What your winter cough could be trying to tell you...ByAngela Epstein
While most coughs clear up within days, around 20 per cent become chronic and some can persist for years. It's important that any cough that has lasted for more than eight weeks is checked out by your GP. Here, with the help of experts, Angela Epstein looks at chronic coughs, their causes, and what treatment is available.
Most people find themselves with a cough for a part of the winter, but if it hangs around for days and weeks it is worth checking it out
POST NASAL DRIP COUGH
SYMPTOMS:Irritating, tickly or dry cough with a feeling of mucus or catarrh dripping down the throat. Can feel like there is a lump in the throat, eased by continually clearing it.
It may last for years and cause the throat to become sore and swollen. Accounts for 7 per cent of coughs.
CAUSE: The glands which line the nose and sinuses produce up to four pints of clear thin mucus a day. Little hairs in the sinuses usually brush mucus down the throat - this happens without us realising.
An allergy, hayfever or a cold can make mucus thick and sticky. Instead of draining normally, it drips down the throat, obstructing the airways, causing a coughing reflex.
TREATMENT:If it's due to an allergy, such as an allergy to dust, a steroid nasal spray will ease the inflammation causing the drip.
If caused by sinusitis - acute inflammation of the sinuses - antibiotics can help. Applying drops of a specially prepared salt solution up the nose may provide relief.
To administer them, ensure your head is down and forward so the liquid flows into the sinuses - tilting your head back sends them straight to your stomach.
ACID REFLEX COUGH
SYMPTOMS:A loud, harsh cough. The voice may become hoarse. Tends to occur after meals or at night; lying down allows acid to travel up the foodpipe from the stomach.
Talking, laughing or singing are triggers because they involve the diaphragm, which plays a part in controlling the reflux. Other symptoms are a lump in the throat and a bitter taste in the mouth.
CAUSE:One in ten Britons experiences acid reflux at some point in their lives. It's caused when a valve at the bottom of the gullet (oesophagus) fails to close properly so that acid from the stomach splashes - or 'refluxes' - back up the throat.
Most people associate heartburn with a burning sensation in the chest - but this doesn't always occur, and they may not realise their cough is a symptom of heartburn.
The cough occurs because the lining of the foodpipe is extremely sensitive, and the acid irritates it and triggers a cough.
TREATMENT:Antacids and proton pump inhibitors reduce acid production in the stomach. Avoid large, fatty meals and bedtime snacks, and reduce your alcohol and caffeine intake. It can also be treated with keyhole surgery.
LUNG CANCER COUGH
SYMPTOMS:Constant coughing, or coughing up blood-stained phlegm, shortness or breath or a change in a long-standing cough.
Other symptoms include a dull ache or sharp pain in the lung area when you cough or take a deep breath, shoulder pain or loss of appetite and weight.
'The problem is that it's possible to mistake symptoms such as constant coughing for a chest infection,' explains Dr Jesme Fox, medical director of the Roy Castle Lung Cancer Foundation. 'Though lung cancer is quite rare, it's vital you don't ignore these symptoms and see your GP, just to be sure.'
CAUSE:Lung cancer is the deadliest form of cancer in the UK, killing 92 people a day on average. Cigarette smoking is the cause of nearly all lung cancers and this risk increases with the number and strength of cigarettes a person smokes.
However, 10 per cent of lung cancer patients are non-smokers.
TREATMENT:Dependent on cancer - often involves surgery, radiotherapy and chemotherapy.
SYMPTOMS:Constant phlegmy cough, often worse in early morning. Wheezing, chest tightness and difficulty breathing.
Shortness if breath when sitting down. Symptoms are ongoing but worse in winter.
CAUSE:Chronic Obstructive Pulmonary Disease (COPD) - the collective name for lung conditions chronic bronchitis and emphysema.
The cough occurs as a result of inflammation in the lungs; this destroys the elasticity that allows them to expand and contract, and also affects the rate of oxygen absorption into the blood stream.
