Coughs that choke

A cough could be a sign of a serious illness, writes Dr Daniel KC Lee

WE all cough at some point or other. It is inevitable. After all, everyone breathes the same air no matter where you are in the world.

It is therefore no surprise that coughing is the most common symptom that a patient presents to a doctor.

But it’s not necessarily a bad thing. In fact, coughing is categorised as a reflex action, meaning the cough actually protects your airways.

For example, if you accidently inhale food or fluid into your lungs while eating or drinking, the cough reflex protects your lungs by expelling the foreign matter.

However, sometimes, a cough may be serious, perhaps more than just a simple “cough and cold”. The duration of the cough is certainly important. Coughs that simply will not go away will require medical attention.

On average, one expects a “normal” cough to get better in 3-5 days. If it  persists beyond that time frame, a visit to the doctor will not be a bad idea.

There are times however, when the cough will need to be investigated even if it lasts just for a day. This is particularly so if someone coughs up blood (medically known as haemoptysis)  or if the cough is accompanied by fever or breathlessness.

COUGHING BLOOD

One should never really cough up blood although there are occasions especially when the coughing is so violent, it may tear the lining between the gullet and the stomach.

 If blood is present, a chest X-ray is required to rule out conditions such as severe infection of the lungs, pneumonia and the presence of abnormal growths or tumours (pulmonary neoplasm).

In Malaysia, with the prevalence of tuberculosis, one will also need to exclude this disease. Tuberculosis is completely treatable and cured by taking medication, usually for six months. If left untreated, it will damage the lungs and can be potentially fatal if the infection spreads to other parts of the body.

THE SYMPTOMS

A cough may be serious if there are accompanying symptoms such as loss of appetite and weight, extreme tiredness or an inexplicable fever.

When these are present, a chest X-ray should be conducted without delay, especially if there is a history of smoking.

Smoking can cause lung cancer, and the sooner this is detected, the better the chances of recovery. This is because early lung cancer, which has not spread to other parts of the body, can be removed by surgery.

Heart disease may also manifest as a cough. This usually occurs when the heart is not pumping as well as it should be and fluid may accumulate in the lungs, prompting a cough. Sometimes, one may be suffering from a problem in the stomach such as inflammation and ulcers.

Excessive acid in the stomach may move up to the gullet (gastro-oesophageal reflux), causing one to cough. This may be a direct effect of the presence of acid in the voice box, triggering a cough or an indirect effect where cough is triggered through a reflex with the presence of acid in the gullet.

INFLAMMATION INDICATOR

A cough may also indicate an illness in the upper airways where inflammation of the nose (rhinitis) and sinuses (sinusitis) may cause the accumulation of secretions which are discharged to the back of the throat (postnasal drip).
This in turn will irritate the voice box, causing one to cough as a protective mechanism to ensure that harmful secretions do not enter the lungs and cause infection or inflammation.

Finally, coughing may point to an illness in the lungs. Asthma may present with just a cough without the usual symptoms of breathlessness or wheezing (cough variant asthma).

When the airways or tubes of the lungs are inflamed (bronchitis) from the effects of allergy, inhalation of harmful substances, or infection, coughing may be a symptom.

Tobacco smoke may destroy the lungs by creating holes in it (emphysema). Sometimes, the substance of the lungs itself is destroyed (interstitial lung disease) by either diseases (autoimmune disorders) or inhalation of toxic material such as  silica or asbestos.

There are occasions when even the respiratory physicians are surprised by what they find at the end of their bronchoscopes. Not uncommonly, one may discover foreign objects in the airways of the lungs, such as rice or even vegetable! These are, of course, removable.

One should always take a cough seriously, especially a cough that does not seem to go away, or a cough that is associated with worrying symptoms which, in turn, may point to serious problems either in the lung or elsewhere in the body.

Time is of the essence when it comes to treating a cough. The sooner one seeks help, the sooner one receives treatment, the sooner one recovers.

The writer is respiratory medicine physician at Prince Court Medical Centre

Coughing can be mild, serious and even symptomatic of other conditions

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