Overview
Cough can be productive (wet or “chesty”) or nonproductive (dry or “hacking”). Productive coughs expel secretions from the lower respiratory tract to prevent impairment of ventilation and the lungs’ ability to resist infection. Productive coughs may be effective (secretions expelled easily) or ineffective (secretions present but difficult to expel). A nonproductive cough serves no useful physiologic purpose. Nonproductive coughs are associated with viral infections, atypical bacterial infections, gastroesophageal reflux disease (GERD), cardiac disease, and some medications.
The treatment of cough is symptomatic, with a goal of reducing the number and severity of cough episodes. Cough is a symptom of many acute and chronic diseases; the underlying disorder must be treated to stop the cause of the cough. It is important that self-treatment not delay effective treatment of the underlying disease.
Etiology
- Acute cough (duration <3 weeks) usually is caused by viral upper respiratory tract infection (e.g., the common cold), acute left ventricular failure, or asthma.
- Subacute cough (duration 3–8 weeks) is commonly caused by infection (i.e., postinfectious cough), bacterial sinusitis, or asthma.
- The most common causes of chronic cough (duration >8 weeks) in adult nonsmokers are upper airway cough syndrome (previously known as postnasal drip syndrome), asthma, and GERD.
- In children, cough may be a symptom of (1) aspiration caused by poor coordination of sucking and swallowing or (2) esophageal motility disorders.
- Angiotensin-converting enzyme inhibitors cause dry cough in approximately 20% of treated patients.
- Systemic and ophthalmic beta-adrenergic blockers may cause cough in patients with obstructive airway disease, such as asthma or chronic obstructive pulmonary disease (COPD).
Complications
- Common complications of cough include insomnia, exhaustion, musculoskeletal pain, hoarseness, excessive perspiration, and urinary incontinence.
- Less common complications include cardiac dysrhythmias, syncope, stroke, and rib fractures.
Treatment
General/Nonpharmacologic Treatment Measures
- Nonmedicated lozenges may reduce cough by decreasing throat irritation.
- Cool-mist humidifiers or vaporizers may soothe irritated airways by increasing the amount of moisture in inspired air (and in the case of vaporizers, producing a medicated vapor). However, high humidity may increase the amount of mold, dust mites, minerals, and microorganisms dispersed in the air.
- Raising the head of the bed at night promotes drainage of nasal secretions.
- Less viscous and thus easier-to-expel secretions are formed when a person is well hydrated. Cautious hydration is recommended for patients with lower respiratory tract infections, heart failure, renal failure, and other conditions potentially exacerbated by overhydration.
Pharmacologic Therapy
- Antitussives are the drugs of choice for self-treatment of acute nonproductive cough caused by chemical or mechanical respiratory tract irritation. Antitussives should not be used to treat productive coughs unless the potential benefit outweighs the risk (e.g., coughing is affecting the patient’s sleep). Suppression of productive coughs may lead to retention of lower respiratory tract secretions, increasing the risk of airway obstruction and secondary bacterial infection.
- Codeine is available without a prescription in 33 states. Usual antitussive dosages have low toxicity and little risk of addiction.
- Dextromethorphan is a nonopioid with no analgesic, sedative, respiratory depressant, or addictive properties at usual antitussive doses. It is considered approximately equipotent with codeine.
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- Codeine is available without a prescription in 33 states. Usual antitussive dosages have low toxicity and little risk of addiction.
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