Off with that cough

A-cough-can-be-a-symptom-of-an-illness,-or-even-a-reaction-to-medicine
What has age got to do with a cough? Dr. Aditya Agrawal explains

Cough is a protective reflex of our bodies. We cough involuntarily to protect ourselves or else we would damage the breathing systems in our body.

It can occur due to a large number of reasons. The lungs, heart, ear, nose, throat and also acidity or that blood pressure may result in a cough. But before we advance to the treatment or grab a bottle of cough syrup, we need to ask ourselves – what I am treating.

Classifying cough on the basis of the duration of symptoms helps to start our quest to identify the reason for the cough. Further on we need to look for any red flags related to our cough such as blood, or a person over 45 years getting a new or worsening cough with or without voice disturbance, a smoker (Current or ex) who has smoked more than a pack a day for 10 years, prominent shortness of breath in the day or at night on lying down, fever, weight loss, swelling over the feet or recurrent pneumonia, vomiting with or without an abnormal respiratory physical examination or chest radiograph.

Type of cough

The type of cough can tell a lot about the reason for your cough and what measures would be required to cure you of your ailment.

Cough is often associated with several side effects. We have had people having a loss of sleep or their partners are disturbed because of their sleep. Some have had blackouts due to attacks of cough and in the most severe cases, we have patients come to us with broken ribs due to the shear forces upon it. The elderly person coughing is at the greatest risk for falls and that is one dreaded complication.

In the younger population, allergies of the nose or throat, postnasal drip, asthma, and acid reflux are the cause of chronic cough in over 90% of the cases. Sudden onset of cough in children often makes us look in their mouth for choking hazards. Other causes of sudden onset of cough in a younger population revolve around infections of the nose, throat or tonsils.

Old age problems

Old age brings lower immunity and a higher risk of infections. All elderly should receive adult vaccinations. I know that my elderly grandparents and parents do take it and so do I. Seasonal influenza and Pneumococcal vaccines are highly recommended because they happen to be the most frequent reasons for respiratory infections.

Indoor and outdoor air pollution is increasing and it often results in bronchitis which leaves the insides of our lungs inflamed and constricted making us choke every second. With bronchitis comes the cough and breathlessness. Keeping our indoors clean, clutter-free and avoiding the use of aerosols helps. Early treatment of bronchitis helps prevent prolonged suffering.

Lung fibrosis is usually seen in older persons. The lungs get scarred and the process is usually irreversible. The scarred lung causes one to have a dry cough lasting several weeks or months or even years. An expert usually can help you navigate life through this complex disease.

Various conditions

In the elderly, new onset of cough should often send us looking for signs of pneumonia and more importantly an entity called aspiration pneumonia. This is a common cause of pneumonia where contents of the stomach and or intestines are inhaled into the lungs. Due to the lowering of the guard and weakness of the neck muscles, often the elderly have small quantities of stomach contents going into the lung. Patients with a history of stroke or muscle paralysis often have this type of pneumonia-causing cough. Alcoholics too are guilty of the same. Some elderly may have inhalation of small objects like food particles and even tooth or lose dentures.

Heart failure is a condition where the lungs fill up with fluids either in the lung or around it. This results in sleepless nights as this cough tends to increase on lying down. Patients usually complain of sudden onset of cough immediately or a few hours after lying down and the need to rush to the window to get fresh air. This occurs due to the redistribution of fluids from the bottom of the lungs to the top. Treatment of this revolves around the restriction on the number of fluids we drink and increased urination. Other signs of heart failure include swelling in the feet and legs.

The elderly often have more than one illness, and high blood pressure and heart diseases are common. A set of blood pressure medicines called ace inhibitors can result in a very nagging cough in some patients, if not all, and it is useful to let your doctor know what medicines you are taking each day.

Acid reflux

Another very common and often overlooked cause is acid reflux or acidity as we commonly know it. Acid returning upwards into your throat from the stomach often drips into the lungs. This results in a long-standing cough. It is often a very difficult diagnosis to prove, but trials with acid-reducing medications and lifestyle changes often result in a reduction of the symptoms.

With so many causes of cough known our old habit of grabbing for that cough syrup in which a friend of a friend was prescribed by a cousin who is a doctor in another town will not help. At the first instance set out to a doctor for identification of the cause of your cough and have appropriate treatment. Self-care is indeed the best care!

About Dr Aditya Agrawal

Dr Aditya Agrawal is a consultant pulmonologist at the Opera House Clinic and is attached to several large hospitals in South Mumbai. He has had extensive training in respiratory diseases in India and New York, and is a dedicated researcher and a peer influencer in management of respiratory diseases.

View all posts by Dr Aditya Agrawal

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