Cough

=Cough=

What it is
Coughing is a reflex which protects the lungs from the inhalation of irritants and cleans the airways of an excess build-up of secretions and solid particles.

Questions to Ask
Duration of cough: acute or chronic? Nature of cough: productive (chesty) or non-productive (dry), if productive - nature of sputum Onset of cough: morning (post-nasal drip, bronchiectiasis, chronic bronchitis), night (pneumonia or asthma) Are you a smoker?: Smoking history etc. Other symptoms?: wheeze, shortness of breath, chest pain, fever, sinus pain, nasal congestion Medical history/medications: GORD, asthma, heart problems

Causes
Cough may be characterised as: • acute – lasting <3 weeks (viral URTI, allergic rhinitis, acute bacterial sinusitis, exacerbation of COPD) • subacute – lasting 3-8 weeks (respiratory tract infection, bacterial sinusitis, pertussis or asthma) • chronic – lasting >8 weeks (chronic bronchitis due to smoking, post-nasal drip, asthma, GORD)

Drugs: ACEi, beta-blockers

How to Treat
Cough suppressants: dextromethorphan, codeine, pholcodine Expectorants: guaifenesin, ammonium salts and senega Demulcents: glycerine, honey Mucolytic: bromhexine Antihistamines: diphenhydramine, chlorpheniramine, promethazine Decongestants: pseudoephedrine

Other advice
- Attempts should always be made to identify the cause of a persistent cough - Persistent cough in a smoker always requires further investigation because of the risk of malignancy or other serious pathology

Additional Resources
[|PSA cough] [|NPS Case Study: Dry Cough] [|Patient Materials - Troublesome Cough]: has simple wording, good for 'phrasing responses' about coughs and requiring antibiotics