Cough

Coughing is your body’s way of removing foreign substances and mucus from the lungs and throat. This helps to reduce irritation and prevent infections from reaching the lungs.

We often associate cough with infections of the airway including viral infections such as the common cold or flu, or bacterial infections such as pneumonia or tuberculosis. However, cough may also be caused by:

• Choking
• Dry air
• Dust/animal dander (tiny flakes of skin)
• Smoke/air pollution
• Smoking
• Quitting smoking (in the first two weeks of the quit journey) 
• Postnasal drip (mucus dripping from the back of the nose into the throat) or Allergic rhinitis (https://www.healthhub.sg/a-z/medications/44/Allergic-Rhinitis) 
• Gastroesophageal Reflux Disease (GERD) – a condition where acid from the stomach flows back up from the food pipe to the airways, causing irritation and coughing
• Worsening asthma 
• Long-term medical conditions such as heart failure 
• Medications – some blood pressure medications may cause a chronic dry cough
• Rare but serious conditions where fluid or blood becomes trapped in the lungs 

There are 2 main types of cough:

 1. Unproductive/Tickly/Dry cough (cough without phlegm)

• The throat is typically scratchy, tickly or painful
• It may be caused by a viral infection, or by irritants which enter the throat such as dust and pollutants. 
• Coughs due to allergic rhinitis, a postnasal drip, medications and GERD are usually dry.

2. Productive or Chesty or Wet cough (cough with phlegm)

•  Phlegm is produced by the body to trap germs and keep the airway moist.
• However during an infection, more phlegm is produced, which may be thicker and need more effort to expel. During this period, phlegm tends to be worse in the morning due to a build-up of phlegm when you are sleeping. 
• While infections are the most common cause, a wet cough can also be due to asthma, heart failure, or more serious conditions where fluid or blood becomes trapped in the lungs.

Other types of cough include:

Barking or Whooping or Croup cough: 

• These are caused by specific viral or bacterial infections which lead to airway swelling.
• Such coughing make unique, high pitch wheezing sounds or a specific “whooping” sound at the end of the cough. At times the airway swelling can make it difficult for the person to breathe.
• Such coughing can be distressing in small children.

If your cough is due to another medical condition such as postnasal drip, asthma, or GERD, treating that condition is important in stopping the cough. 

If your cough is due to a medication, speak to your doctor to consider a change in your medication. However, do not stop taking your medication on your own without advice from your doctor.

If your cough is caused by smoking, it is highly recommended that you consider quitting. During the quitting process, you may notice an increase in coughing for the first two weeks as the lungs clear out the waste products which build up in your lungs when smoking cigarettes.

Cough can be treated using the medications below and you can ask your pharmacist for recommendations.

• Cough suppressants may be taken to reduce the body’s urge to cough. These are available through the doctor or can be obtained without prescription from your pharmacist. (https://www.healthhub.sg/a-z/medications/389/Cough-Suppressants)
• Expectorants and Mucolytics may help by thinning the phlegm and making it easier for your body to clear it either by spitting it out or swallowing it. These are readily available on the shelf of any grocery store or pharmacy or can be obtained through a pharmacist or doctor. (https://www.healthhub.sg/a-z/medications/390/Mucolytics-and-Expectorants)

Some doctors may prescribe medications which help open your airway. These may be  useful in providing relief if you have croup, whooping or asthmatic cough.

Although most coughs can be treated without a doctor’s consultation, there are times when the condition might be more serious.

If your cough does not get better in 2 weeks with self-treatment, gets worse or lasts for more than 8 weeks, you should see a doctor. You should also see a doctor if you:

• Have cough with thick yellow or green phlegm
• Have fever higher than 38.6°C
• Also have weight loss
• Cough out a large amount of phlegm or bloody or pink frothy phlegm
• Have night sweats
• Have difficulty breathing, wheezing or chest pains
• Are taking medications such as steroids or any medications which suppresses your immune system
• Have a history of medical conditions such as heart failure, asthma or chronic obstructive pulmonary disease (COPD)

Other than using medications to treat cough, it can also be managed by the following methods:

• Take care of your long-term medical conditions through regular visits to your doctor and take your medications as prescribed
• Drink plenty of water unless your doctor has advised you to limit your fluid intake
• Drink warm water with honey and lemon to soothe your throat
• Steam inhalation
• Applying natural oils such as eucalyptus to your chest and throat

Below are some suggestions to make it less likely for you to get a cough again:

• Wash your hands often with soap and water
• Avoid touching your eyes, nose and mouth
• Go for your yearly Influenza (flu) vaccination
• Elderly (those above 65 years old) and those with chronic lung conditions should also consider getting the pneumococcal vaccination
• Handle food with clean hands
• Have a healthy diet
• Get enough sleep
• If you are sick, wear a mask. Use a tissue to cover your mouth and nose when coughing and dispose of used tissues quickly
• Quit smoking and/or avoid second-hand smoke