Cough and its treatment

  1. What can we do at home for cough is good?

Simple measures that can be taken at home when coughing first starts include:

  • First of all, it is necessary to drink plenty of warm water, the best treatment to soften the secretions is to drink plenty of water, but it is appropriate to drink warm water, not cold. At least two lukewarm waters per day, and more if possible, are recommended.

  • If the cough increases at night – especially during the first hospitalization, it may increase due to post-nasal drip – the head of the bed should be elevated, and if necessary, a double pillow should be used.

  • The nose must be kept open. If the nose remains blocked, mouth breathing will occur and the throat will dry out and the cough will increase.

  • It would be appropriate not to smoke if the cougher smokes himself, not to smoke if he does not smoke, and to stay away from all kinds of sharp odors during this period.

  • Again, heavy exertion can trigger coughing, the patient with cough should avoid heavy exertion.

  • If the cause of the cough is reflux, precautions should be taken, and if the diagnosis has been made before, the physician should be informed and the treatment should be reviewed.

  • If cough exceeds 2 weeks and/or increases after URTI, a physician should be consulted.

  • Cough suppressants are not suitable for the patient to use on their own, they must be used under the supervision of a physician. Moreover, today, the use of cough suppressants is very limited, and it is preferred to treat the cause rather than cutting the cough.

  1. How is cough treated?

Cough will only go away if the cause is treated. It is useless to use antibiotics and cough syrups, as we often encounter, if there is a tickling cough due to asthma. What needs to be done is to organize the treatment according to the level of asthma in line with the recommendations of a chest diseases specialist and to follow up. In the presence of reflux-related cough, the patient should be referred to gastroenterology and treated after necessary examinations and follow-up should be performed by a specialist physician. It is also important to inform the patient about nutrition. It may also be the blood pressure medication used by the patient causing the cough, in this case, the cough will be stopped by changing the medication. However, sometimes the cough may be prolonged up to 3 months after the cessation of treatment, and the patient should be informed about this. In the case of interstitial fibrosis with loss of flexion in the lungs, necessary treatment should be applied in the follow-up of the pulmonologist. Again, if the cough due to post-nasal drip is allergic, it will be appropriate to plan surgical treatment with ENT intervention in the presence of a condition that requires treatment for the cause in terms of allergy and surgery such as bone curvature. Sometimes, we may encounter coughs that are not due to a physical cause, which we call psychogenic cough. After all other causes have been ruled out, that is, if the patient’s examination findings, chest X-ray, pulmonary function tests, ENT examination, evaluation in terms of reflux do not reveal any pathology, but if the tickling cough continues, if the patient’s history also suggests psychic cough, it is useful to ask for a psychiatric consultation.

  1. When should we go to the doctor if we are coughing?

If there is sputum with a cough and the sputum is yellow-green in color and has a thick consistency, if there is fever with it, we should definitely go to the doctor. Because a pneumonia, that is, pneumonia, should not be missed, the lower respiratory tract of the patient should also be examined by the physician. If bloody sputum comes out with coughing, we should immediately consult a pulmonologist. This may be due to a simple nosebleed or bleeding due to post-nasal drip after sinusitis, or it may be due to a much more serious cause. A tumoral mass in the lung or tuberculosis, ie tuberculosis, or bronchiectasis or pulmonary embolism, may be the case of clotting in the pulmonary vein, and all of these conditions require very serious treatment. Apart from this, any cough that lasts for a long time should be investigated. A doctor should be consulted for coughs exceeding 2 weeks. Bronchial hyperreactivity – airway edema – that develops after viral URTI may cause a long-lasting dry cough, or a prolonged cough may be the only symptom of mild asthma. Again, in the case of interstitial fibrosis, which goes with loss of flexibility in the lungs, there is a long-term cough, and it is seen only during exertion in the early period. In other words, in the presence of cough with exertion, a physician should be consulted. In summary, cough can be a sign of many serious diseases, long-term cough should be investigated.

