COUGH

Symptom 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.

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WHEN TO CALL YOUR DOCTOR FOR COUGH

Call 911 Now (you may need an ambulance) If:

  • Passed out
  • Severe difficulty breathing (e.g. struggling for each breath, unable to speak)
  • Lips or face are bluish now
  • Wheezing 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 started suddenly after bee sting
  • 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:
    • Have diabetes mellitus or a weakened immune system (e.g. HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy)
    • Are bedridden (e.g. nursing home patient, stroke, chronic illness, recovering from surgery)
  • Increasing ankle swelling

Call Your Doctor Within 24 Hours (between 9am and 4pm) 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
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HOME CARE ADVICE FOR COUGH

  1. Mild Coughs: Use cough drops.
  2. 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.
  3. Cough Suppression Medications: The most common cough suppressant in over the counter cough medications is dextromethorphan. An example is Robitussin DM. Do not try to suppress coughs that produce mucus and phlegm. Dextromethorphan is best used in the late stages of a respiratory infection when the cough is dry and hacking.
  4. Cough Expectorant Medications: To loosen and cough up thick phlegm, try using a cough medication that contains guaifenesin (e.g. plain Robitussin).
  5. 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.
  6. Hydration: Drink plenty of liquids (6-8 glasses of water daily). If the air in your home is dry, use a humidifier
  7. Avoid Tobacco Smoke: Smoking or being exposed to smoke makes coughs much worse.
  8. Fever Relief: 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.
  9. 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.
  10. Call Your Doctor If:
    • Difficulty breathing
    • Cough lasts more than 3 weeks
    • You become worse or develop any of the "Call Your Doctor" symptoms.
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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.

Adult HouseCalls Online. Copyright © 2000-2003 David Thompson, M.D. FACEP

Reviewed 8/2003

Revised 8/2003

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