Why we Cough:

    Coughing is the the body's way of getting rid of "stuff" that has accumulated in your air pasages. The respiratory tract starts high up in your nose and end in your lungs. Every day a small amount of mucus is produced by the cells that line this tract. This mucus keeps the airways moist and traps any particles you have inhaled before they get into your lungs and we all don't want this happen. Even though mucus is being made constantly, it doesn't normally accumulate, because it's continually swallowed in small amount during the day. But when an excessive amount is produced in response to an infection or an irritation, you expel it by coughing. The appearance of what you spit out is important: while phlegm indicates simple irritation; a yellow color suggests infection; and red, of course, mean blood.

    You'll also cough if you inhale some substance or object. Ever had a piece of food "go down the wrong way"? You start coughing in an instant, reflexively. Most reflexes can't be controlled. when your doctor taps your knee with a reflex hammer, just try hold back the kick! The sneezing reflex is partially controllable ---you can often delay or abort it; but a cough is almost always manageable, at least for a while. The only time it can't be stop is when your lungs are exposed to an immediate danger such as when you swallow something "the wrong way" or inhale irritant fumes.

    A cough may last for just a few days if you have a cold, or continue indefinitely if you suffer from chronic bronchitis. (The main air passages going to your lungs are called "bronchi", "itis" is a generic suffix meaning irritation or infection. So bronchitis is an irritation or infection of the bronchi.) When a cough persists for more than four weeks in anyone at any age, it must be evaluated. While periodic coughing is normal, a chronic cough is not, unless it is due to a nervous habit. It can mean something as ominous as lung cancer.

    Some people developed a persistent dry, nonproductive cough --- that is, one in which they spit nothing up. They have no fever, they weren't smokers, their sinuses were okay --- yet they coughed. They all, however, were taking a fairly new medication called an ACE (angiotensin-converting enzyme) inhibitor. the four brands now on the market in U.S. are captopril (Capoten), enlapril (Vasotec) and lisinopril (Zestril, Prenivil). ACE inhibitors are effective in the treatment of high blood pressure and chronic heart failure, but in some people they do cause a dry cough. Unless you and your doctor are aware of this peculiar side effect, you may hack for weeks on end without relief.

    There are some people who cough when they're under stress. they can tell it's psychological, because it disappears when they sleep. Chronic cough due to most other causes persist or even worsens at night.

    A chronic cough may also be due to a enlarged uvala. That's the little tongue like structure hanging in the midline in the back of your throat. When food or liquid comes into contact with the uvala, it triggers a muscular contraction which propels the substance toward the esophagus. But when the uvala becomes too big and stays that way (sometimes it swells briefly during an allergic reaction), it can repeatedly trigger a cough and require surgical removal.

    If you have allergic or infection asthma, in which the major airways go into spasm periodically, you will cough and wheeze.

    Another cause of cough is cardiac failure. If your heart is too weak to pump out all the blood that is returned to it, the excess backs up into the lungs, filling them with "fluid." You're then unable to lie flat without coughing or shorten of breath.

    Here are some useful pointers to help you determine why you are coughing, but be sure to see your doctor anyway. This symptom is too important to ignore or self-diagnose.

   * If you've been coughing for three or four days and have fever, it's probably due to an acute respiratory tract infection. If it persists beyond two or three weeks, it is, by definition, chronic. You must then consider the possibility of a lung tumor, especially if you're a smoker.

   *Years ago tuberculosis was much more common than it is today. With the advent of specific antibiotics, its incidence has dropped dramatically. Now for a variety of reasons --- an older populations with impaired immunity, AIDS, crowded living conditions---TB is on the rise again. So whenever a cough persists or appears in an older person living in a nursing home, the diagnosis of tuberculosis must be considered.

   *When somebody has been coughing on and off for several years and lung cancer and TB have been ruled out, then smoker's cough, chronic bronchitis and a disease called  bronchiectasis must be considered. This last is a weakening wall of the air passages complicated by severe infection within the lung, triggering an ongoing production of foul-smelling sputum mixed with blood.

