Cough: what causes it and how to treat it

By Cristiano Antonino On Feb 12, 2023

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A cough is a rapid forced exhalation with a closed glottis, voluntary or reflex, aimed at clearing the airways of foreign bodies or irritants

Types of cough

A cough can be

dry (non-productive)
productive, with sputum expulsion of more or less purulent mucous material.

It can also be

acute: lasting less than 3 weeks;
subacute: lasting between 3 and 8 weeks;
chronic: lasting more than 8 weeks.

The approach to the patient with a cough must follow a diagnostic criterion aimed at excluding serious underlying processes

This process begins with a careful history (smoking habit, occupational exposure to toxic substances, taking ACE inhibitors) and a thorough objective test.

Often a history and objective examination are sufficient to explain the cause of a cough; if they are not, the causes are investigated more thoroughly with laboratory and instrumental tests such as a chest X-ray or respiratory function tests.

Causes of cough

The most frequent causes of an acute cough are:

upper respiratory tract infections
sinusitis;
pneumonia.

The most frequent causes of chronic coughs, on the other hand, are represented by:

chronic bronchitis;
sinusitis;
airway hyperresponsiveness after resolution of a viral or bacterial respiratory infection;
gastroesophageal reflux;
chronic obstructive pulmonary disease (COPD).

Symptoms not to be underestimated

In the presence of a cough, the warning signs that should not be underestimated are

dyspnoea (difficulty breathing)
haemoptysis (sputum mixed with blood);
weight loss;
persistent fever.

Treatment and therapy

The treatment of a cough consists of treating the cause.

At the pharmacological level there are

antitussigens, such as codeine, which act on the cough centre by depressing it and thus reducing the cough;
expectorants, such as n-acetylcysteine, which reduce the viscosity of secretions facilitating their expectoration with coughing;
bronchodilators, such as ipratropium, or inhaled corticosteroids, which may be effective for coughs secondary to upper respiratory tract infection or in asthma.

Why the cough increases in the evening

At night, coughing is more frequent due to the greater activation of the parasympathetic system (bronchus constricting tendency) than the sympathetic system (bronchus dilating tendency), which leads the smooth muscles to relax, offering greater resistance to the flow of oxygen.

In addition, in patients with gastro-oesophageal reflux, lying down leads to an increased flow of gastric material in the upper respiratory tract, causing irritation that triggers coughing.

For such patients, behavioural rules such as not consuming acidic foods (jams, chocolate, oranges) before going to bed are indicated, as well as avoiding eating immediately before going to bed.

If these precautions still do not suffice, anti-reflux medication should be taken before bedtime.

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