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Coughs - Topic Overview

Coughing is the body's way of removing foreign material or mucus from the lungs and upper airway passages or of reacting to an irritated airway. Coughs have distinctive traits you can learn to recognize. A cough is only a symptom, not a disease, and often the importance of your cough can be determined only when other symptoms are evaluated. For information about coughs in children, see the topic Coughs, Age 11 and Younger. Productive coughs A productive cough produces phlegm or mucus (sputum). The mucus may have drained down the back of the throat from the nose or sinuses or may have come up from the lungs. A productive cough generally should not be suppressed-it clears mucus from the lungs. There are many causes of a productive cough, such as: Viral illnesses. It is normal to have a productive cough when you have a common cold. Coughing is often triggered by mucus that drains down the back of the throat. Infections. An infection of the lungs or upper airway passages can cause a cough. A productive cough may be a symptom of pneumonia, bronchitis,sinusitis, or tuberculosis. Chronic lung disease. A productive cough could be a sign that a disease such aschronic obstructive pulmonary disease (COPD) is getting worse or that you have an infection. Stomach acid backing up into the esophagus . This type of coughing may be a symptom of gastroesophageal reflux disease (GERD) and may awaken you from sleep. Nasal discharge (postnasal drip) draining down the back of the throat. This can cause a productive cough or the feeling that you constantly need to clear your throat. Experts disagree about whether a postnasal drip or the viral illness that caused it is responsible for the cough. Smoking or other tobacco use. Productive coughs in a person who smokes or uses other forms of tobacco is often a sign of lung damage or irritation of the throat or esophagus.

Nonproductive coughs A nonproductive cough is dry and does not produce sputum. A dry, hacking cough may develop toward the end of a cold or after exposure to an irritant, such as dust or smoke. There are many causes of a nonproductive cough, such as:

Viral illnesses. After a common cold, a dry cough may last several weeks longer than other symptoms and often gets worse at night. Bronchospasm. A nonproductive cough, particularly at night, may mean spasms in the bronchial tubes (bronchospasm) caused by irritation. Allergies. Frequent sneezing is also a common symptom of allergic rhinitis. Medicines called ACE inhibitors that are used to control high blood pressure. Examples of ACE inhibitors include captopril (Capoten), enalapril maleate (Vasotec), and lisinopril (Prinivil, Zestril, or Zestoretic). Exposure to dust, fumes, and chemicals in the work environment. Asthma. A chronic dry cough may be a sign of mild asthma. Other symptoms may include wheezing, shortness of breath, or a feeling of tightness in the chest. For more information, see the topic Asthma in Teens and Adults. Blockage of the airway by an inhaled object, such as food or a pill. For more information, see the topic Swallowed Objects. Many coughs are caused by a viral illness. Antibiotics are not used to treat viral illnesses and do not alter the course of viral infections. Unnecessary use of an antibiotic exposes you to the risks of anallergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria. A careful evaluation of your health may help you identify other symptoms. Remember, a cough is only a symptom, not a disease, and often the importance of your cough can only be determined when other symptoms are evaluated. Coughs occur with bacterial and viral respiratory infections. If you have other symptoms, such as a sore throat, sinus pressure, or ear pain, see the Related Topics section. Use the Check Your Symptoms section to decide if and when you should see a doctor.

Signs and symptoms

The typical symptoms of a cold include cough, runny nose, nasal congestion and a sore throat, sometimes accompanied by muscle ache, fatigue, headache, and loss of appetite. present in about 40% of the cases and a cough in about 50%, half.
[3] [2] [1]

A sore throat is
[3]

while muscle ache occurs in about The

[4] [3]

In adults, a fever is generally not present but it is common in infants and young children.

cough is usually mild compared to that accompanying influenza. While a cough and a fever indicate a higher likelihood of influenza in adults, a great deal of similarity exists between these two conditions. number of the viruses that cause the common cold may also result in asymptomatic infections.
[7] [5][6]

The

color of the sputum or nasal secretion may vary from clear to yellow to green and does not predict the class of agent causing the infection.

