Just about everywhere you turn, it seems, ?people are coughing and spluttering. Yet a recent study by the University of Leicester found that although coughs are one of the most common ?complaints seen by GPs, only 60 per cent of people find a cause.
Coughs are mainly a protective reflex to remove foreign ?bodies, mucus or irritants such as dust from the respiratory tract, explains Alyn Morice, professor of respiratory ?medicine at the University of Hull, and one of the country’s leading experts.
‘But persistent coughs can also be caused by viruses and ?infections,’ he says.
Symptom of an underlying problem: Persistent coughs can be caused by viruses and ?infections
If your cough lasts for more than eight weeks, he advises ?seeing a GP.
‘a chest X-ray should be ?performed to rule out any serious ?underlying ?disease. however, see your doctor immediately if you experience ?symptoms you’ve never had before, such as coughing up blood.’
Here, we talk to the UK’s cough experts to help you work out what’s behind your symptoms . . .
A stubborn dry cough that comes and goes, but never quite ?disappears. it usually occurs during the day, prompting a coughing fit that lasts around ten minutes. In extreme cases, sufferers experience ?incontinence and even fractured ribs.
CAUSE: Such coughs used to be ?simply written off as ‘unexplained’. But doctors have recently ?discovered that in some cases the problem is hypersensitivity in the upper ?airways, triggered by a reflux of gas from the stomach.
‘This gas is like a mist — ?containing air, bits of food and stomach enzymes, which irritate the upper area of the throat,’ explains ?Professor Morice.
Once this hypersensitivity has set in, sufferers will have a coughing fit if anything — such as dust or cold air — touches their throat. however, not everyone who has gas reflux will develop a cough as a symptom.
TREATMENT: Some antihistamines and small doses of ?morphine, ?prescribed by a specialist, might help, says Professor Morice. for ?immediate relief, suck a strong menthol ?lozenge, such as Fisherman’s Friend.
CHRONIC, TICKLY COUGH
Although this cough doesn’t ?produce phlegm, you feel as if mucus or catarrh is dripping down the back of your throat. sometimes it can also feel as if there’s a lump in the throat.
CAUSE: This is known as a post-nasal drip — the cause of about 7 per cent of coughs, says Professor Peter Barnes, head of ?respiratory medicine at Imperial College, London.
Normally, we produce up to four pints of clear thin mucus every day from the glands which line the nose and sinuses. This usually drips ?unnoticed down your throat.
However, when mucus becomes thick or if there is a lot of it — usually due to an allergy or ?infection, such as a cold or flu — it triggers a ?coughing reflex as it drips down the throat.
TREATMENT: Products such as Otrivin, a non-steroid, can give immediate relief by reducing ?swelling in the nose and the post-nasal drip.
Administer the drops with the head down and forward, so that the ?liquid flows into the sinuses — don’t tip your head back or the drops will go straight into your stomach.
However, Professor Barnes advises only using these for a few days.
‘if used for longer, once you stop you get a rebound effect and the condition gets worse.’
If post-nasal drip is caused by an allergy, such as cats, house dust or hay fever, you might need a topical nasal steroid, such as Beconase, to dampen down the inflammatory responses ?causing the drip, says Dr Anindo Banerjee, a consultant respiratory physician at ?Southampton General Hospital. see your GP about allergy tests.
The cough might be accompanied by some wheezing, but no phlegm. it occurs at night and intermittently during the day.
CAUSE: This cough usually happens after a bout of cold, flu or other ?respiratory infections and might be caused by increased inflammation in the airways, says Dr Nicholas ?Hopkinson, a consultant respiratory physician at the Royal Brompton Hospital.
TREATMENT: In most cases, it should go away by itself after a few weeks, says Professor Barnes. Lozenges can help — choose those with a strong ?flavour, as they will promote ?salivation to help coat and soothe a sore throat.
Symptoms might also be eased by leaning over a bowl of boiling water with a towel over your head, as ?moisture from the steam will soothe and lubricate the airways. Adding a few drops of menthol might help.
SPASMS OF DRY COUGHING
A painful cough could be caused by bronchitis
A coughing fit starts as a tickle at the back of the throat; in some cases, coughing can lead to vomiting.
CAUSE: certain ?medications can cause coughing, particularly ACE inhibitors, prescribed for high blood pressure, explains Professor Barnes.
This ?usually happens in about 15 per cent of people who use them — possibly because the drugs stop the ?breakdown of a naturally-occurring chemical called bradykinin which, in turn, makes the nerve endings in the lungs more sensitive to irritation.
TREATMENT: Your GP can ?prescribe alternative blood pressure ?medications, such as ?angiotensin II receptor antagonists, advises ?Professor Ron Eccles, director of the Common cold Centre at Cardiff University.
Around 90 per cent of users who swap medication clear their cough within a week or so, although it can take up to three months.
PAINFUL, HACKING COUGH
A constant cough, that is ?particularly bad in the morning. it tends to bring up thick yellowy/grey or green/rust-coloured mucus. there might also be pain behind the breast bone, a sore throat, ?wheezing and a blocked nose.
