Coughing is a cleansing and defense mechanism of the bronchial system. It occurs whenever the bronchi’s self-cleansing mechanism is impaired—for example, by smoke and dust. If a cough lasts longer than eight weeks, it is considered chronic.
Find information and doctors for cough treatment here.
Coughing is a secondary cleansing and defense mechanism of the bronchial system. It occurs when the bronchi’s self-cleansing mechanism is disrupted, for example by
- smoking or
- foreign matter such as extreme smoke and dust exposure
. When necessary, different sections of the airways can be cleared by a coughing fit. This is also referred to as mucociliary clearance.
If a cough lasts longer than eight weeks, it is considered chronic. The eight-week threshold is based on the duration during which a cough typically occurs in uncomplicated (infectious) illnesses. It therefore marks the point at which a comprehensive cough evaluation is required.
A chronic cough is usually a symptom of another underlying condition and can have a wide variety of causes. Therefore, a chronic cough should always be evaluated by a doctor.
Productive and Non-Productive Coughs
Clinically, a distinction is also made between productive coughs (with sputum) and non-productive or dry coughs (without sputum). However, the line between the two forms is blurred. A cough is considered productive if 30 milliliters (about 2 tablespoons) of secretions are coughed up within 24 hours.
Distinguishing between productive and non-productive coughs is crucial for treatment planning: Mucolytics are typically used for productive coughs, while cough suppressants are used for non-productive coughs.
Chronic cough: usually caused by an underlying condition
Coughing is an important protective reflex of the respiratory tract. At the same time, it is a symptom of nearly all pulmonary (lung-related) and some extrapulmonary diseases.
Nevertheless, those affected often do not take the cough seriously until it has persisted for some time, so an early diagnosis is usually not made. In most cases, a chronic cough is due to repeated respiratory tract infections.
If a cough lasts longer than three months, a doctor should be consulted to determine whether obstructive pulmonary disease (COPD) or asthma is present.
Chronic cough is often caused by tobacco use, which damages the bronchi (smoker’s cough). However, other inhaled pollutants, such as industrial dust, can also cause 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 conditions of the upper respiratory tract (persistent allergic rhinitis or allergic runny nose)
- Chronic sinusitis
- Pneumonia
- Tuberculosis
- Irreversible damage to the alveoli associated with pulmonary emphysema
- Pathological increase in the proportion of connective tissue in the lungs (pulmonary fibrosis)
- Certain medications: ACE inhibitors, cortisone, beta-blockers
- Bronchial tumors (chronic cough is the leading symptom of lung cancer)
- Vocal cord paralysis (recurrent laryngeal nerve palsy)
- Heart failure (coughing during physical exertion or while lying down)
- Heart attack and inflammation of the heart muscle (myocarditis)
- Food intolerances, such as lactose intolerance
- Reflux of acidic stomach contents into the esophagus (gastroesophageal reflux disease)
- Foreign body aspiration (especially in children)
- Pseudocroup (viral infection, especially in children)
- Whooping cough (pertussis, especially in children)
- Chronic obstruction of nasal breathing (especially in children)
- Cystic fibrosis (a genetic metabolic disorder that leads, among other things, to lung damage)
Therapeutic measures for chronic cough
Before beginning any therapeutic measures, the cause must always be determined. Otherwise, the condition cannot be cured. A cough usually resolves with successful treatment of the underlying condition. For example, a cough resulting from chronic bronchitis typically improves within four to six weeks after quitting smoking.
Symptomatic treatment of a cough without diagnostic evaluation is the most common clinical error observed in the management of coughs. Nevertheless, in cases of chronic cough, symptomatic treatment with cough suppressants or expectorants may be appropriate in addition to causal therapy. This applies, among other things, to:
- acute respiratory tract infections, to relieve symptoms associated with a severe and painful cough
- severe diseases in an advanced stage with no chance of cure (including lung cancer)
- cases in which the cause of the cough cannot be determined (so-called idiopathic chronic cough)
- cases in which the effects of causal therapy are delayed (including tuberculosis)
Cough suppressants
For productive coughs with sputum, mucolytic and expectorant substances are used for treatment in the form of
- tablets,
- syrups, and/or
- inhalations
. These include so-called secretolytics, mycolytics, or expectorants.
These reduce the viscosity (thickness) of bronchial secretions, making them more fluid and easier to cough up. The protective mucus layer on the mucous membranes of the respiratory tract and the cilia, which have been impaired by the thick mucus, can regenerate.
Medications that can be used here include
- acetylcysteine (ACC) as well as
- bromhexine, guaifenesin, and ambroxol, and
- from the group of plant-based essential oils, fennel oil and anise oil
can be used.
Cough suppressants
For dry coughs, on the other hand, cough suppressants (so-called antitussives) are usually used. Cough suppressants primarily inhibit the urge to cough. A dry, irritating cough, in particular, requires relief at night through cough-suppressing medications so that the person affected can sleep.
However, cough suppressants should only be taken until mucus has formed that needs to be coughed up to clear the airways. In some cases, they should not be taken for longer than a week, as there is a risk of addiction (especially with codeine).
The following medications are available:
- codeine,
- dihydrocodeine,
- clobutinol,
- pentoxyverine, and
- dextromethorphan.
The plant world also offers cough-suppressing effects. For example,
- thyme,
- Drosera,
- marshmallow, and
- ribwort plantain extracts
be used.
The effects 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 lasts about 20 to 30 minutes. Other active ingredients commonly found in these products include local anesthetics, herbal antitussives, and expectorants.
Additional Measures for Coughs
To alleviate inflammation of the mucous membranes in the throat and bronchi, anti-inflammatory substances (including corticosteroid inhalations) may be used in some cases.
Antibiotics may be used for bacterial infections and in cases of bronchiectasis with a persistent cough.
Through respiratory physiotherapy, patients can learn coughing techniques that facilitate the expulsion of mucus or suppress a nonproductive cough.
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