ABSTRACT
Cough is one of most common symptom encounters in clinical practice, cough is a rapid expulsion of air from the lungs typically in order to clear the lung airways of fluids, mucus, or material. This article provides an overview of the aetiology, diagnosis, and appropriate general & homoeopathic management for different types of cough.
INTRODUCTION
Cough is also called tussis. A cough is a protective reflex in healthy individuals which is influenced by psychological factors. Cough can be categorized as acute (less than three weeks) or chronic (greater than three weeks). There are many different types of cough and can hear them all during winter – tickly coughs, chesty coughs, croupy coughs – but they all have one thing in common; they cause distress and discomfort to the sufferer (not to mention the listener!) They lead to irritability, sore muscles, and lack of sleep.
Frequent coughing usually indicates the presence of a disease. Many viruses and bacteria benefit evolutionarily by causing the host to cough, which helps to spread the disease to new hosts. Most of the time, irregular coughing is caused by a respiratory tract infection but can also be triggered by choking, smoking, air pollution, asthma, gastroesophageal reflux disease, post-nasal drip, chronic bronchitis, lung tumors, heart failure and medications such as ACE inhibitors.
Classification of Cough:
A cough can be classified by its duration, character, quality, and timing. The duration can be either acute (of sudden onset) if it is present less than three weeks, subacute if it is present between three and eight weeks, and chronic when lasting longer than eight weeks. A cough can be dry or productive, depending on whether sputum is coughed up. It may occur only at night, during both night and day, or just during the day.
Acute Cough: The cause of the acute cough is usually determined by the person’s history and physical exam.
· If cough is present less than three weeks.
· Most commonly relates to
o Viral – induced lower respiratory tract infections.
o Post-nasal drip resulting from rhinitis or sinusitis.
o Throat - clearing secondary to laryngitis or pharyngitis.
Post-nasal drip: Mucous accumulation in the back of the nose and throat leading to or giving the sensation of mucus dripping downward from the back of the nose.
Subacute Cough: if it is present between three and eight weeks. The most common causes are: Post infectious Cough, Acute Sinusitis, Asthma.
Chronic Cough:
· When cough lasting longer than eight weeks.
· Patients with chronic cough often represent more of a diagnostic challenge like individuals with a normal examination, chest radiograph and lung function tests.
· Most cough can be explained by Post-nasal drip secondary to nasal or sinus disease. Asthma , where cough may be the principal or exclusive clinical manifestation Or Gastro-oesophageal reflux (may require ambulatory pH monitoring or a prolonged trial of antireflux therapy to diagnose.
Dry Cough:
Cough is dry i.e. there is no phlegm when a person coughs. The throat feels itchy and scratchy due to the dryness. The throat pains due to excessive coughing. It is difficult to eat due to excessive coughing. Fever may accompany the cough but it is not a necessary symptom.
The dry, hacking cough is caused by: a virus infection, cold or dry air, or Air pollutants such as cigarette smoke, smog and dust. This sometimes feels like a tickle at the back of your throat.
Productive Cough:
Productive cough are coughs that produce phlegm, in contrast to dry coughs. Productive cough may be associated with tuberculosis, bacterial pneumonia, and bronchitis . The loose productive cough is a sign of chest congestion or infection due to colds or flu. It clears the lungs and air passages of excess mucus.
Phlegm is a sticky material from your mucous membranes in our respiratory system. When have a cold it might be yellowish brown. If there's an infection, it might be greenish brown. Normal phlegm is usually clear.
Conditions that cause coughs
Colds and Flu - Almost all coughs due to the common cold come and go without trouble; still they can be a big hassle if they keep you up all night or doubled over during the day.
Post-nasal drip - Most types of coughs are caused by postnasal drip, triggered by allergies, fumes or an upper respiratory infection. The sinuses produce fluid that drips down the throat and that produces a cough, because your body won’t let you drown in your own secretions,” she says. The cough can be dry or wet, accompanied by a tickling or sore throat.
Sinusitis/Rhinitis - Sinusitis, an inflammation of the sinuses, causes that tickling, dripping sensation down the back of the throat that triggers various types of coughs.
Rhinitis is inflammation of the nasal passages, which also leads to postnasal drip.