COPD usually affects people over 40 as damage to the lungs happens gradually. Although most commonly caused by smoking, around 10 per cent of cases are due to family history or exposure to dust or air pollution.
TREATMENT:There is no cure for COPD but the damage can be slowed down. It's vital to stop smoking and avoid passive exposure. Patients are encouraged to increase lung capacity by exercising as much as possible.
Physiotherapy clears mucus from the lungs and strengthens the upper body. Medication can be prescribed to make the airways wider, while steam inhalation and humidifying rooms can also help.
SYMPTOMS:Usually starts with a tickle at the back of the throat. This triggers spasms of coughing that can lead to vomiting.
Once coughing stops there should be no other ongoing symptoms. Tends to be a mucus-free cough.
CAUSE:Certain medications can cause coughing, particularly ACE Inhibitors, which are prescribed for high blood pressure; 5 per cent of those who use the drugs experience coughing.
'It may be that the drugs stop the breakdown of a chemical called bradykinin which, in turn, makes the nerve endings in the lungs more sensitive,' explains Professor Peter Barnes, head of respiratory medicine at Imperial College, London.
'Some people taking these medications also say their throat feels slightly raw and sensitive to touch.
'It can be especially noticeable when there's some pressure on the throat, perhaps when it's pressed against a pillow at night.'
TREATMENT:Ask your GP about alternative medication to lower blood pressure, such as angiotensin II receptor antagonists, which should not cause coughing.
'Doctors usually prescribe ACE inhibitor I receptors first because they are better at preventing the side effects from heart disease,' explains Ashley Woodcock, professor of respiratory medicine at University Hospital, South Manchester.
'Around 90 per cent of users who swap from type I to type IIclear their cough within a week or so, although some users can take up to three months.'
UNDIAGNOSED ASTHMA COUGH
SYMPTOMS:Wheezy cough; tight chest and difficulty breathing.
Cough tends to be worse at night or upon waking - lying flat allows mucus to collect in the airways.
'Ten per cent of people don't realise they have asthma,' says the British Lung Foundation's Dr Keith Prowse.
CAUSE:Asthma is a chronic disease in which sufferers have repeated attacks of difficulty in breathing, as well as coughing attacks.
When the sufferer comes into contact with something that irritates their airways, such as dust, the muscles around the walls of the airways tighten, narrow and the lining of the airways becomes inflamed and starts to swell.
TREATMENT:Usually a steroid inhaler; commonly beclomethasone, budesonide or fluticasone.
Taken to immediately relieve asthma symptoms and deliver a small dose of the drug to the airways, relaxing the muscles around the narrowed airways. This allows them to open up, making breathing easier.
SYMPTOM:A chronic, dry cough that goes on intermittently for years. Usually happens during the day and produces a coughing 'fit' that lasts for around ten minutes.
This then spontaneously settles down but can recur an hour or so later. Sufferers can cough up to 400 times in 24 hours and suffer side effects such as fractured ribs and even incontinence.
CAUSE:Up to 15 per cent of chronic coughs have no obvious cause, according to University Hospital's Professor Woodcock.
He says: 'These coughs are not caused by a disease itself, but by a hypersensitivity of the person's cough reflex. This means they are overly sensitive to anything that contacts their throat and this triggers a coughing fit.
'Many sufferers have rib fractures as a result of the intense pressure put on their ribcage caused by coughing, which is very painful.
'And because the action of coughing can cause muscles in the pelvis to contract, it can result in incontinence, which is deeply distressing.'
TREATMENT:It's important that all potential causes, such as post-nasal drip and acid reflux are investigated.
This can be done through a range of tests such as a bronchoscopy, where a camera at the end of a flexible tube is inserted into the throat, and a function test on the oesophagus to test acid levels.
'If there is no specific trigger, soothing the cough is the only option, perhaps by sucking a strong menthol lozenge,' says Professor Woodcock.http://www.dailymail.co.uk/health/article-1079214/What-winter-cough-trying-tell-
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