  1. What are the causes of cough?

Cough can be caused by various reasons. In order to determine the cause of the cough, it is important to take a detailed history, the duration of the cough, its character – that is, whether it is sputum or not. In addition, the factors that trigger cough and accompanying complaints should be known. All this information is evaluated and the cause of the cough is tried to be determined.

*The common cold is the most common cause of cough, but it usually clears up in a short time.

* Asthma- The most common cause of prolonged coughing is asthma. Sometimes the early symptom of asthma is a tickling cough and the patient has no other complaints. Especially in the presence of a dry cough for more than 3 weeks, the patient should apply to the chest diseases department and be evaluated for asthma, examined and pulmonary function test should be performed. Triggering cough with strong odors, cold, and exertion are findings supporting asthma. Again, cough that increases at night should bring to mind the asthma disease.

* Nasal discharge due to conditions such as chronic upper airway cough syndrome, chronic sinusitis in the upper respiratory tract, and allergic rhinitis can lead to dry cough. It is more common in allergy sufferers.

* Gastroesophageal reflux–GER is the cause of a significant proportion of patients with chronic cough. Cough usually starts a few hours after eating. Sometimes it can occur after going to bed at night. Cough may be accompanied by burning and heartburn in the stomach, bitter water in the mouth, a burning sensation in the chest, and hoarseness.

* It has been determined that 50-90% of asthma patients have reflux. In other words, reflux is more common than normal in people with asthma. This is because asthma relaxes the muscles surrounding the stomach head. In this case, it is easier for the acidic contents of the stomach to escape into the esophagus. In addition, today air pollution, additives, GMO foods, etc. For many reasons, the rate of allergy and asthma is increasing all over the world. Therefore, the association of asthma reflux should not be overlooked.

*Cigaret

* Tuberculosis, that is, tuberculosis – In 2010, 16,500 registered tuberculosis patients were detected in our country. Symptoms of tuberculosis are fever, night sweats, weight loss, loss of appetite and fatigue, especially in the evening. cough lasting more than two weeks, sputum production, coughing up variable amounts of blood, chest pain and shortness of breath. Complaints usually begin mildly and progress slowly. Patients may attribute these complaints to other causes and go to the doctor late. For this reason, it is also important to evaluate the coughing patients who have tuberculosis in their relatives, that is, who have a contact history, in this direction. The domestic contacts of the patients are screened in VSDs, but there is no problem in screening, and it is important to be more vigilant for patients who have complaints afterwards.

*Diffuse interstitial lung disease, i.e. loss of flexibility in the lungs, fibrosis

*ACE inhibitor blood pressure medications

*Pleura-lung membrane- diseases

*Mediastinal diseases

*External ear diseases

*psychogenic

  1. Is cough contagious?

If the cough is caused by an infection, it can also occur in the surrounding individuals with the transmission of the infection. This is due to the transmission of the infection, not the transmission of the cough. Especially children and the elderly, individuals with allergic structure, those with chronic lung, heart, kidney disease, diabetics, immunosuppressed individuals receiving chemotherapy and radiotherapy are more susceptible to all kinds of infections, especially respiratory viral and bacterial infections, and are more susceptible to epidemics in winter months. Therefore, cough complaints may also occur. Again, since tuberculosis is contagious, people infected with this disease also have a cough.

