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Productive cough

Read in Hindi

Dr. Rajesh Vandra
Chest Physician/ Pulmonologist

verified

When you have a cough, what do you do? Wait for 2–3 days before reaching out for the cough syrup in your kitchen cabinet? Do you know if it is effective enough for the type of cough you suffer from? Before you answer that, do you even know what type of cough you have? A productive cough is one that produces mucus (sputum) or phlegm. This kind of cough helps in clearing mucus from the lungs. Therefore, it should not be suppressed.[1]

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Symptoms

A classic symptom of a productive cough is coughing with sputum or phlegm production. Usually, phlegm contains mucus with bacteria, debris or dead tissue, and sloughed-off cells. Other symptoms include:


  • Heaviness in the chest

  • Slight to severe breathlessness

  • Fever

  • Runny nose

  • Drainage of mucus into the throat

Causes And Risk Factors

Causes


Productive cough can be caused because of a number of factors. Some of them include -

  • Viral or bacterial lung infections such as in the case of a common cold.

  • Other more serious diseases such as asthma, pneumonia, chronic obstructive pulmonary disease (COPD), lung abscesses or other conditions such as bronchitis could manifest as productive cough.

  • Gastroesophageal reflux disease (GERD) is when the acid of the stomach backs up into your oesophagus (food pipe). A productive cough may be a symptom of GERD and may cause you to awaken from your sleep.

  • Postnasal drip or nasal discharge may cause a productive cough because of the discharge constantly draining into your throat. This may lead to irritation of your throat causing you to feel a constant urge to clear your throat.

  • Moreover, certain lifestyle factors such as smoking could lead to a person suffering from it. Either smoking or using tobacco or forms of tobacco can produce irritation to your throat and even damage to your lungs.[1]


Risk Factors


Risk factors for a productive cough are as follows.

  • Cigarette smoking: Either being a current smoker or someone who has quit smoking, remains a risk factor for cough. The toxins present in the cigarette cause the cough. Either being an active smoker or constantly inhaling second-hand smoke can risk a cough.

  • Exposure to certain infectious and contagious respiratory infections.

  • Allergies- Certain allergy triggers can increase your chances of getting a cough.

  • Environmental- Areas that have a lot of irritants in the air can cause a cough. Using coal for cooking can increase your cough.

  • Chronic lung diseases- Certain lung diseases such as COPD, asthma, and previous lung infections can increase your risk of cough because of the previous scarring in your lungs.
    Female gender- Compared to men, women have a very sensitive cough reflex, putting them more at risk of a cough.[2]

Prevention

Prevention of cough may not be possible; however, you can take certain preventive measures as follows.


  • Keep your hands clean by frequently washing them, especially during flu season.

  • Avoid coming in contact with individuals who have a cough

  • Avoid smoking and try to quit smoking and use of tobacco products

  • Avoid exposure to second-hand smoke

  • Increase fluids to help thin the mucus and enable you to cough it out

  • Get your yearly influenza vaccine

  • If you are above 65 years or older you should get a pneumococcal injection, especially if you have other risk factors present

  • Keep your immunizations up to date.[1]

Diagnosis

The diagnosis of productive cough is usually very easy. The doctor will ask the patient about his/her symptoms, and listen to the patient’s chest sounds or breathing to check for any sign of congestion or difficulty in breathing (identified by a raspy intake of air). In cases where the doctor suspects other causes, he/she may order additional tests, including a sputum sample, blood tests, chest x-ray, and lung function tests. A methacholine challenge test may be performed to rule out asthma. Therefore, it is essential that one go to the doctor at the earliest to minimize complications because of underlying diseases.[2]

Treatment

Treatments for wet cough are primarily aimed at relieving the congestion in the chest. Over the counter (OTC) expectorants can provide some relief. Along with other medication, the cause of the cough should be treated. For example, asthma is treated with inhaled bronchodilators that may or may not contain inhaled steroids, pneumonia and lung abscess are treated with antibiotics. In the case of a condition called bronchitis, there are prescription medicines that contain bronchodilators or inhalers that contain steroids. Moreover, there are tablets available that contain these bronchodilators and steroids. If the situation is severe, there are injectables available. In some cases where the congestion might be severe, a doctor might prescribe mucolytic agents (substances that break down the mucus) such as bromhexine or ambroxol with or without a bronchodilator. These medications are important to provide symptomatic relief.

While your doctor is treating the cause of your cough, you can take the following measures to reduce your symptoms.