Progression
A cold usually begins with fatigue, a feeling of being chilled, sneezing and a headache, followed in a couple of days by a runny nose and cough. typically peak two to four days after onset. for up to three weeks.
[10] [1]

Symptoms may begin within 16 hours of exposure

[8]

and

[3][9]

They usually resolve in seven to ten days but some can last

In children, the cough lasts for more than ten days in 35 40% of the cases and
[11]

continues for more than 25 days in 10%.

Cause
Viruses

Coronaviruses are a group of viruses known for causing the common cold. They have a halo, or crown-like (corona) appearance when viewed under an electron microscope.

The common cold is a viral infection of the upper respiratory tract. The most commonly implicated virus is a rhinovirus (3080%), a type of picornaviruswith 99 known serotypes.
[14] [12][13]

Others

include: coronavirus (1015%), human parainfluenza viruses, human respiratory syncytial virus, adenoviruses,enteroviruses, and metapneumovirus. present.
[15]

Frequently more than one virus is

[3]

In total over 200 different viral types are associated with colds.

Transmission
The common cold virus is typically transmitted via airborne droplets (aerosols), direct contact with infected nasal secretions, or fomites (contaminated objects).
[17] [2][16]

Which of these routes is of primary importance

has not been determined, however hand-to-hand and hand-to-surface-to-hand contact seems of more importance than transmission via aerosols. The viruses may survive for prolonged periods in the
[16]

environment (over 18 hours for rhinoviruses) and can be picked up by people's hands and subsequently carried to their eyes or nose where infection occurs. Transmission is common in daycare and at school
[18]

due to the proximity of many children with little immunity and frequently poor hygiene. are then brought home to other members of the family. commercial flight is a method of transmission. risk.
[17] [19] [16] [18]

These infections

There is no evidence that recirculated air during

However, people sitting in proximity appear at greater

Rhinovirus-caused colds are most infectious during the first three days of symptoms; they are

much less infectious afterwards.

Weather
The traditional folk theory is that a cold can be "caught" by prolonged exposure to cold weather such as rain or winter conditions, which is how the disease got its name. factor for the common cold is controversial.
[21] [20]

The role of body cooling as a risk

Some of the viruses that cause the common colds are

seasonal, occurring more frequently during cold or wet weather. to increased time spent indoors in proximity;
[23]

[22]

Some believe this to be due primarily

[18] [23]

specifically children returning to school.

However, it may Low humidity

also be related to changes in the respiratory system that result in greater susceptibility.
[24]

increases viral transmission rates potentially due to dry air allowing small viral droplets to disperse farther and stay in the air longer.

Other
Herd immunity, generated from previous exposure to cold viruses, plays an important role in limiting viral spread, as seen with younger populations that have greater rates of respiratory infections. immune function is also a risk factor for disease.
[27][28] [25][26] [25]

Poor

Insufficient sleep and malnutrition have been

associated with a greater risk of developing infection following rhinovirus exposure; this is believed to be due to their effects on immune function.

Pathophysiology

The common cold is a disease of theupper respiratory tract.

The symptoms of the common cold are believed to be primarily related to the immune response to the virus.
[29]

The mechanism of this immune response is virus specific. For example, the rhinovirus is typically
[29] [29]

acquired by direct contact; it binds to human ICAM-1 receptors through unknown mechanisms to trigger the release of inflammatory mediators. These inflammatory mediators then produce the symptoms.
[3]

It

does not generally cause damage to the nasal epithelium. The respiratory syncytial virus (RSV) on the other hand is contracted by both direct contact and airborne droplets. It then replicates in the nose and throat before frequently spreading to the lower respiratory tract. damage.
[30] [30]

RSV does cause epithelium

Human parainfluenza virus typically results in inflammation of the nose, throat,

and bronchi.

[31]

In young children when it affects the trachea it may produce the symptoms of croup due to
[31]

the small size of their airway.

Diagnosis
The distinction between different viral upper respiratory tract infections is loosely based on the location of symptoms with the common cold affecting primarily the nose, pharyngitis the throat, and bronchitis the lungs.
[2] [2]

There however can be significant overlap and multiple areas can be affected.
[3] [32]

The common cold Self-diagnosis

is frequently defined as nasal inflammation with varying amount of throat inflammation. is frequent. Isolation of the actual viral agent involved is rarely performed,
[3]

[32]

and it is generally not

possible to identify the virus type through symptoms.