Dry cough and its treatment**

  1. Dry cough, how is it treated?

Treatment of dry cough should be directed towards the cause. The main causes of dry cough are asthma, postnasal drip and reflux due to upper respiratory tract problems. In the presence of dry cough due to asthma, treatment should be arranged according to the level of asthma, and bronchodilator (bronchodilator) and anti-inflammatory (protective) drugs should be given at the required dose. In addition, the patient should be informed about the disease and the details of the treatment, and it should be ensured that he/she uses his/her medications for the required time and dose. Again, if the dry cough due to post-nasal drip is allergic, cause-specific treatment should be applied in terms of allergy. Long-term antibiotic therapy under the supervision of an otolaryngologist in the presence of chronic sinusitis; In the presence of a condition that requires surgical operation, such as intranasal polyp, curvature of the nasal bone, it would be appropriate to plan surgical treatment with ENT intervention. If there is a dry cough due to reflux, the patient should be referred to gastroenterology, if necessary, endoscopy should be performed and treatment should be arranged. It is also important to inform the patient about nutrition. Sometimes it is the blood pressure medication used by the patient that causes dry cough. In this case, changing the drug will be sufficient to relieve the cough. Sometimes, we may encounter coughs that are not due to a physical cause, which we call psychogenic cough. If no other physiological reason to explain the dry cough can be found after all other causes have been ruled out, and if the patient’s history also suggests psychic cough, it is appropriate to ask for a psychiatric consultation in these cases.

  1. What causes dry cough?

Cough is a mechanical defense barrier that prevents the intake of foreign and harmful objects into the respiratory system and protects the lung by removing excessive secretions from the airways. Cough, which is defined as dry cough, is a type of cough in which sputum does not come out or very little sticky sputum can be forced out. It usually comes in attacks, it is a cough that makes the patient tired. The most common causes of dry cough are cough triggered by nasal discharge due to upper respiratory tract problems, cough due to asthma and reflux. If the nasal discharge is small and sticky during URTI, it may cause a dry cough, and if an asthma-like picture develops with edema in the membrane lining the inner surface of the bronchi, which we call airway hyperreactivity, this may cause long-lasting dry coughs. Another cause of dry cough is asthma. Sometimes the only symptom of asthma – especially mild asthma – may be a prolonged dry cough. The increase in dry cough at night, triggered by exertion, sharp odors, exacerbation in a dusty environment, humid environment or seasonal changes suggest asthma. In addition, one of the most common causes of dry cough is reflux. There may be a burning sensation in the stomach and a feeling of pain in the back of the chest. Increasing cough after meals and increasing at night should bring reflux to mind. In addition, in the conditions of our country, tuberculosis disease, some blood pressure medications, smoking, the condition we call fibrosis in the lungs, diseases of the space between the two lungs, which we call the mediastinum, psychological reasons, etc. Many conditions can cause a dry cough.

  1. How to prevent dry cough?

The priority in the prevention of cough is to eliminate the causes.

For example, in the presence of asthma, it is important to stay away from triggers. If the patient is allergic, it should be ensured that measures are taken depending on the substance that is allergic, that is, allergen, not smoking at home, avoiding sharp odors, and most importantly, the patient should use the necessary drugs in the required dose. Of course, early diagnosis of asthma is important for this. Because sometimes the only symptom of asthma is a long-lasting dry cough, and if the patient does not reach the pulmonologist and pulmonary function tests are not performed, the diagnosis of asthma may be delayed.

Similarly, an asthma-like picture occurs in airway sensitivity after upper respiratory tract infections and causes long-lasting dry coughs. In this case, starting treatment for airway sensitivity early, especially in allergic patients, will prevent prolonged coughs. Taking a good history in terms of reflux is also highly instructive. The increase in cough after meals and sometimes at night suggests reflux first. In this case, both the necessary treatment is started and the increase in cough is prevented by informing the patient about nutrition and lifestyle. Again, when the dry cough starts, if the patient has other findings such as weight loss, night sweats, chest X-ray should be taken and the possibility of tuberculosis, that is, tuberculosis, should be evaluated, and sputum and blood tests should be requested if necessary. Sometimes used blood pressure medications can cause dry cough, it is important to change the medication used by the patient if there is a medication that will cause this. In addition, smoking is definitely a cause of cough and it is necessary for all individuals to be encouraged to quit smoking as early as possible.

