Coughs

What are the symptoms of this condition?

Although the symptoms of a cough appear quite straightforward, coughs can be divided into two main types: a chesty or productive cough; or a dry, unproductive cough. These will be explained in more detail in the next section. Briefly, the productive cough results from an accumulation of phlegm in the lungs, the cough being a response to clear the phlegm from the lungs. Dry coughs are not associated with excess phlegm; it is irritation or inflammation inside the air passages that triggers the cough reflex.

What is the cause of the condition?

Coughs are usually associated with viral infections in the airways (nose, throat, windpipe and lungs), including colds.

Productive cough
Air breathed in through the nose and mouth is transported down the windpipe and deep into the lungs through a dense network of tubes. The tubes branch repeatedly, becoming smaller and smaller, until finally they terminate in tiny air sacs called 'alveoli'. It is in the alveoli that oxygen is transferred into the bloodstream and the waste gas, carbon dioxide, removed. This process is repeated each time that you breathe.

Lining the whole system, including the alveoli, is a clear sticky mucus. This helps to lubricate and protect the inner surfaces of the lungs. The quantity of mucus being released into the lungs and airways depends in part on the presence of irritants such as viruses, bacteria or dust.

This is an efficient system, as long as the air passages and alveoli remain free from blockages. However, if the lungs are irritated in some way, perhaps through infection or inflammation, then the breathing tubes can become swollen and the quantity of mucus being produced can rise dramatically. The mucus collects in the lower air passages and alveoli preventing the efficient transfer of oxygen and carbon dioxide. To restore the efficient functioning of the lungs, the surplus mucus must be removed.

Coughing is the body's means of removing this unwanted material from the lungs. Coughs are triggered automatically by the build-up of fluid and mucus deep inside the lungs. When the cough takes place this material is forcibly expelled, clearing the air sacs and improving breathing.

Dry coughs
A cough occurring without the mucus production is a dry cough. The cough reflex here is triggered by inflammation in the air passages and the lungs, although there are some prescription medicines which can cause a dry cough as a side effect. Also, a persistent cough which is resistant to treatment may be a sign of asthma - contact our pharmacist for more advice if you are in doubt.

Since there is no excess phlegm to clear from the lungs, a different method of treatment can be employed. While productive coughs are generally to be encouraged, because they are removing phlegm, dry coughs can be managed by cough suppressants which reduce the urge to cough.

What complications might occur?

Coughs can sometimes be an indicator of a more serious condition. The following are signs to watch out for:

Coloured sputum or mucus, being coughed up from the lungs
If the sputum is coloured yellow or green (rather than the usual clear) it may be due to a bacterial infection such as bronchitis, and an examination by your doctor is required to see if antibiotics are required. If an infection is diagnosed, you may be prescribed simple antibiotics such as amoxycillin or erythromycin, unless you have a history of infections or other medical conditions.

Blood, or blood staining, in the sputum
This may not be a problem but can sometimes indicate a more serious underlying condition. If you do notice any blood you should report this to your doctor without delay.

Duration
If the cough is not improving after one or two weeks, you should obtain advice from the Pharmacy2U pharmacist or your own doctor. Persistent coughs that don't respond to treatment may require a different approach to their treatment.

Severity of symptoms
If a cough is due to a viral infection, you may feel particularly miserable with fever, headache and associated symptoms. However, if associated with chest pain, breathlessness or wheezing, a doctor's assistance should be sought. In children, worrying symptoms such as wheezes and whooping need urgent medical attention.

Concurrent disease
If you suffer from a pre-existing illness in addition to the cough then you should seek advice from the pharmacist before purchasing any products. Some cough medications can interact with other drugs designed to treat, for example, heart disease, asthma, or glaucoma and so need to be used with care.

What can I do to treat myself?

The key to self-treatment with conditions of this kind is to rest and take plenty of fluids. Resting allows the body's natural defences to concentrate on fighting the infection. Increasing your fluid intake, if you have a productive cough, helps to keep the phlegm watery and easier to cough up.

Try to avoid conditions which might irritate the cough. For example, if you are a smoker this will make you more likely to suffer from persistent coughs, and provides another good reason to give up smoking - ask our pharmacist for more advice. Cigarette smoke is very irritant to the lining of the lungs and the presence of an infection or inflammation will only make this worse.

It would also make sense to avoid atmospheres which are very dry or dusty. Dust or other particles in the air may aggravate the cough, and very dry air will make any inflammation in the air passages worse.

You can also treat yourself with a variety of medications designed to ease the symptoms and severity of the cough. These are described in detail in the next section.

What treatments are available for me to purchase?

Pharmacy2U can provide a wide range of medications suitable for treating coughs. Cough remedies fall into three types: Soothing remedies Most cough mixtures contain a glucose syrup base which will soothe inflamed membranes. An example is Veno's Dry Cough Mixture. These soothing preparations are safe to take for most people; diabetics should seek the advice of the Pharmacy2U pharmacist or their family doctor advice before taking any medicine containing a sugar base, as there is likely to be a suitable alternative.

Cough suppressants
These are drugs which suppress the cough reflex and so help to quickly and effectively reduce the coughing. They are suitable to treat dry coughs, but not productive coughs. The main two cough ingredients found in non-prescription medicines are pholcodine and dextromethorphan - products include: Benylin Dry Cough Non-drowsy and Robitussin Dry Cough.

To view the full range of Pharmacy2U dry cough treatments, click here.

Expectorants
These are designed to increase the fluidity of the mucus thus helping the body to clear it when coughing. Common expectorants are guaiphenesin and ipecacuanha, and are included in products such as: Benylin Chesty Cough Non-drowsy and Sudafed Expectorant.

To view the full range of Pharmacy2U chesty cough treatments click here.

Other Ingredients
Many cough preparations contain other ingredients. These include:

Decongestants - such as pseudoephedrine, which may help to open the airways and reduce the amount of mucus. Please read the product details carefully, or consult the Pharmacy2U pharmacist, as these products may not be suitable if you suffer from certain medical conditions, or take certain medicines from the doctor. Products containing pseudoephedrine include the Sudafed and Actifed range of medicines.

Sedating antihistamines - such as diphenhydramine, which may aid sleep if taken at bedtime; these cause drowsiness and should not be taken if you are to be driving or performing skilled tasks. An example of a product containing a sedating antihistamine is Benylin Original.

What treatments are available from my doctor?

If the cough fails to respond to the remedies suggested above, or is worsening, you should consult your doctor. He or she may prescribe antibiotics, if they are appropriate. For a simple cough there are no stronger expectorants nor cough suppressants available on prescription than those which can be purchased over the counter.

What additional investigations might be needed?

A persistent cough that does not respond to treatment or which worsens over time needs investigating. There may be a more serious underlying condition causing the cough, or an infection in the lungs. A sample of any phlegm being coughed up may be requested for laboratory analysis and a chest X-ray may be needed as well.

Any other information I should have?

Although troublesome at the time, most coughs will respond well to simple self-treatment with the products described above. Generally these are safe products to use and will not cause significant problems, although some ingredients commonly found in cough remedies can interact with some medical conditions and prescription medicines; if you have any doubts about the choice of product then please consult the Pharmacy2U pharmacist.