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TYPES OF COUGH

What is 'cough'?

Cough is a familiar and protective reflex for all of us. Even when we are feeling healthy, most of us will cough as a way of clearing our throat, preventing food and fluid from entering our airways and lungs, or simply from the shock of breathing in cold air.1,2  For healthy children, coughing is common, with most of them coughing an average of 11 times a day.3

Unfortunately, a cough can become a nuisance when it is frequent or chronic and interferes with everyday life,4,5 or accompanies illness. When this happens, many of us will head to the pharmacy, and some will head to the doctor.6,7 In fact, a cough is one of the most common reasons for seeking medical advice.6,7

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What happens when we cough?

Cough is caused by the irritation of receptors which are found throughout your airways.8,9 Receptors are present in the pharynx at the top of your throat, all the way down your trachea (or windpipe) to even the smallest airways.8 Any of these may be triggered by mechanical factors (such as touch, deformation and pressure) or chemical factors (such as smoke, ammonia, chemical substances and mucus).9 These cough receptors send a message to the brain, which in turn sends a message to the muscles in the chest to cause a cough.10

Sect1

Build-up of mucus or other irritants stimulates receptors throughout the respiratory system6,10 

Sect2

Receptors pass a signal through the vagus nerve to the cough centre of the brain, in the medulla oblongata6,10 

Sect3

The cough centre then sends directions to muscles in the chest, triggering a cough10 

typesofcough2

What is the difference between productive and non-productive coughs? 

These are the two main types of cough.10,11 You might be more familiar with the terms wet cough or dry, chesty and tickly cough.11 Being able to identify your cough can be useful in helping you to choose the right type of over-the-counter (OTC) remedy.2

If a cough is not bringing up much phlegm (mucus that comes from the lower respiratory tract), it is usually termed non-productive.11 This does not mean that there is no phlegm with a non-productive cough, but simply that if there is any, it is usually minimal.12 Non-productive cough may be associated with an irritating, tickling or scratchy sensation in the throat.13

A productive cough is often considered to be a wet cough as phlegm is present.12 Although your cough might start as a non-productive cough, it could become a productive cough if the airways start to produce more mucus.14 Understanding the usual timeline of a cough can be helpful. 

typesofcough3

Interestingly, a child might not appear to have much phlegm with their cough but studies have shown that children swallow more of their phlegm and it may therefore still be considered a productive cough.12,14

Because a cough is triggered when something within the airways and lungs is irritated, a productive cough may be considered to be a helpful cough: when this is caused by irritants like phlegm, the body responds with a protective cough in an attempt to remove it.10,11

When a cough lasts less than three weeks, it is referred to by doctors as an acute cough.4,15

When a cough lasts for longer, doctors may refer to it as a subacute cough (three to eight weeks) and then as a chronic cough (more than eight weeks).16 There is a risk of an acute cough becoming a chronic cough if effective treatment is not taken.15

There are many unknown irritants that can cause a productive cough, including:2,13

  • mucus, phlegm and catarrh (an excessive discharge or build-up of mucus in the nose or throat, usually linked to inflammation of the mucous membrane) caused by infections such as the common cold
  • asthma
  • smoking
  • dust
  • pollen.
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What is the difference between non-specific and specific coughs?

Your doctor or pharmacist may also refer to a non-specific or specific cough. A non-specific cough is a dry cough with no signs of breathing difficulty.17 This type of cough may have a range of causes but none are considered serious. It is likely to mean that you are recovering from an infection rather than developing one.17

A specific cough is linked to a defined, treatable condition. In childhood, the most common cause is acute respiratory infections.17

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How can a cough impact your overall health?

If a cough continues without any improvement, there is a risk that it can start to impact other areas of your life and lead to:4,5

  • loss of sleep
  • fatigue
  • chest pain
  • headache
  • vomiting 
  • frustration
  • relationship tensions
  • irritation of colleagues.

This is why it's important to do everything you can to get better as quickly as possible. There are various ways to aid your recovery and it is important to understand your treatment options.

Identifying what kind of cough you’re suffering from can help narrow down possible suspects for the condition that’s causing it. Getting the right treatment will put you on the road to recovery sooner rather than later.

References
  1. Eccles R and Mallefet P. Soothing properties of glycerol in cough syrups for acute cough due to common cold. Pharmacy 2017; 5(1)4.
  2. Chung KF. Management of cough. In: Chung KF et al. Cough: Causes, mechanisms and therapy 2003; Chapter 27:283-297.
  3. Munyard P and Bush A. How much coughing is normal? Arch Dis Child 1996; 74:531-534.
  4. Morice AH et al. Recommendations for the management of cough in adults. Thorax 2006; 61 Suppl 1:i1-24.
  5. Chung KF. The clinical and pathophysiological challenge of cough. In: Chung KF et al. Cough: Causes, mechanisms and therapy 2003; Chapter 1:3-10.
  6. McGarvey LPA. Clinical assessment of cough. In: Chung KF et al. Cough: Causes, mechanisms and therapy 2003; Chapter 4:27-37.
  7. Irwin RS et al. Managing cough as a defense mechanism and as a symptom: A consensus panel report of the American College of Chest Physicians. Chest 1998; 114:133S-181S.
  8. Polverino et al. Anatomy and neuro-pathophysiology of the cough reflex arc. Multidiscip Respir Med 2012; 7:5.
  9. Haddad G. The pathophysiology of cough. In: Elzouki AY et al. Textbook of clinical pediatrics 2012; Chapter 226:2149-2151.
  10. Murata A et al. Discrimination of productive and non-productive cough by sound analysis. Intern Med 1998; 37:732-735.
  11. Begic E et al. Productive cough in children and adolescents – view from primary health care system. Med Arch 2017; 71:66-68.
  12. Chang AB et al. Cough quality in children: A comparison of subjective vs. bronchoscopic findings. Respir Res 2005; 6:3.
  13. Dicpinigaitis PV et al. Acute cough: A diagnostic and therapeutic challenge. Cough 2009; 5:11.
  14. Alsubaie H et al. Clinical practice guidelines: Approach to cough in children. Int J Ped Adol Med 2015; 2:38-43.
  15. De Blasio F et al. Cough management: A practical approach. Cough 2011; 7:7.
  16. Silvestri RC and Weinberger SE. Evaluation of subacute and chronic cough in adults. Available at: https://www.uptodate.com/contents/evaluation-of-subacute-and-chronic-cough-in-adults?search=COUGH&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Last accessed 28 Feb 2018.
  17. Chang A. Causes, assessment and measurement of cough in children. In: Chung KF et al. Cough: Causes, mechanisms and therapy 2003;Chapter 7:57-73.