  1. Does smoking too much cause a dry cough?

Smoking is one of the most important causes of cough. There are more than 4000 different harmful substances in cigarettes. Cigarette is an irritant. The most common type of substance abuse in the world is cigarette addiction. Cigarette smoking is the cause of nearly 50 chronic diseases and nearly 20 fatal diseases. The most well-known harm of smoking is on the lungs. Smoking is responsible for 80% of chronic lung diseases.

*80% of people with COPD are smokers, on the other hand, 20% of smokers develop COPD. There is a dose-dependent relationship between smoking and COPD, and heavy smokers have a higher risk of developing COPD. Passive smoking exposure also increases the risk of developing COPD. COPD is one of the major causes of cough.

* Since smoking causes permanent damage to the airways, destruction of the lung defense systems, and unresponsiveness to the treatments for the lungs, it causes diseases that cause airway narrowing such as chronic bronchitis and emphysema.

* Half of smokers have chronic bronchitis. In these patients, morning cough and sputum begin first, and then shortness of breath is added.

*Smoking paves the way for asthma, complicates the treatment of asthma, and causes severe asthma attacks. Environmental cigarette smoke exposure is the most frequently reported airway irritant in pediatric asthmatics. Reducing contact with environmental risk factors, especially smoking, is important not only to prevent the development of asthma, but also to control symptoms in those with asthma.

*Smoking increases reflux as it reduces the pressure of the lower end of the esophagus. Reflux is also one of the important causes of cough.

*Smoking suppresses the body’s immune system and prepares the ground for infection. Upper respiratory tract infections, sinusitis, otitis media, acute tonsillitis (tonsillitis), pharyngitis are common in smokers, and dry cough complaints related to these are very common.

*Lung cancer is 15-20 times more common in smokers than non-smokers, and cough is one of the most important symptoms in lung cancer.

Considering that every cigarette smoked shortens life by 5 minutes, I would like to remind you once again that smoking, which has an addictive effect 8 times more than cannabis and heroin, should be avoided.

EVERYTHING YOU KNOW ABOUT Cough

  1. Why do we cough?

Cough is a reflex mechanism created by the lower respiratory tract for self-cleaning and protection. Generally, coughing occurs involuntarily as a result of stimulation of the membrane lining the inner surface of the bronchus, which is located between the larynx and the bronchial tree. Irritant substances such as secretions and secretions in the airways, foreign bodies, mechanical factors pressing on the outer wall of the bronchi, nicotine, bleach and detergents, and polluted air are responsible for the initiation of the cough reflex. It is divided into 3 groups according to the duration of cough.

*Acute Cough – Cough lasting less than 3 weeks. Of the upper respiratory tract infections, the common cold is the most common cause of acute cough. However, acute cough can also be seen in lower respiratory tract infections, asthma, bronchiectasis, exacerbations in COPD patients, pneumonia, foreign body aspirations due to inhalation of toxic gas, and pulmonary embolisms.

*Subacute Cough – Cough lasting between 3-8 weeks. As this cough is frequently seen after pneumonia, bronchitis and pertussis infections in children; also unrelated to infection; It is a prolonged and recurrent cough that is also encountered in upper respiratory tract cough syndrome – that is, due to post-nasal drip – asthma patients, GER and bronchitis.

*Chronic Cough- It is a cough that lasts longer than 8 weeks, and in this case, the first thing to ask is whether the patient smokes and whether he has taken ACE inhibitor group blood pressure medication. If these are not present in the patient’s history, then the most common causes of chronic cough are upper respiratory tract cough syndrome – that is, cough due to post-nasal drip-, asthma and GER.

