Cough: Understanding Causes and Management

Cough

• Coughing is a defense mechanism to clear the airway.
• It occurs when the airway is obstructed or irritated.
• Viral upper respiratory tract infections (URTIs) are the most common cause of cough.
• Cough can signal various conditions like bronchitis, laryngitis, pneumonia, and GERD.
• Acute cough lasts less than 3 weeks, and chronic cough persists beyond 8 weeks.
• Refer any cough lasting longer than 3 weeks to a doctor.
• Important information to collect from the patient includes:
  • Age
  • Duration of cough
  • Nature of cough (dry or productive)
  • Associated symptoms (cold, sore throat, fever, chest pain, shortness of breath, wheezing)
  • Previous history (COPD, asthma, diabetes, heart disease, GERD, smoking habit)
  • Current medication
• Possible causes of cough based on their likelihood in community pharmacy:
  • Most Likely: Viral infection
  • Likely: Upper airways cough syndrome, acute bronchitis
  • Unlikely: Croup, chronic bronchitis, asthma, pneumonia, ACE inhibitor induced cough
  • Very Unlikely: Heart failure, tuberculosis, cancer, pneumothorax
• Trigger points for referral:
  • Chest pain, hemoptysis (coughing up blood), pain on inspiration, wheezing, or shortness of breath
  • Cough lasting longer than 3 weeks
  • Cough that recurs regularly
  • Debilitating symptoms in the elderly
  • Persistent nocturnal cough in children
• Treatment timescales:
  • Patients should consult their doctor 3 weeks after the cough onset if it hasn't improved.
  • Antitussives are used for non-productive coughs.
  • Mucolytics and expectorants are indicated for productive coughs.
  • Antitussives suppress cough:
    • Narcotics: Codeine, dihydrocodeine, pholcodine (can be addictive, cause constipation, dysphoria, and fatigue)
    • Non-narcotic: Dextromethorphan (no analgesia, low addictive potential, better side effect profile)
    • Topical Antiussives: Menthol and camphor (provide cooling and local anesthetic effects, available as ointments, lozenges, and steam inhaler)
  • Mucolytics break down mucus:
    • Acetylcysteine (can cause bronchospasm, GI irritation and high liability for drug-drug interactions)
    • Carbocysteine (safer in asthmatic patients as it doesn't cause bronchospasm, more effective in chronic conditions due to decrease in mucus hyperplasia)
  • Expectorants stimulate respiratory secretions:
    • Guaifenesin
    • Side effects of expectorants include nausea, vomiting, and diarrhea

Headaches

• Headaches occur due to stimulation of pain-sensitive structures in the head and neck.
• These include meninges, blood vessels, nerves, and muscles.
• Primary Headaches are more common and recurrent. These are:
  • Tension headaches:
    • Most common type, more frequent in females.
    • Slow, gradual, bilateral, tight, "band-like" with no other symptoms.
    • Lasts between 30 minutes and a week.
    • Triggered by stress and dehydration.
    • Treatment: NSAIDs for pain relief, Amitriptyline or other tricyclic antidepressants for chronic pain.
  • Migraine Headaches:
    • Also more common in females.
    • Usually have specific triggers (foods, weather, lights, noises, exertion, sleep deprivation).
    • Typically severe, unilateral, throbbing, worsening with movement.
    • Lasts 4-72 hours.
    • Accompanied by nausea, vomiting, photophobia, phonophobia.
    • Treatment: NSAIDs, analgesics, Sumatriptan for severe migraines.
    • Prevention: Lifestyle changes, beta-blockers like propranolol, amitriptyline.
    • Aura: Precedes or occurs during headache, includes visual symptoms (bright lights, zig-zag lines) or neurological symptoms like tinnitus, aphasia, confusion.
    • Hemiplegic Migraine is a type of migraine with temporary paralysis of one side of the body, which can be mistaken for a stroke.
  • Cluster Headaches:
    • Rarest type, mainly affecting males.
    • Excruciating, stabbing pain located behind the eye, occurring unilaterally.
    • Occur daily for 8-10 weeks in a year, followed by periods of absence.
    • Happen at similar time every day.
    • Last 15 minutes to 3 hours.
    • Linked to smoking and alcohol.
    • Symptoms: Individuals pace around, seeking relief, experience autonomic symptoms on the affected side (ptosis, miosis, lacrimation, nasal congestion).
    • Treatment: 100% oxygen, Sumatriptan.
    • Prophylaxis: Verapamil, valproic acid, lithium.
• Secondary Headaches are caused by specific underlying medical conditions:
  • Subarachnoid hemorrhage
  • Meningitis
  • Sinusitis
  • Brain abscess
  • Brain tumor

Explore the nuances of cough, a vital defense mechanism for clearing airways. Learn about acute versus chronic cough, common causes, and essential patient information to gather. This quiz will enhance your understanding of coughs related to various respiratory conditions.