  • Stay hydrated

  • Raise the head end of your bed or use extra pillows for children at nighttime to reduce coughing

  • Maintain an ambient temperature

  • Avoid vigorous activities when you have a cough. Rest adequately

  • Avoid smoking or inhaling other people’s smoke

  • One to two teaspoons of honey can help reduce nighttime cough if taken around half an hour before sleeping. Honey should not be given to children who are less than a year old.

  • Avoid cough medicine for children below six years because they are ineffective

  • If your cough is attributed to an infectious cause, then avoid going in crowds to prevent the spread of your cough

  • A steamy shower or an air vaporizer can soothe your airways when they are irritated because of constant coughing. It helps decrease congestion.[2,3]

Home Remedies

Certain homemade remedies for cough can help in alleviating symptoms. To decrease the tickle in your throat or irritation that makes you feel like coughing, you can try the following home remedies.
Three months to one year of age - Warm and clear fluids such as lemonade or apple juice, 5–15 ml, four times a day, can help soothe the cough. Avoid giving honey to children below the age of 1 year.
In children over the age of one - Honey, 2–5 ml, as required, can be used as cough medicine. Honey can be substituted with corn syrup.
For children above the age of 6 years - Cough drops can be used to reduce irritation of the throat. Hard candy may be used if you do not have cough drops. Avoid giving cough drops to children below the age of 6 years to prevent incidents of choking.[4]

Lifestyle/management

What to eat and what not to eat


Following foods help to control a cough.

  • Honey - In particular, for older kids, this works well in controlling night-time cough

  • Probiotics - Lactobacillus can help reduce your chances of getting a cough

  • Pineapple - Natural enzymes in the pineapple, bromelin, help in suppressing your cough and reducing mucus production

  • Chicken soup - This old remedy helps with mucus congestion in your nose

  • Liquorice root tea - It is a traditional treatment for sore throat and cough because it soothes your airways and helps in thinning mucus. It helps in soothing and relaxing you when you are feeling stuffy and congested.


Certain foods such as dairy products and any foods that cause allergies should be avoided because they may increase symptoms of cough.[5]

Prognosis

The prognosis of a productive cough is good. It primarily depends on what the cause of your cough is. If you continue to smoke, it may aggravate your symptoms of cough and may lead to breathlessness. Most causes of cough are viral infections that are short-term and may get better within 1–3 weeks.[6]

Complications

Usually, since productive cough is the manifestation of an underlying condition, if left untreated, the condition may worsen, leading to multiple complications. For instance, a lung infection might spread to organs and damage them, and a patient with asthma or COPD may develop difficulty in breathing. The excessive cough itself can cause chest and abdominal pain, giddiness, unconsciousness, and rupture of organs such as the oesophagus (food pipe), and lung (leading to the air outside the lungs, i.e., pneumothorax) and an increase in blood pressure.

Other complications of a cough are as follows.


  • Cardiovascular complications: Low blood pressure, abnormal heart rhythms, loss of consciousness, and rupture of veins in the eyes, nose, or anus can occur.

  • Constitutional complications: Loss of appetite, exhaustion, and excessive sweating can occur because of constant coughing

  • Gastrointestinal complications: Gastroesophageal reflux and rupture of organs in the gastrointestinal system are some of the complications that can occur because of excessive force exerted on the internal organs while coughing

  • Genitourinary complications: Incontinence or lack of control over your bladder can occur

  • Musculoskeletal complications: Fractures and rupture of the diaphragm may occur

  • Neurological complications: Headache or dizziness can occur

  • Decreased quality of life because of constant cough.[7]


References

1. Cough. University of Michigan Health. Available at: https://www.uofmhealth.org/health-library/cough. (https://www.uofmhealth.org/health-library/cough)
2. Cough. Chest Foundation. Available at: https://foundation.chestnet.org/lung-health-a-z/cough/?Item=Symptoms. (https://foundation.chestnet.org/lung-health-a-z/cough/?Item=Symptoms)
3. Cough. Health Direct. Available at: https://www.healthdirect.gov.au/cough. (https://www.healthdirect.gov.au/cough)
4. Cough. Children’s Hospital. Available at: https://www.stlouischildrens.org/health-resources/symptom-checker/cough. (https://www.stlouischildrens.org/health-resources/symptom-checker/cough)
5. Foods to eat and avoid when you have a Cough. Prospan. Available at: https://www.prospan.com.au/chesty-coughs/foods-to-eat-and-avoid-when-you-have-a-cough/. (https://www.prospan.com.au/chesty-coughs/foods-to-eat-and-avoid-when-you-have-a-cough/)
6. Cough. Patient. Available at: https://patient.info/chest-lungs/cough-leaflet. (https://patient.info/chest-lungs/cough-leaflet)
7. Irwin RN. Chest Journal. 2006;129(1):54S-58S

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