Allergies - Coughs related to rhinitis, sinusitis and post-nasal drip all can be triggered by allergies.
Asthma - The second most common cause of coughs is asthma, some people, instead of loud wheezing, get only a cough.
Smoker’s cough - Many smokers think of it as a morning cough. But a cough can be a sign of a more serious disease like COPD (chronic obstructive pulmonary disease) or lung cancer.
Acute bronchitis/Pneumonia, Acute – sudden, but short – bronchitis is essentially a cold or a viral infection. It can also be bacterial. Pneumonia, an infection of the lungs, also can be viral or bacterial.
Reflux (GERD) - Surprisingly, if you have acid or non-acid reflux – the back-up of stomach fluids into your esophagus – your only symptom may be a cough, not heartburn. More than half of people with reflux disease have only a cough.
Types of Cough by Sound
"One of the best ways to diagnose a cough, and the way we do it, is by listening,"
· A sharp gasp for breath at the end of a long coughing spell characterizes whooping cough, it puts infants at risk and kills one to three babies a year
· Infamous for its "barking" cough, croup is a viral infection that results in swollen vocal chords and throat. It commonly affects children and worsens at night,
· A dry cough is so called because it doesn’t produce phlegm. It can result from a wide variety of problems, from mild environmental irritants,such as smoke, to disorders or infectious diseases, such as asthma, the flu or pneumonia.
· Productive/Wet Cough - Just a regular old cold gives you wetness in the cough because again all that junk in your nasal passages it goes back into your throat into your airways, you’re coughing it up, Besides a cold or influenza, bronchitis and pneumonia can also cause wet coughs.
Characteristics of cough originating at various levels of Respiratory Tract:
Origin | Causes | Characteristics |
Pharynx | Post nasal drip | Usually Persistent. |
Larynx | Laryngitis, tumor, whooping cough, croup | Harsh, barking, painful, persistent, often associated with strider. |
Trachea | Tracheitis | Painful |
Bronchi | Acute Bronchitis and COPD | Dry or Productive, , worse in mornings |
Asthma. | Dry or productive, worse at night. | |
Bronchial Carcinoma | Persistent often with haemoptysis. | |
Lung Parenchyma | Tuberculosis | Productive, often with haemoptysis. |
Pneumonia | Initially Dry, Productive later. | |
Bronchiectasis | Productive | |
Pulmonary edema | Often at night ( may be productive) | |
Interstitial Fibrosis | Dry, irritant and distressing. |
General Management
v Eat healthy food and avoid sugar or sugary foods which suppress the immune system for up to 5 hours after being eaten.
v Get plenty of rest so your body can recover
v Maintain hydration and keep your mucus membranes moist with frequent drinks of water or soothing teas.
v Soothe inflamed airways and loosen mucus with steam inhalations and warm showers.
v Avoid cigarettes and tobacco smoke which paralyse and eventually destroy the microscopic hairs that line your airways.These fine hairs, called cilia, normally sweep the mucus upwards in waves, away from your lungs.
Natural Home remedies
A specific tip for coughs involves black pepper. Pepper has an antimicrobial effect but in truth, its ability to soothe coughs probably has more to do with the homeopathic effect of ‘like treats like’; pepper can induce coughing in a healthy person and so will relieve it in someone suffering from a cough. Pepper is best added to raw honey and taken by the spoonful several times a day.
Cinnamon is another natural antibiotic. It is rich in compounds that inhibit bacterial growth and strengthen resistance. Add it to your food or drinks to boost your immune system. Turmeric contains an anti-inflammatory compound called curcumin, which has strong cold and flu fighting properties. Stir a teaspoon into a glass of water or use it in your cooking
Honey and lemon soothe the mucous membranes of the throat and have an antibacterial effect – raw honey is best. Research shows that children who take a spoonful of honey before bed cough less and sleep better than those who take over-the-counter products for coughs and colds. Adding a little lemon to the honey will increase its anti-microbial effect. Honey and lemon can also be combined with hot water to make a soothing tea.
Chocolate and cough - Chocolate can help a cough! Theobromine, a compound found in the cocoa bean, will suppress coughs just as effectively as many cough medicines but without their side effects. Milk chocolate contains very little theobromine compared to dark chocolate. To obtain an effective dose, need to eat 50 – 100g of dark chocolate. Enjoy!
