Cough: Information & doctors on cough treatment

A cough is a cleansing and defense mechanism of the bronchial system. It always occurs when the self-cleaning mechanism of the bronchial tubes is impaired by smoke and dust, for example. If a cough lasts longer than eight weeks, it is described as chronic.

Find information and doctors for cough treatment here.

Coughing is a downstream cleansing and defense mechanism of the bronchial system. It occurs when the self-cleaning mechanism of the bronchial tubes is impaired, for example due to

• smoking or
• foreign material such as extreme exposure to smoke and dust

is impaired. If necessary, different sections of the airways can be cleansed by a cough. This is also referred to as mucociliary clearance.

If a cough lasts longer than eight weeks, it is described as chronic. The limit of eight weeks is derived from the period during which a cough occurs in unproblematic (infectious) diseases. It therefore marks the obligatory start of a detailed cough diagnosis.

A chronic cough is usually a symptom of another illness and can have very different causes. A chronic cough should therefore always be investigated by a doctor.

Productive and non-productive coughs

A clinical distinction is also made between productive (with sputum) and non-productive or dry cough (without sputum). However, the transition between the two forms is fluid. A cough is considered productive if 30 milliliters (about 2 tablespoons) of secretions are expelled within 24 hours.

The distinction between productive and non-productive coughs is of great importance for treatment planning : in the case of productive coughs, mucus-promoting agents tend to be used, while in the case of non-productive coughs, cough-irritant blocking agents are used.

Coughing is a defense reflex to clear the bronchial tubes © kues1 | AdobeStock

Chronic cough: usually caused by an illness

Coughing is an important protective reflex of the respiratory tract. At the same time, it is a symptom of almost all pulmonary (lung-related) and some extrapulmonary diseases.

Nevertheless, those affected do not take the cough seriously until it is too late, so that an early diagnosis is usually not made. In most cases, chronic cough is due to repeated respiratory infections.

If the cough persists for more than three months, a doctor should check whether obstructive pulmonary disease(COPD) or asthma is present.

Chronic coughing is often caused by tobacco consumption that damages the bronchial tubes(smoker's cough). However, other inhaled pollutants such as industrial dust can also cause a chronic cough.

The most common causes of chronic cough are

• Chronic (non-obstructive) bronchitis and obstructive lung disease (especially in smokers)
• Bronchial asthma (chronic cough as a cardinal symptom)
• Allergic diseases of the upper respiratory tract (persistent allergic rhinitis or allergic rhinitis)
• Chronic inflammation of the paranasal sinuses (chronic sinusitis)
• Pneumonia
• Tuberculosis
• Irreversible damage to the alveoli as part of pulmonary emphysema
• Pathological increase in the amount of connective tissue in the lungs(pulmonary fibrosis)
• Certain medications: ACE inhibitors, cortisone, beta blockers
• Bronchial tumors (chronic cough is a leading symptom of lung cancer)
• Vocal cord paralysis (recurrent paresis)
• Heart failure (coughing during physical exertion or when lying down)
• Heart attack and inflammation of the heart muscle(myocarditis)
• Food intolerances such as lactose intolerance
• Reflux of acidic stomach contents into the oesophagus(gastroesophageal reflux disease)
• Foreign body aspiration (especially in children)
• Pseudocroup (viral infection, especially in children)
• Whooping cough (pertussis, especially in children)
• Permanently obstructed nasal breathing (especially in children)
• Cystic fibrosis (genetic metabolic disorder that leads to damage to the lungs, among other things)

Therapeutic measures for chronic cough

Before starting any therapeutic measures, the cause must always be clarified. Otherwise the disease cannot be cured. Coughs usually disappear with the successful treatment of the underlying disease. For example, a cough caused by chronic bronchitis usually improves after four to six weeks of abstinence from nicotine.

The symptomatic treatment of coughs without diagnostic clarification is the most common practical error observed in the treatment of coughs. Nevertheless, in addition to causal therapy, symptomatic treatment with cough blockers or cough suppressants can be useful in chronic coughs. This applies, among other things, to

• acute respiratory tract infections to relieve the symptoms of a severe and painful cough
• severe illnesses in an advanced stage with no chance of cure (e.g. lung cancer)
• Cases in which the cause of the cough cannot be determined (so-called idiopathic chronic cough)
• Cases in which the effect of causal therapy is delayed (e.g. tuberculosis)

Cough suppressants

For productive coughs with sputum, mucolytic and expectorant substances in the form of

• tablets,
• juices and/or
• inhalations

are used. These include so-called secretolytics, mycolytics or expectorants.

These reduce the viscosity (viscosity) of the brochial secretions so that they become more fluid and can be coughed up more easily. The protective mucus layer on the mucous membrane of the respiratory organs and the cilia, which are impaired by the viscous mucus, can regenerate.

The following medicines can be used here

• Acetylcysteine (ACC) and
• bromhexine, guaifenesin and ambroxol and
• fennel oil and aniseed oil from the group of herbal essential oils

are used.

Cough blockers

In contrast, cough suppressants (so-called antitussives) are usually used for dry coughs. Cough blockers primarily inhibit the urge to cough. A dry, irritating cough in particular needs to be relieved at night with antitussive medication so that the person affected can sleep.

However, cough blockers should only be taken until mucus has formed to clear the airways. In some cases, not even longer than a week, as there is a risk of addiction (especially with codeine).

The following medicines are available

• Codeine,
• dihydrocodeine,
• clobutinol,
• pentoxyverine and
• dextromethorphan.

The plant world also offers cough-inhibiting effects. For example

• thyme,
• Drosera,
• marshmallow and
• ribwort extracts

can also be used.

The effect of

• syrups,
• cough syrups,
• gargle solutions or
• lozenges

is also based on "coating" the cough receptors in the throat with sugar syrup. The duration of action corresponds to the length of time the sugar remains on the cough receptors and is around 20 to 30 minutes. Other frequently used active ingredients are local anesthetics, herbal antitussives and expectorants.

Further measures against coughs

In some cases, anti-inflammatory substances (e.g. inhalations containing cortisone) can also be used to relieve inflammation of the mucous membranes in the throat and bronchi.

Antibiotics can be used for bacterial infections and bronchiectasis with a persistent cough.

In respiratory physiotherapy, those affected can learn coughing techniques that make it easier to cough up mucus or inhibit a non-productive cough.