinical examination the tests required by pulmonologist may include:

   Chest X ray

   Spirometry (a lung function test)

   Sputum test or Allergy tests

   Occasionally Chest CT scan, Bronchoscopy (Rigid or Flexible) may be considered.

MANAGEMENT :

Post Nasal Drip Syndrome( PNDS): Nasal decongestant sprays, anti allergic medicines, antibiotics, saline rinses.

Asthma, COPD:

Inhaler therapy , Nebulisation Therapy (Broncho dilators, steroids) , Smoking cessation, Avoidance of allergens.

GERD:

High dose proton pump inhibitors avoiding caffeine, fatty foods, chocolates, alcohol, smoking and weight loss if overweight.

Infections like Pneumonia /TB : Antibiotic course, Oxygen therapy if necessary, IV fluids under Pulmonologists supervision and Anti Tuberculous Treatment (ATT) in TB cases.

"DON'T NEGLECT LINGERING COUGH - BE ALERT FOR ANY RED FLAG SIGNS"