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Cough
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Definition

Cough is non-productive (dry cough) if there is minimal clear-white or no phlegm (sputum)
Cough is productive (wet cough) if there is yellow, green, or brown phlegm (sputum)

General Information

Cough is a very common symptom. It is the fifth most common reason for visits to physicians.
Smokers may have a chronic cough, especially in the morning.

Why We Cough - A cough has two important functions:

It serves to clear the airways of infection, mucus, foreign bodies, and other irritants.
It protects against aspiration of oral and stomach contents.

Common Causes

Most common cause: postnasal drip syndrome from a cold, from allergic rhinitis, or from sinusitis.
Other common causes: asthma, bronchitis, pneumonia, gastroesophageal reflux, smoking.

If not, see these topics

You are coughing because of an ASTHMA ATTACK
You have a COMMON COLD
Any CHEST PAIN
EARACHE is your main concern

Should I
Call?

Care at
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When to Call Your Doctor

	Call 911 Now (you may need an ambulance) If
	Passed out (fainted) Severe difficulty breathing (e.g., struggling for each breath, unable to speak) Lips or face are blue Wheezing or coughing started suddenly after medicine, an allergic food or bee sting Difficulty breathing after exposure to flames, smoke, or fumes
	Call Your Doctor Now (night or day) If
	You feel weak or very sick Chest pain (EXCEPTION: mild chest pain lasting only a few seconds that occurs only when coughing) Difficulty breathing Wheezing is present Coughing up blood and more than a few streaks Fever of 103Â° F (39.4Â° C) or higher Fever of 100.5Â° F (38.1Â° C) or higher and you Are over 60 years of age OR Have diabetes mellitus or a weakened immune system (e.g., HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy) OR Are bedridden (e.g., nursing home patient, stroke, chronic illness, recovering from surgery) Increasing ankle swelling
	Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
	You think you need to be seen Sinus pain or pressure (around cheekbone or eyes) Fever present for more than 3 days Earache is present
	Call Your Doctor During Weekday Office Hours If
	You have other questions or concerns Coughing up blood Coughing has kept you home from school or work for 3 or more days Nasal discharge lasts more than 10 days Fever returns after being gone for more than 24 hours Symptoms of nasal allergy are also present (e.g., itchy eyes, clear nasal discharge, postnasal drip) Taking an ACE Inhibitor medication (Including: benazepril/LOTENSIN, captopril/CAPOTEN, enalapril/VASOTEC, lisinopril/ZESTRIL) Exposure to TB (Tuberculosis) Cough lasts more than three weeks
	Self Care at Home If
	Cough with no complications and you don't think you need to be seen

Symptom
Description

Care at
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HOME CARE ADVICE FOR COUGH

Mild Coughs: Use cough drops.
Cough Medications:
- In cough and cold medications, there is either a "cough suppressant" to reduce the cough or a "cough expectorant" to thin thick phlegm.
- Some medications contain both a cough suppressant and an expectorant.
- Generally, medications containing a cough suppressant should be avoided if you are coughing up phlegm.
Cough Suppression Medications:
- The most common cough suppressant in over-the-counter cough medications is dextromethorphan (DM). An example is Robitussin DM.
- Do not try to suppress coughs that produce mucus and phlegm. Cough suppression medications are best used in the late stages of a respiratory infection when the cough is dry and hacking.
- Read the package instructions thoroughly on all medications that you take.
- Special notes about dextromethorphan. Some recent research suggests that dextromethorphan is no better than placebo at reducing a cough. However, there is no over-the-counter medicine that works better than DM and generally DM has no side effects. It should also be noted that dextromethorphan has become a drug of abuse. This problem has been seen most commonly in adolescents. Overdose symptoms can range from giggling, euphoria, to hallucinations or coma.
Cough Expectorant Medications:
- To loosen and cough up thick phlegm, you can try using a cough medication that contains guaifenesin (e.g., plain Robitussin).
- Breathing in the mist from a steamy shower probably works even better. It moistens and helps loosen up the phlegm.
Coughing Spasms:
- Drink warm fluids. Inhale warm mistÂ (Reason: both relax the airway and loosen up the phlegm).
- Suck on cough drops or hard candy to coat the irritated throat.
Hydration: Drink plenty of liquids (6-8 glasses of water daily). If the air in your home is dry, use a humidifier
Avoid Tobacco Smoke: Smoking or being exposed to smoke makes coughs much worse.
Fever Medication:
- For fevers above 101Â° F (38.3Â° C) take acetaminophen or ibuprofen. The goal of fever therapy is to bring the fever down to a comfortable level. Remember that fever medicine usually lowers fever 2 degrees F (1 - 1 1/2 degrees C).
- Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
- Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
- People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
- CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
- CAUTION: Do not take acetaminophen if you have liver disease.
- Read the package instructions thoroughly on all medications that you take.
Expected Course: Viral bronchitis causes a cough that lasts 1 to 3 weeks. Sometimes you may cough up lots of phlegm (sputum, mucus). The mucus can normally be white, gray, yellow or green.
Call Your Doctor If:
- Difficulty breathing
- Cough lasts more than 3 weeks
- You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Symptom
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 5/12/2008

Content Set: Adult HouseCalls Online