Prevention
Physical measures to prevent the spread of cold viruses have been deemed the only potentially effective measures for prevention.
[33]

These measures include primarily hand washing and face masks; in the
[33]

health care environment, gowns and disposable gloves are also used.

Efforts such as quarantine are

not possible as the disease is so widespread and symptoms are non-specific. Vaccination has proved difficult as there are so many viruses involved and they change rapidly. vaccine is thus highly improbable.
[34] [33]

Creation of a broadly effective

Regular hand washing appears to be effective at reducing the transmission of cold viruses especially among children.
[35]

Whether the addition of antivirals or antibacterials to normal hand washing provides

[35]

greater benefit is unknown.

[35]

Wearing face masks when around people who are infected may be
[36]

beneficial; however, there is insufficient evidence for maintaining a greater social distance. Zinc supplementation may be effective at decreasing the rate of colds. Routine vitamin

C supplementation does not reduce the risk or severity of the common cold, though it may

Management

Poster encouraging citizens to "Consult your Physician" for treatment of the common cold

There are currently no medications or herbal remedies which have been conclusively demonstrated to shorten the duration of infection.
[14] [38]

Treatment thus comprises symptomatic relief.

[39]

Getting plenty of rest,

[40]

drinking fluids to maintain hydration, and gargling with warm salt water, are reasonable conservative measures. Much of the benefit from treatment is however attributed to the placebo effect.

Symptomatic
Treatments that help alleviate symptoms include simple analgesics and antipyretics such as ibuprofen
[41]

and acetaminophen/paracetamol.
[43]

[42]

Evidence does not show that cough medicines are

[44][45]

any more effective than simple analgesics

and they are not recommended for use in children due to a In 2009, Canada restricted the

lack of evidence supporting effectiveness and the potential for harm.

[44]

use of over-the-counter cough and cold medication in children six years and under due to concerns regarding risks and unproven benefits. cough medications.
[46] [47]

In adults there is insufficient evidence to support the use of

The misuse of dextromethorphan (an over-the-counter cough medicine) has led to

its ban in a number of countries.

In adults the symptoms of a runny nose can be reduced by first-generation antihistamines; however, they are associated with adverse effects such as drowsiness.
[39] [48]

Other decongestants such Ipratropium nasal spray may reduce the

as pseudoephedrine are also effective in this population.

symptoms of a runny nose but there is little effect on stuffiness. antihistamines however do not appear to be effective.
[50]

[49]

Second-generation

Due to lack of studies, it is not known whether increased fluid intake improves symptoms or shortens respiratory illness
[51]

and a similar lack of data exists for the use of heated humidified air.
[53]

[52]

One study

has found chest vapor rub to be effective at providing some symptomatic relief of nocturnal cough, congestion, and sleep difficulty.

Alternative treatments
While there are many alternative treatments used for the common cold, there is insufficient scientific evidence to support the use of most.
[39]

As of 2010 there is insufficient evidence to recommend for or Studies suggested that zinc, if taken within 24 hours of the
[36]

against either honey or nasal irrigation.

[58][59]

onset of symptoms, reduces the duration and severity of the common cold in healthy people.
[60]

Due to

wide differences between the studies, further research may be needed to determine how and when zinc may be effective. Vitamin C's effect on the common cold while extensively researched is disappointing,
[62][63]

except in limited circumstances, specifically, individuals exercising vigorously in cold environments.

[37][61]

Evidence about the usefulness ofechinacea is inconsistent.

[62] [65]

Different types of
[64]

echinacea supplements may vary in their effectiveness. trial of vitamin D did not find benefit.

It is unknown if garlic is effective.

A single

Prognosis
The common cold is generally mild and self-limiting with most symptoms generally improving in a week.
[2]

Severe complications, if they occur, are usually in the very old, the very young or those who
[66]

are immunosuppressed. an ear infection.

[67]

Secondary bacterial infections may occur resulting in sinusitis, pharyngitis, or

[68]

It is estimated that sinusitis occurs in 8% and an ear infection in 30% of cases.

Epidemiology
The common cold is the most common human disease typically have two to five infections annually twelve colds a year for school children). a worsening immune system.
[25] [39] [2][3] [66]

and all peoples globally are affected.

[18]

Adults

and children may have six to ten colds a year (and up to

Rates of symptomatic infections increase in the elderly due to