Cough is a protective reflex mechanism, which removes foreign material and secretions from the respiratory tract. It can be caused by external stimuli such as foreign materials, dust particles, gases, sudden changes in temperature, but the most common cause is the accumulation of secretions in the bronchi due to inflammatory or allergic processes. It is important to emphasize that the cough is not a disease but a symptom of respiratory diseases.

Types of coughs

Coughing is a useful mechanism if it performs its function. In this case we say that it is productive and we strive to make it easier. On the contrary, if it is dry, non-productive, and exhausts the patient, we try to prevent it, or turn it into being useful. Dry and inflammatory cough is the most common in the beginning and it occurs due to mucosal inflammation .After a few days, due to the increased secretion of mucus, it turns into productive cough which ejects secretion.

In terms of duration, cough can be acute (if it lasts less than three weeks), sub acute (if it lasts between 3 and 8 weeks), and chronic (if it lasts longer than 8 weeks).
Types of coughs are: laryngeal(a cough from the throat), tracheal(a cough from the trachea), cough caused by bronchitis, cough caused by asthma, cough caused by food, cough that contains traces of blood, cough caused by abscess and bronchitis (enlargement of the bronchi), cough caused by heart diseases, cough caused by lung fibrosis, and smoker's cough.

Causes of coughs

• Viral respiratory infections (cold, flu, and other viral infections)
• bacterial respiratory infection(treated with antibiotics, unlike viral infections)
• allergic reactions to pollen, dust, dust mites, etc.
• cough as a result of the primary disease(asthma, COPD - Chronic Obstructive Pulmonary Disease),
• -lung cancer, tumors of the respiratory tract, heart failure, the presence of foreign bodies in The bronchi
• neurological disorders, GERD (the return of stomach acid into the esophagus and mouth), etc.; Treatment is directed to the primary disease and thus solves the problem of cough)
• smoking(cigarette smoke destroys the cells lining the airways, reducing the removal of secretions which results into a chronic cough; the same applies to passive smoking)
• irritants in the environment(gases, sudden changes in temperature, humidity, etc.)
• Medications (e.g., antihypertensive that belong to the category of ACE inhibitors, whichcause a lasting and dry cough)

Treatment of cough

Treatment of cough regularly is symptomatic. Therefore, it is necessary to try to find its cause and remove it if possible. As it is already stated, if the cough is the consequence of the primary disease, then the treatment focuses on the primary disease, and thus solves the problem of coughing. In case where cough is the result of mucosal inflammation of the respiratory system, it must be determined whether it is caused by bacterial infection, cold or viral infection. The appearance of sputum can also help in the diagnosis. Yellowish or greenish color is usually a sign of bacterial infection, especially if the disease is accompanied by fever. In this case, it is recommended to use antibiotics that are prescribed by a doctor. Symptomatic therapy is used instead of antibiotics when the cough is dry and irritating, and the secretion is translucent. The first step in choosing a remedy for cough is to determine whether the cough is productive, accompanied by sputum or dry and non-productive. If the cough is dry, it exhausts the patient and therefore must be prevented or made useful and productive. Assets used in the treatment of dry cough are called antitussives. They reduce the cough reflex locally (lining the mucous membranes and protecting the airway from irritation –marshmallow root, marshmallow leaf, mallow flower, plantain leaf) or centrally, acting on the center of the cough in medulla oblongata (pholcodine, butamirate, dextromethorphan). Central antitussives are usually given in case of aggressive attacks that disrupt patient’s daily life and sleep. It is not recommended to use them in case of the presence of secretions in the airways, due to the possibility of development of obstructions or complications (pneumonia, respiratory insufficiency) .Expectorants are drugs used for reducing the viscosity of secretions and helping their expectoration, or to increase the secretion of the mucous membrane if the cough is dry and non-productive in order to improve its natural protection (bromhexine, acetylcysteine, carbocysteine). A good body hydration, accomplished by taking the increased amount of fluid – 3 to 4 liters per day, is the best expectorant activity. Demulcents, in the form of pellets that create a protective layer in the throat, are best used in case of laryngeal cough, and they prevent a reflex cough as well. Antihistamines and inhaled corticosteroids are used in case of allergic inflammation of the lining of the respiratory system. Asthma is treated with the combination of antihistamines, inhaled corticosteroids and bronchodilator (used for widening of the bronchi).

When is it necessary to seek medical advice?

• if cough lasts longer than seven days, with no signs of improvement
• if it is accompanied simultaneously by fever, sore throat, ear pain or chest pain
• if it is accompanied by thick purulent sputum, or there are traces of blood in sputum
• if it is accompanied by sever general condition or fever for more than three days, fatigue, shortness of breath, decreased appetite and weight loss
• if it is persistent during the night
• if it is a symptom of respiratory diseases(influenza, pneumonia) or symptom of the worsening of chronic lung disease(COPD, asthma)

Particular attention should be paid to conditions in young children, lung patients, smokers, and people with heart failure.

Before using any preparation or medication to relieve cough, feel free to contact your pharmacist for advice!

Preparations used to relieve cold and cough made by Galen laboratory