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    When a Cough Is Not “Just a Cough”

    By By Paula Spencer
    November 27, 2012, 8:02:22 AM EST



    From a discreet tickle in the throat to a relentless “smoker’s cough,” coughing is a reflex we can’t resist. Though these odd noises that come up the respiratory tract and out the mouth are wordless, they have plenty to tell.

    In fact, coughing is the top complaint people bring to doctors’ offices. “Coughing is a very general symptom that can reflect minor irritation or serious problems in the airways or the lungs themselves,” says internist and pulmonologist Norman Edelman, MD, medical director of the American Lung Association. So what’s your cough saying? Here are six questions that lead to important clues. Cough clue #1: How long has the cough been going on? Not long; minutes or hours. We cough because something irritates the nerves of the respiratory tract. The pest can be fleeting — a cloud of perfume or bug spray, an inhaled hot chili pepper, water swallowed the wrong way so that it clogs the windpipe. Or it can be something that hangs around longer, like dust, mucus, or stomach acid.

    With any cough, first we take a short breath and then the voice box (larynx) closes. The abdominal and chest muscles contract, and pressure builds to release air from the lungs when the larynx reopens — whereupon whoosh, the fast burst of air whisks through the airways, clearing them. That’s important, because invasive bodies in the lower respiratory system can harbor bacteria that cause an infection in the airways or even pneumonia (infection of the lung itself).

    For many sudden coughs, the drama ends when the airway is cleared and/or the offending substance goes away. It’s been less than a month. The common cold is the number-one reason for “acute” coughs (those lasting less than three weeks). Colds tend to run their course in seven to ten days. But the rule of thumb on the cough that usually accompanies a cold is that it can take as long as two to four weeks to end, says Edelman. That’s because airways may continue to be inflamed and sensitive even after the infection has cleared.

    Most coughs that come with colds clear on their own without any treatment, research shows.

    Argh, it’s been more than two months now.

    Between one and two months, coughs are considered “subacute” — they might clear up or they might flag an underlying disease. After eight weeks, a cough is considered “chronic.” Among the most common causes of a chronic cough:

    -Upper-airway cough syndrome (UACS), the newish term for postnasal drip syndrome. It’s the most common cause of acute and common coughs. -Asthma, a constriction of the airways. A top cough-causer for kids, adults get it, too. -Chronic obstructive pulmonary disease (COPD). This can take the form of chronic bronchitis (damage to the bronchi or large air tubes) or emphysema (damage to the tiny air sacs deep in the lungs), or both. People who smoke are at highest risk.

    Gastroesophageal reflux disease (GERD). (The old term “acid reflux” is fading because there’s also nonacid reflux.) GERD happens when the stomach content backs up into the esophagus.

    In many cases, when the problem is treated, a long-term cough disappears. 6 Doctor-Tested Ways to Keep a Cold Away Cough clue #2: When does the cough happen?

    I cough at certain times of the year.

    Does the cough seem to follow a calendar? Seasonal allergies can affect the airways to produce a cough right along with the most common hay fever symptoms of sinus blockage and eye irritation.

    Cold weather, especially exercising in it, can trigger a kind of asthma called “hyperactive airwaves.”

    I’ve coughed since starting new blood pressure medication.

    A chronic dry cough afflicts 10 to 20 percent of people who take angiotensin-converting enzyme inhibitors (ACE inhibitors) for high blood pressure and heart failure. The cough may appear right away or months after beginning treatment. The throat also feels raw. This cough clears within a week to a few months of changing meds.

    I cough before I speak.

    Even though coughing is automatic, you can also cough voluntarily (as with blinking and swallowing). Some people develop the nervous habit of throat clearing before they talk — ahem! — or during public speaking. The phenomenon is so common that lung experts have given it a name: a “habit cough.”

    I cough whenever my body wants to; I can’t control it.

    This is the most common situation. A persistent, uncontrollable cough is usually linked to an underlying disease.

    More rarely, coughing and throat clearing can be a tic — a semivoluntary movement that could be suppressed but that people feel a compelling urge to do anyway, partly because doing so brings a brief relaxing sensation.

    How To Stop a Cold Before It Starts

    Cough clue #3: Is the cough productive — that is, do you cough up anything yucky?

    Nope, it’s a dry cough.

    A dry cough (in which nothing comes up from the lungs but air) is the usual aftermath of catching a cold. Depending on the severity of the infection, it can be muffled or loud, a series of short little coughs or great noisy hacks. Other coughs that are sometimes dry: a smoker’s cough in early stages of lung dysfunction or some types of asthma-related coughs.

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    Yes, I cough up a light (clear to pale yellow) mucus.

    Mucus is the stuff that moisturizes your nose and keeps the passages clean. (You might know it as phlegm or sputum — same stuff.) Colds and the flu tend to produce colorless or pale mucus. Sometimes there’s a lot of it, which must be blown out through the nose, coughed up, or swallowed. It’s a myth, by the way, that it’s bad for you to swallow the gunk.

    A cough with excessive mucus (of any color) most days of the month is a key feature of chronic bronchitis, the lung problem that’s part of COPD.

    Yes, I cough up greenish or tan phlegm.

    “Green stuff” usually indicates a bacterial infection. That’s why daycares and preschools usually check the color of kids’ drips and forbid the green. Adults should take care, too.

    Coughing up colored phlegm — whether green, brown, or yellow — is also a main symptom of pneumonia, a lung infection that can make a person very sick. The lungs begin to fill with fluid while fighting invaders to your system. Pneumonia usually follows another illness, which can have been started by a virus, bacteria, or fungi. (People who are over age 65 or who have a chronic lung or heart illness should consider the pneumonia vaccine, which can lessen symptoms if pneumonia develops.)

    The mucus coughed up with chronic bronchitis or emphysema tends to be in the green-brown-tan family. During a COPD exacerbation — a sudden worsening of symptoms — the secreted mucus may get thicker, darker, and harder to cough up. That’s because the airways are narrowing further.

    Yes, I cough up a little red stuff.

    Seeing blood (any reddish shade from pink to rust) in mucus warrants consulting a doctor. Sometimes blood-streaked mucus shows up in the smoker’s cough associated with COPD. Pneumonia,
    tuberculosis, and lung cancer are other serious concerns producing bloodied sputum. Frothy pinkish mucus indicates pulmonary edema, an accumulation of fluid in the lungs’ air sacs, which is an emergency-room situation.

    For more information about what your cough could mean continue to Care2.com.

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