Tuesday, December 20, 2016

Symptomatic variations in cough

Hey Awesomites!

Cough is a common symptom that may be associated with an infection of upper respiratory tract, which if not given attention to can progress to a life- threatening chronic disease! Normally, its just a common reflex that helps clear mucus off from the throat and the upper airways. But there are certain variations in the presence and progression of cough. So what is your cough trying to tell you about your health? Let's know about this...

1. Dry cough- Dry cough is probably a VIRUS affecting the upper respiratory tract. The viral particles act on certain receptors in our bronchial airways which stimulate the cough reflex, forcing us to expel the virus so others can catch it. (22% chance).
The vulnerables in this case are those who are taking steroids, chemotherapy treatment, and antibiotics.
A previous antibiotic treatment wipes out the protective bacteria in our throat, bowel, bladder and skin as well as the pathogenic ones prescribed for.
Solution for dry cough- Rest, fluids and patience (most cases last for a few weeks)

2. Persistent tickly cough- It is a common side effect of ACE inhibitors (Ramipril and Lisinopril). It is better to take alternative drugs (Angiotensin receptor blockers, ARBs).

3. Hacking productive cough- suggestive of acute chest infection (bronchitis):
- yellow/ green phlegm (viscid mucus)
- soreness (pain or discomfort in throat)
- tightness
     The vulnerable groups in this case are old aged (>65 years),  pregnant women and those with chronic diseases.
Treatment:-
- NSAIDs like paracetamol or ibuprofen for the symptoms of cold.
Fluids such as honey and lemon juice in hot water.
- Antibiotics therapy for 8 weeks.

4. Paroxysmal cough with a deep breath at the end- suggestive of whooping cough (pertussis) :
- Spasmodic cough with a forced gasp at the end after 10 days of normal cough.
- There is often thick mucus or cough that can cause vomiting. 
- The vaccinations like DPT at proper intervals according to the national immunization schedule must be injected in childhood to prevent such infection that usually peaks in winters.  Also, there is increased risk during pregancy.
Treatment:-
- Rest and fluids
- Antibiotics ( Azithromycin, Clarithromycin, erythromycin and sulfamethoxazole) 

5. Cough with runny nose- suggestive of seasonal rhinitis ( due to increase in dust mites)
- Allergies (in winters): resistant/ persistant symptoms of upper airways.
- Excess phlegm goes down to the back of throat that may trigger cough reflex.
Treatment:
       - Antihistamines (preferably second generations)
       - Nasonex (mometasone): on prescription- only.
       - Allergy testing to reveal the trigger.

6. Blood in phlegm- coughing up of blood (hemoptysis) is suggestive of acute bronchitis, though the most common cause is Ca lung.
The expectorate of blood is due to broken capillaries from the airways or from nasal passage.
☆ Rusty colored blood is suggestive of an episode of Tuberculosis.
Other causes-  CAT iN PUB
                    - Congestive heart failure (especially due to mitral stenosis)
                    - Autoimmune disorders (Wegener's granulomatosis, microscopic polyangiitis, churg- strauss syndrome)
                    - Trauma (gunshot wound or motor vehicle accident)
                    - pNeumonia
                    - Pulmonary embolism
                    - Use of blood thinners
                    - Bronchiectasis

Also, severe hematemesis can be the cause of hemoptysis too. (Excess vomiting of blood from the stomach may lead to drainage of blood into the trachea.)

Treatment:- ABCDE
Antibiotics (for pneumonia and TB)
Bronchial artery embolization (BAE)
Chemotherapy (for Ca lung)
Drugs (steroids- for inflammatory conditions)
Exposure to radiations

7. Hacking cough with high fever, rigors and breathlessness- suggestive of pneumonial infection  with symptoms of cold, breathlesness. fever, rapid breathing, and pain in the chest.
Inflammation of lung tissue may spread to other organs via blood and cause life- threatening sepsis. (often viral infections)

Treatment: Antibiotics, rest and fluids for a few months, pneumococcal vaccination.

8. Hacking cough, fever and pain on breathing in- suggestive of infection in periphery of the lung affecting a particular part or lobe of lung. The pain is worse on inspiration. Pulmonary embolism (a blood clot in the lung) may also lead to pleurisy.

Treatment- NSAIDs like Ibuprofen may help in reducing pain and inflammatory processes in the lung. Also, lie down on the side that hurts to reduce pain.

9. Persistent cough with breathlessness and recurrent chest infections- suggestive of Chronic Obstructive Pulmonary Disease triggered by active or passive smoking. Diagnosis is often late and presents in old age. also called "Smoker's cough".
Treatment: The aim is to improve the symptoms.
- Stop smoking and start physical activity even if breathlessness prevails to slow down the progression of the disease.
- Bronchodilators and steroids are a must to reduce inflammation and open airways.
- Inject flu vaccine every year.
- Surgery using a fibre optic camera to place valves into the airways.

10. Productive cough that goes on and on and on... suggestive of bronchiectasis: due to repeated chest infections and weakened immune system.
Treatment- specific chest physiotherapy techniques and aggressive antibiotic therapy.

11. Lingering cough (more than 3 weeks)

Thats all

- Jaskunwar Singh

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