Cough- When to Worry, What to Do

Cough- When to Worry, What to Do

Cough is one of the most agonizing experiences a healthy person can have.

More than runny nose or itchy eyes, a cough really causes a lot of suffering.

The sound is irritating, and coughing whenever you breathe is exhausting, robs you of sleep, and hurts.

Also, cough, more than most problems, can keep happening.  Some people can cough every day for months and months.  But even a few weeks of coughing is enough to create tremendous discomfort. 

And yet, cough is one of the most common experiences of humanity.  Everyone coughs at some time in their life.

Here we have a problem that everyone experiences, literally everyone, so how can a parent tell if there child's cough is different from what we all see come and go without any harm done.

So what is a cough, when is it a problem, what helps?

What is a Cough?

A cough is a sharp exhalation, really an explosion of air out of the chest.

Coughs occur always in response to an irritation in the airway, and typically an irritation somewhere in the throat, vocal cord area, and/or lungs.

There are only a small number of causes of the irritations that cause us to cough:

• Viral infection (tend to last no more than a few days or weeks)
• Bacterial infection (tend to make one rapidly ill with high fever and getting sicker every hour or day)
• Allergy (may go on with no change in intensity for months)
• Irritation (such as smoke)

So coughs can cause a great deal of suffering, and last for many weeks and months, but the number of types of causes of cough is actually fairly small.

When to Worry?

Most of us get worried about a cough if it sounds bad, lasts too long, or is bothersome.
One would think these are good signs to watch for, but it turns out that these clues tend not to help figure out if you are in trouble.

Keeping in mind that a cough almost always is a sign that the lining of the airway is inflamed, the key thing to worry about with a cough is if it indicates that the inflammation is serious enough to interfere with air coming in and out of the body.

Here is another way to think about this.   The air moves in and out of our body via a set of hollow tubes.  Every one of those tubes has a living lining.  That lining often gets inflamed, meaning it can get swollen, make lots of mucus, and get very tender.  If the lining of a tube gets swollen and makes mucus, the whole tube gets more narrow.  If the tube gets narrow enough, air does not pass in and out of the tube very well.

So, a cough is a clear sign that the tubes that carry air in the body are inflamed.  So now the key question becomes: how inflamed are the tubes?  Are they inflamed enough to interfere with air flow or not?  If so, then we have a serious problem, a potentially dangerous problem.  If not, then the cough is a sign of an inflammation that is harmless and will go away.

This leads us to the key signs that someone with a cough is of concern:

• Most Important:  Do you have any trouble breathing when not coughing?
• The best indicators of trouble breathing are:
• breathing rapidly
• tugging or working hard to get air in or out of the chest (not nose)
• skin on the chest tightening with each breath
• grunting with breaths
• if the child says they are having trouble getting air in and out of the chest

If none of these symptoms are present, and your child looks very comfortable breathing when not coughing, then the tubes carrying the air are likely not too swollen, and the inflammation is very likely mild and harmless.

If ANY of these symptoms are present, you should call for medical attention.

How to Get Rid of Cough?

The next question when it comes to cough is how to get rid of it.

That all depends on the cause:

• Bacterial infections are best treated with antibiotics, and antibiotics are only helpful for this cause.
• Allergic reactions are best treated with antihistamines and inhaled steroids
• Irritations are best treated by removing the irritation.
• Viral infections are incredibly resistant to all known drugs.  There are no drugs yet invented that can significantly reduce the inflammation caused by viruses.  This includes cough syrups.  No cough syrup has yet been shown to decrease the number of coughs one has per hour or days one coughs.   In fact, the FDA launched an investigation of over 500 cold remedies in March of 2011 with an eye towards exposing which  are frankly ineffective and/or fraudulent.

Bottom Line

• Cough means the airways are inflamed.
• The causes are usually one of four causes
• The best indicator that a cough is worrisome is how you are breathing when not coughing.
• The cough itself can be quite agonizing even if the underlying condition is harmless
• Coughs caused by viruses (colds, flus) cannot be stopped by any known medication, including cough syrups and antibiotics.
• If you think your child is having any trouble breathing, getting air in and out of their chest, call for medical help immediately

Dr. Arthur Lavin

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