Dr Jay Deshmukh :- Continuous dry cough is an irritating phenomenon and can adversely affect our quality of life in many ways. Dr Jay Deshmukh says This is one of the commonest symptom that brings an individual to a health care personnel. The causes could be as trivial as post nasal drip and nasobronchial allergy to a serious one like tuberculosis , pulmonary embolism or malignancy of the lung or excessive fluid accumulation in the lung due to cardiac or kidney disorders.
What is the commonest cause of cough ?
- Dr Jay Deshmukh :-Post nasal drip, viral infection of the throat, pharyngeal infection are a few common causes. Cough that occurs in the early morning hours or in the late evening is generally due to allergy of the nasal mucus membrane or of the lung passages known as bronchi or bronchioles. Dr Jay Deshmukh says A foreign body in the lung passage like a betel nut or a pea nut can cause recurrent dry cough. Dry cough associated with mild breathlessness with wheezing is generally due to bronchial asthma. Early morning cough associated with sticky sputum production is associated with COPD.
When should one consider dry cough significant requiring immediate attention ?
- Cough persisting for more than 2 weeks, cough associated with fever and weight loss, cough associated with breathlessness or chest pain , cough associated with blood in sputum should be evaluated as soon as possible.
What about cough associated with blood in sputum ?
- Dr Jay Deshmukh :- This should not be ignored. In heavy smokers this could be the first evidence of cancer of the lung. In some this could be the first sign of pulmonary embolism. Besides this tuberculosis, pneumonia, bronchitis could be associated with blood in sputum.
Can heart failure be associated with cough ?
- Patients with heart failure have dry cough and mild degree of breathlessness that occurs for the first time at night. The individual is more comfortable in sitting position than in lying down position. This may be associated with frothy sputum and requires immediate medical attention.
How is asthma diagnosed ?
- Dr Jay Deshmukh :- Individuals with asthma have dry irritating cough associated with mild breathlessness on effort and at times wheezing. The symptoms are more in the late evening hours and early morning. Many have symptoms on exposure to dust, smoke, perfumes or have a family history of asthma. In many the eosinophils may be increased in blood. The IgE immunoglobulin may be increased. Pulmonary function tests and the clinical profiling may clinch the diagnosis.
What about tuberculosis and cough ?
- Tuberculosis in India continues to be a huge challenge. Dry cough persisting for more than 2 weeks, fever, blood in sputum, weight loss, night sweating and loss of appetite are a few cardinal features . In these situations Xray of the chest is absolutely necessary.
Can acidity or gastrointestinal disorders be associated with cough ?
- Gastro oesophageal reflex disease also known as GERD is a common cause of recurrent dry cough. These individuals are generally overweight and have cough more after dinner at night. Do not lay down in bed immediately after meals. Have your night meal early and let it not be heavy. Certain anti reflux drugs and proton pump inhibitors are recommended. Avoiding smoking, alcohol and spicy food is recommended. Pain relief drugs like aspirin, ibuprofen or diclofenac should be avoided.
How is dry cough treated ?
- Anti allergic medications like Cetrizine, Fexofenadine are generally recommended for allergy related cough. Inhalers or nebulisations are recommended for asthma. Nasal drops are recommended for allergy of the nasal mucus membrane. However the treatment depends on the cause.The diagnosis can be reached by appropriate investigations.
How to prevent dry cough ?
- Avoiding exposure to smoke, dust , grain dust is easily said than done. Prophylactic anti allergy medications, inhalers and avoiding smoking can help. Weight reduction if you are overweight , control of blood pressure and diabetes is important. Certain drugs like ACE inhibitors can cause cough. Vaccination against flu and pneumonia is recommended in specific individuals.Dr Jay Deshmukh :- Dry cough as a symptom spares nobody. In most the symptom disappears on its own with simple remedies. However in some it may be a beginning of asthma, COPD , tuberculosis or even cancer of the lung. Dry cough lasting for more than 2 weeks requires detailed evaluation.
Author: Dr Jay Deshmukh
Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.