CAUSE: the likely cause is acute bronchitis, an infection of the large airways of the lungs (bronchi), which causes them to become ?irritated and inflamed. This often starts after a respiratory infection, such as a cold.
Acute bronchitis itself is usually caused by a virus — but around 5 to 10 per cent of cases are triggered by bacteria; in bacterial infections, the phlegm will be green or rust ?coloured, says Dr Sneh Khemka, medical ?director of BUPA International.
This cough could be confused with a swine flu cough. however, a cough caused by swine flu would usually be accompanied by a high fever (usually above 38C) sore throat, headache, aching muscles, chills and shivers, a fever, upset stomach and general exhaustion, says Dr Banerjee.
TREATMENT: Bed rest and drinking lots of fluids to prevent ?dehydration and to thin the mucus, making it ?easier to cough up. Over-the-?counter products might relieve your cough, although they cannot speed up your recovery.
‘look for medicines containing linctus,’ says Professor Morice, ‘as this ingredient lessens the cough by lining the back of the throat.’
Products such as Robitussin ?contain the cough suppressant dextromethorphan. however, many over-the-counter cough ?medicines also contain ?paracetamol, so if you are already taking it to relieve your headaches or fever, make sure you don’t exceed the maximum dose.
If you are breathless, feel unwell or the cough lasts longer than a week, or the phlegm coughed up is a green, rusty colour, see your GP.
THROAT-?CLEARING COUGH
It feels like you have a lump in your throat and coughing leaves you with a nasty, bitter taste in the mouth. the cough can be ?triggered by talking, laughing, singing or eating particularly dry food. it also tends to occur at night.
CAUSE: the most likely cause is stomach acid splashing up the ?gullet — this affects about 25 per cent of the adult Western ?population and is known as reflux. As the lining of the gullet is extremely soft and sensitive, this leads to inflammation, which ?triggers a coughing fit.
Reflux can lead to a condition called Barrett’s Oesophagus — this causes ?abnormalities in the cells and raises the risk of ?oesophageal cancer.
TREATMENT: Over-the-counter ?antacids such as Alka-Seltzer can neutralise acid in the stomach.
Other drugs, known as H2 ?blockers (available both on ?prescription or over the counter) act on acid production. cut back on ?exacerbating factors, such as ?coffee, high-fat food or going to bed shortly after a large meal, and try to avoid eating after 9pm, says Professor Morice. if you suffer with reflux for a ?couple of months, see your GP.
DRY COUGH WITH WHEEZE
You tend to cough more during the night or first thing in the morning.
CAUSE: one likely culprit is asthma. ‘Ten per cent of asthma sufferers don’t realise they have it,’ says Dr Keith Prowse, of the British Lung Foundation. when someone with asthma comes into contact with something that irritates their airways, the muscles around the airways tighten.
An asthma cough can be triggered by a cold, exposure to certain foods or irritants, such as pollen. it is not known why the cough is worse at night or in the morning.
TREATMENT: Your GP can normally diagnose asthma with tests. the first line of ?treatment involves inhalers to open up the airways and make it easier to breathe.
If inhalers are ineffective, inhaled steroids can ease a severe or ?prolonged attack of asthma and reduce the inflammation in the airways.
BREATHLESS, PAINFUL COUGH
A persistent cough ?accompanied by shortness of breath.
Other symptoms might include coughing up blood, loss of ?appetite, losing weight and a dull ache or sharp pain in the lung area when you cough or take a deep breath. This cough is unrelenting and ?happens most of the time.
CAUSE: one possibility is lung ?cancer. ‘the problem is that it is possible to mistake these ?symptoms for a chest infection,’ explains Dr Jesme Fox, medical director of the Roy Castle Lung Cancer Foundation.
‘the difference is that the cough persists for weeks, with little sign of getting better.
‘though lung cancer is quite rare, it’s vital you don’t ignore these symptoms and get checked out by your GP, just to be sure,’ she adds.
TREATMENT: This depends on the type of lung cancer — though often it involves surgery, radiotherapy and chemotherapy.
This brings up lots of phlegm — and there can be wheezing, chest ?tightness and some ?difficulty breathing.
It’s often worse in the mornings and the ?winter, as it’s exacerbated by viruses that affect the lungs.
CAUSE: Chronic Obstructive ?Pulmonary Disease (COPD) — the ?collective name for lung ?conditions, such as chronic bronchitis and emphysema. COPD is commonly caused by smoking.
However, about 10 per cent of cases happen in non-smokers due to exposure to dust, air pollution and family history.
It usually affects people over 40, as the damage to the lungs that causes COPD happens gradually.
‘the ?important thing is to notice symptoms that haven’t happened before, such as this chesty cough or breathlessness,’ says Dr Keith Prowse, of the British Lung ?Foundation.
‘it could be a sign of the disease and they should see their GP.’
TREATMENT: there is no cure for COPD, but the damage can be slowed. the most important steps are to stop smoking, avoid ?passive exposure and exercise as much as you can.
Short and long acting inhalers will help with breathlessness by widening the airways.
Steam inhalation and ?humidifying rooms can also help by ?loosening mucus.
For an online breath test to screen for COPD, go to ?lunguk.org/breathtest