Coughing: what might it be a sign of?
Written by:In 2021, we are more aware of our own health, and in-particular symptoms of an underlying lung disorder. We got in contact with the experienced and recommended specialist in pulmonology and respiratory medicine Dr Farid Bazari, who is based in London, to find out about the different types of cough and what their causes are. We also discussed the warning signs that indicate you should see a doctor about a cough.
Why do we cough in general?
Cough is a reflex to airways irritation in the lungs. The cough is to aid for clearance of lungs, as a natural clearance method. A cough can also be a controlled reaction, it can be initiated at will. It’s a natural reflex if you irritate the airways for example. It can be a natural response to irritants, habit or other factors to clear lungs, or may be the first common symptom of a range of lung diseases.
What are the different possible characteristics of a cough?
Assessing a patient with a cough requires a full history and examination, to be followed by specialist investigations to try and identify a cause.
In terms of history, the chronicity, characteristics at onset, other associated symptoms, whether it is a dry or productive cough gives information. If it’s productive it means there is mucus that needs to be cleared.
We look at characteristics, the time of day coughing occurs, external factors, (for example, cold air) and whether it occurs during exercise. We also look at certain characteristics, if the cough has a barking nature, or a whooping cough. These all are clues to the cough that will guide the investigation. Whooping may be a sign of bronchitis for example.
Associations with other red flag symptoms, such as losing weight, breathless, fevers or sweats or if there is blood produced, are all red flags.
What are the possible conditions that it might be a symptom of?
Cough is one of the most common symptoms presenting to medical practitioners, it can be due to a whole range of respiratory symptoms, and most cough of less than 3 weeks is self resolving.
However, if the patient has an underlying respiratory disease, or there are other associated symptoms, a history of significant smoking, or a cough lasting more than 3 weeks, we would investigate as to the underlying cause.
Serious conditions can include:
- COVID-19 or other viral bronchitis
- Lung fibrosis
- Lung cancer
- Asthma or other obstructive airways disease such as COPD
- Allergies
- Acid reflux
- Post nasal drip
- Bronchiectasis
- Chronic lung infections or TB
- Idiopathic cough
The commonest causes can often be identified through a chest x ray or lung function tests. A CT scan of the chest is often helpful if there are other symptoms accompanying the cough, or to exclude more serious conditions. There are blood tests and other tests such as those of airways inflammation through breath assessment that can help in making a definite diagnosis and treatment plan.
What about a cough in relation to COVID-19?
A common symptom of COVID-19 is a persistent cough. During the pandemic, if you are suffering from a persistent cough, you will need to isolate and get a PCR test. Lots of other causes may be identified, if its chronic and persistent, other symptoms may include coughing up blood and weight loss. You should seek medical advice from a specialist if this is the case.
Most cough caused by COVID-19 will resolve, but a small proportion may become chronic that may require specific treatment. If the initial infectious period has passed, or there is breathlessness, a chest x ray or CT scan to makes sure there’s no COVID-19 inflammation in the lungs will be necessary.
When should someone see a doctor about their cough?
If a person develops a new cough with other associated symptoms such as breathlessness, fevers, sweats, weight loss, chest pain, coughing blood or coloured sputum, they should seek early medical advice. Of course, during the pandemic, any person with a new persistent cough should seek advice and request a PCR test to exclude COVID-19. If the cough has associated symptoms, a chest Xray and further investigations are necessary. We would always investigate a cough that has lasted more than 3 weeks, in-particular if there are underlying lung disorders or a history of significant smoking.
If you are concerned about a recurrent cough and wish to schedule a consultation with Dr Farid Bazari, you can do so by visiting his Top Doctors profile.