Allopathic treatment uses suppression or palliation to relieve symptoms for short periods of time. The drawback is that in the long run, continual suppression leads to worsening
health. Depending on whether the cough is wet or dry, conventional medicine will offer a suppressant or an expectorant.
HOMOEOPATHIC MANAGEMENT
Homoeopathic Remedies
Homoeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homoeopathy is not only to treat cough but to address its underlying cause and individual susceptibility. The unique physical, emotional and mental expression of illness is characteristic and is used to channel the course of Homoeopathic treatment. The remedies work by stimulating body’s natural ability to heal itself, acting as a catalyst for healing. As far as therapeutic medication is concerned, several well-proved remedies are available for cough which can be selected on the basis of cause, location, sensation, modalities and extension of the complaints. Homoeopathic medicines are often effective in treating the acute symptoms of coughs, though professional constitutional care is usually necessary to achieve a deeper level of cure of chronic respiratory problems.
Some important cough remedies are given below which are much helpful in treatment of rheumatoid arthritis:
Indicated Remedies | Indications |
Aconite | Sudden onset often after exposure to cold air. Dry croupy cough with runny nose and sneezing. Irritation of respiratory tract, hoarseness/dryness of throat. Worse: cold dry winds, talking and deep breathing. Better: lying on back. |
Anti Tart | Noisy, rattling, loose cough as if chest full of mucus. Young children or elderly with cough too weak to expel the mucus. Worse: night, especially from 10 pm until after midnight, lying flat, eating. Better sitting up and after expectoration |
Bryonia | Dry hacking cough in the evening and night without sputum. Spasmodic cough shaking the whole body, pain in the head an abdomen from coughing, better for holding the painful part. Dryness of all air passages with thirst. Worse: movement, deep breathing, lying in bed. Better: fresh air and for pressure of painful part. |
Causticum | Cough with raw, sore feeling in chest. Hollow, hard, dry cough from tickling in throat pit. Expectoration not easy to cough up and slips back down the throat. Worse: lying down, talking and bending head forward. Better: cold drinks |
Coccus Cacti | Paroxysmal, hard, short hacking cough ending in copious thick, ropes of mucus. Worse: 6-7 am or after 11.00 pm, becoming heated, warm rooms. Better: cold, open air, cold drinks. |
Drosera | Spasmodic, dry irritating coughs like whooping cough. Barking cough which is dry in the evening and loose in the morning. Sputum is yellow/green, bitter or offensive, bloody or pus like. Retching after spasmodic cough. Worse: after midnight, lying down, singing, laughing and drinking. Better: holding chest. |
Phosphorous | Cough may be dry or loose, (useful in the early stages of bronchitis/pneumonia) Every cold descends to the chest. Burning in the chest with raw larynx and feeling of tightness. Scratchy sensation in the throat, tickling cough. Worse: change from warm air to cold air, talking, laughing. Better: heat, sleep and lying on right side |
Pulsatilla | Catarrhal cough with copious yellow/green lumpy mucus. Dry cough at night, loose in the morning. Worse: warm stuffy rooms, lying down, becoming warm in bed. Better: fresh air, gentle walking, sitting up in bed. |
HOMOEOPATHIC RESEARCH
One interesting study with seriously ill patients on respirators in an intensive care unit showed that homoeopathy not only effectively reduced their respiratory secretions but also helped them come off their respirators more quickly. The length of time they spent in the unit was also shorter and without respiratory complications. In contrast, those in the control group who had not received homoeopathic treatment took considerably longer to recover. Some also had to be returned to the respirator after extubation because they were struggling to breath from excessive secretions in their airways – something that was not a problem for the homeopathic group. As excess respiratory secretions are a major trigger for coughs, the homeopathic treatment would also have reduced the incidence of coughs – something that is also substantiated clinically.
Another study of children with upper respiratory tract infections, including coughs, showed that those who received homeopathic treatment recovered much more quickly than those who were treated conventionally in the control group.
A third study showed that those children whose colds (and accompanying coughs) were treated with homoeopathy were more likely to feel and do better than those children whose colds had been treated conventionally. The homeopathically treated children had fewer complications, and their parents took significantly less sick-leave than the parents of those children treated with antibiotics.