  1. Night cough can be a symptom of what ailments?

  • A dry cough, especially a tickling type, that increases at night should first bring to mind the asthma disease. Asthma patients often wake up at night with dry cough complaints. Then attacks of shortness of breath may be added. Moreover;

  • Nasal discharge due to conditions such as chronic upper respiratory tract cough syndrome, chronic sinusitis and allergic rhinitis in the upper respiratory tract can cause a tickling cough. This is more common in allergy sufferers. Finally

  • Gastroesophageal reflux is another condition that frequently causes nighttime coughs. GER is the cause in 5-41% of patients with chronic cough. Cough usually starts a few hours after eating. Cough often occurs after going to bed at night. Cough may be accompanied by a burning sensation in the chest, bitter water in the mouth, stomach complaints, hoarseness, but it is not necessary. Another issue to be considered is the association of asthma reflux. It has been determined that 50-90% of asthma patients have reflux. Especially today’s obesity, diet, additives, GMO foods, etc. For many reasons, the rate of allergy and asthma is increasing all over the world. Therefore, the coexistence of asthma reflux is an important problem that should be emphasized.

  1. In which situations can cough be a sign of lung cancer?

Cough in lung cancer is the first symptom in a quarter of patients, but in the absence of other suspicious symptoms, it alone does not suggest lung cancer and may be overlooked. At the time of diagnosis, 50-75% of lung cancer patients have cough and 25% have a cough with sputum. Especially bloody sputum is important. Lung cancer should be considered as the cause of cough and examination should be performed in the presence of a new cough in smokers, a change in the character of the previous cough, and bloody sputum with cough. If there is a history of passive smoking, exposure to carcinogens (cancer-causing substances) such as asbestos and radon, lung cancer should be considered, and if there is a previous history of cancer, the possibility of lung metastasis should be considered.

For persistent coughs lasting more than three weeks, referral to a pulmonologist and chest X-ray is recommended.

In patients who smoke and have bloody sputum, it is recommended to continue the examinations even if the chest X-ray is normal. The rate of diagnosis of lung cancer was found to be 3-5% in the further examinations of people with bloody sputum, over 40 years of age and with normal chest X-ray, and early diagnosis is very important in lung cancer.

  1. My lungs hurt when coughing, why?

*Pain in the chest when coughing is usually the feeling of the fire in the airways due to the inability to produce sputum due to a dry cough.

* Other than that, sometimes long lasting coughs can cause cracks in the ribs, in this case the patient may feel severe stinging pain when breathing. Although this condition is mostly seen in patients with osteoporosis, it rarely occurs in younger patients.

* In the presence of reflux, a severe burning and stinging sensation may occur in the chest with coughing and the passage of acidic stomach contents from the esophagus to the larynx and even to the airways with aspiration. Sometimes this condition is so serious that the patient may mistake it for heartache.

* Apart from this, there may be a feeling of pain in the chest in infectious diseases such as pneumonia (pneumonia), pleurisy (fluid accumulation between the lung membranes). In these cases, there are symptoms such as high fever, cough, sputum production along with chest pain. The pain often begins abruptly with other symptoms and is stinging during coughing or deep breathing and is felt on the lateral part of the chest wall. With the treatment of the infectious disease, its severity decreases in a short time and disappears.

* Chest pain that occurs due to pulmonary embolism is also in the form of flank pain and usually starts suddenly. In pulmonary embolism, apart from chest pain, there may be symptoms of fever, shortness of breath, cough, and coughing up blood, and this picture usually forces the patient to apply to the emergency room. It occurs due to obstruction of the pulmonary arteries or one of the branches of the arteries for any reason, and the blood flow to the lung is cut off. It is a life-threatening condition depending on the size of the occluded vessel. A blockage in one of the main arteries to the lungs can even lead to sudden death. Symptoms are sudden onset of severe and sharp chest pain. Chest pain increases with deep breathing or coughing. Other symptoms of pulmonary embolism are shortness of breath, rapid and short breathing, rapid heartbeat, restlessness and fatigue.

*Pneumothorax (lung collapse) may occur as a result of trauma or injury, or it may occur spontaneously as a complication of many lung diseases. In this case, a feeling of soreness and pain in the chest occurs with coughing, especially in the elderly and those with underlying advanced lung disease, and it is accompanied by shortness of breath, forcing the patient to apply to the emergency room.

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