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Cough  
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Does this describe your symptoms?

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

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 103° F (39.4° C) or higher
  • Fever of 100.5° F (38.1° 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
HOME CARE ADVICE FOR COUGH

  1. Mild Coughs: Use cough drops.
  2. 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.
  3. 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.
  4. 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.
  5. Coughing Spasms:
    • Drink warm fluids. Inhale warm mist (Reason: both relax the airway and loosen up the phlegm).
    • Suck on cough drops or hard candy to coat the irritated throat.
  6. Hydration: Drink plenty of liquids (6-8 glasses of water daily). If the air in your home is dry, use a humidifier
  7. Avoid Tobacco Smoke: Smoking or being exposed to smoke makes coughs much worse.
  8. Fever Medication:
    • For fevers above 101° F (38.3° 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.
  9. 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.
  10. 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.

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

Portions Copyright 2000-2009 Self Care Decisions LLC; Copyright LMS, Inc.

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