   *Did the cough come on suddenly? Is it dry, that is, you don't spit anything up? While any acute process ranging from a cold to viral pneumonia can start that way, in a child you consider the possibility that he or she has inhaled some small object like a peanut, a jelly bean or a piece of toy, partially obstructing the air passages.

   *If you started coughing suddenly, have some pain in your chest and varicose vein in your legs, and your calves are tender, the cough may be due to a blood clot to your lung. This is especially likely if the cough is accompanied by a slight fever and your sputum is tinged with blood.

   *If you've been coughing up varying amounts of colored phlegm for several  months, you've probably got chronic bronchitis. If it's much as half a cup of greenish foul smelling sputum, then you may have a lung abscess (a chronic infection within the lung that has become walled off and cannot easily be reached by antibiotics). If the stuff you cough up is clear or white, the cause is more likely to be due to irritation from pollution, a virus or even cancer, rather than bronchitis or another infection.

   * A cough that produces frothy pink-tinged sputum and is accompanied by a marked shortness of breath (you feel as though you're drowning) signals pulmonary edema, which occur when your lungs fill with fluid due to heart failure.

   * Sputum that is rust or coffee colored and jellylike in consistency is classic evidence of pneumococcal pneumonia. You'll also have pain in the chest, as well as fever.

   *A cough that produces blood in any form should be treated as an emergency. Just so you know, however, strenuous coughing can rupture small vessels in the back of your throat and cause bleeding that's not serious, but you have to check it out anyway.

   * A chronic cough without sputum suggests a tumor, heart disease or a nervous habit, or is a side effect of one of the new ACE-inhibitor drugs.

   * A dry cough accompanied by pain in the center of your chest probably means acute laryngitis or tracheal bronchitis. Conversely, a deep loose cough is originating in your lower respiratory passage or lung (often an infection and a cough will begin high up in the throat and then spread down into the lung).

   *If you hurt when you take a deep breath, and you're coughing, you have pleurisy. The pleura which form an envelope that surrounds the lung can become affected in the early stages of pneumonia, by lung cancer or by a virus.

   * The combination of cough and profuse night sweats suggest tuberculosis.

   * Weight loses and cough raises the specter of cancer of the lung. These same symptoms, along with severe shortness of breath, are also characteristic of the fatal opportunistic lung infections that affect AIDS patients.

   * Cough and hoarseness together are a bad combination and point to the possibility of a tumor.

   *If you wheeze when you cough, you probably have chronic bronchitis and/or asthma.

   *Loss of consciousness induced by coughing sometime occurs in those patients with chronic bronchitis who are overweight, big smokers and heavy drinkers.

   * Do you have a pet bird, or do pigeons roost on your windowsill? You may have psittacosis, a lung infection spread by birds. Fungus; infection of the lungs also cause coughing.

   * Do you have a new cat or dog, or have you recently moved into an apartment, or bought new bedding, new clothes or new rug? You may well be allergic to any one of these. Or you may have an allergic reaction to airborne pollen (hay fever), dust, mold, mites or somebody else's tobacco smoke.

   *Remember this: Every cough must be explained, especially if it lasts longer than three or four days. It's dangerous to assume that it is simply due to your pack-a-day habit and let it go at that.

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Point to Remember

Symptom: Chronic cough.

      What It May Mean                                           What to Do About It

  1. The tail end of a cold.                                         Patience, and cough syrup.

  2. Chronic bronchitis, laryngitis or tracheitis.            Antibiotics, stop smoking.

  3. Lung cancer.                                                      Surgery, medication, radiation.

  4. ACE inhibitors (taken for heart failure or

      hypertension).

  5. Stress.                                                               Lean to deal with it.

  6. Enlarged uvala.                                                   antihistamines, surgical removal.

  7. Asthma.                                                             Bronchodilators, steriods.

  8. Heart failure.                                                      Diuretics, low-salt diet, digitalis.

  9. Respiratory infection (viral, bacterial, TB).          Appropriate antibiotics.

10. Bronchiectasis.                                                   Antibiotics, drainage.

11. Foriegn object (especially in children).                Remove.

12. Blood clot to the lung.                                        Anticoagulants.

13. Lung abscess.                                                    Antibiotics.