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When to Worry About a Cough

It's flu season! Aka coughing, sneezing and sniffling all around.

What is a cough?

A cough is a complex protective reflex. The purpose of this reflex is facilitating the clearance of aspirate, mucous, irritant, etc. from the airways.

The reflex is initiated by an airway stimulant such as mucous. This initiates a 'signal' which travels through the vagus nerve, before dividing into a 'conscious' and an 'unconscious' pathway. The pathway involved in the cough reflex is the unconscious pathway, occurring with the absence of voluntary input. The resulting signal continues towards the spinal cord and then into the branches responsible for the innervation of the respiratory muscles, which become stimulated and lead to a cough.

How do you know if your cough is more than just a symptom of a cold? 

A cough will usually clear up on its own within 3 to 4 weeks, with no need to see a general practitioner (GP). You can help this process along by ensuring you get plenty of rest and drink plenty of fluids.Related image
However, you should see a GP if you have had a persistent cough (which is defined as lasting more than 3 or 4 weeks). You should also consider visiting your GP if your cough is very bad, rapidly worsens or if you feel unwell. Other red flag symptoms include chest pain, the side of your neck (glands) feeling swollen or having trouble breathing. A visit to the GP is also important if your cough is accompanied by an unexplained weight loss or if you have a weakened immune system (as a result of chemotherapy, diabetes, immunosuppressants etc.).

If you are coughing up blood you should see a GP urgently. 

Possible Causes

Most coughs are caused by a cold or flu. However, there are many other causes of a cough such as smoking, asthma, heartburn (acid reflux), allergies (e.g. hay fever), infections (e.g. bronchitis) or mucous dripping down the throat from the back of the nose (sinusitis). A cough is very rarely a sign of something serious such as lung cancer. 

Smokers Cough

Smoking is associated with a nasty chesty cough, referred to as "smoker's cough". However, a persistent chesty cough with phlegm is a symptom of chronic obstructive pulmonary disease (COPD) that is often incorrectly dismissed as "smoker's cough". Often the presence of the phlegm alongside other symptoms will allow doctors to distinguish between the two. Additional symptoms of COPD include increased breathlessness, frequent chest infections and persistent wheezing.

You should visit your GP if you present with any of the above symptoms, if you are over 35 and if you smoke or used to smoke. See the NHS page on COPD for more information.

Asthma

Coughing is also a symptom of asthma. If you are concerned that this may be the case for your/someone close to you's cough then you should also keep an eye out for wheezing, breathlessness and a tight chest. You should visit your GP if you suspect asthma. 

Allergies

You should be concerned that your cough may indicate hay fever if you are also experiencing any of the following symptoms: Sneezing and coughing, a runny or blocked nose, itchy/red/watery eyes, loss of smell, headache, earache, feeling tired or pain around your temples/forehead.

Bronchitis

Bronchitis is an infection of the main airways of the lungs, which causes them to become irritated and inflamed. Symptoms that occur alongside cough include tiredness, a runny/blocked nose, a sore throat or headache. Most cases of acute bronchitis can be resolved with rest, non-steroidal anti-inflammatorydrugs (NSAIDS) and plenty of fluids. 

You should only need to visit your GP if your symptoms become severe or unusual, for example coughing up mucous streaked with blood or having a high temperature for more than 3 days (which in the most extreme cases may indicate pneumonia). See the NHS bronchitis page for more information. 

Sinusitis

Swelling of the sinuses may also result in a cough due to the dripping of mucous down the throat from the nasal cavity. The primary symptoms of sinusitis include: a blocked nose, pain/swelling/tenderness around the cheeks/eyes/forehead, green or yellow mucous from the nose, a sinus headache, a reduced sense of smell, a high temperature, toothache and bad breath. 

Sinusitis can usually be treated without a visit to the GP by resting, drinking plenty of fluids, taking painkillers (ibuprofen or paracetamol) and cleaning your nose with a salt water solution. You should only need to visit a GP if your symptoms are sever or continue to worsen. You can see the NHS sinusitis page for more information.

As previously stated, coughs are not usually an indicator of a more serious underlying condition. However, they can be very inconvenient. Luckily, most coughs can be easily treated at home. 



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