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By Foluke Akinwalere. Freelance Health Writer and DLHA volunteer. With medical review and editorial support by the DLHA Team
Cough is a common and often harmless spontaneous action) reflex that helps clear the airways of irritants and mucus.
It is a natural defense mechanism of the body to protect the respiratory system.
However, its impact on social well-being varies depending on individual circumstances and can lead to challenges in relationships, avoidance of public places, and disruptions in employment.
Even with a clear diagnosis, cough can be difficult to control and can negatively impact the quality of life of the patient.
In this article, you will learn everything you need to know about cough, including the types of cough, causes, symptoms, diagnosis, and treatment options, plus what you need to do when you have a bad cough.
Cough is a crucial defense mechanism in the respiratory system. It is a natural, usually explosive reflex that helps clear the airways of mucus, irritants, and foreign particles.
It is a common symptom of respiratory illnesses and can be classified as acute or chronic.
In Nigeria for example, acute cough is found to be commoner in women < age 45 and chronic cough is commoner in older men. 1
African healthcare providers are often approached by individuals seeking medical assistance for cough symptoms.
There are many types of coughs, each with unique characteristics that can assist your doctor in determining the underlying cause. These include:
A study reported on the factors associated with nocturnal, productive, and dry cough in the young adult population in Sub-Saharan Africa where there is a lack of observational studies on cough.1 These factors include tobacco smoking, HIV /AIDS, malnutrition, environmental pollution, and poverty.
Coughs can be triggered by various factors, and understanding the underlying cause is crucial for effective treatment. Here are some common causes of cough:
Respiratory infections, such as the common cold, flu, bronchitis, and pneumonia are frequent culprits behind coughs. In Africa, these infections can be prevalent, especially during certain seasons.
Cough (that is initially dry and persistent) was identified as one of the early symptoms of COVID-19, along with fever, shortness of breath, and loss of taste or smell. The coughing may be productive of mucus as the condition worsens.
The World Health Organization provided guidelines for the management and isolation of individuals with suspected or confirmed COVID-19 cases, including those with a cough.5
Allergic reactions to pollen, dust mites, pet dander, or other allergens can lead to coughing. Allergic conditions like hay fever are not uncommon.
Exposure to smoke, air pollution, or other environmental irritants, which can be more common in some regions of Africa, can trigger persistent coughing.
Acid reflux can cause stomach acid to flow back into the oesophagus, leading to a chronic cough, particularly after eating or at night.
A group of lung diseases, including bronchitis and emphysema can also cause chronic cough.
Some other chronic respiratory conditions apart from COPD can cause coughing, wheezing, and shortness of breath. Common causes in this category in adults are associated with such lung diseases like cancer, TB (tuberculosis), fungal infections of the lung, etc., which affect 2.5 million people in Africa Region according to a WHO report.2
Some medications, particularly ACE inhibitors, a commonly used blood pressure reducing medication, might cause or potentiate cough. The cough may take some months to settle following the withdrawal of ACE inhibitors 3.
In Nigeria, a study reported on the prevalence of ACE inhibitors-induced cough among Nigerian hypertensive patients. 6 It found a 20.2% rate of occurrence of frequent dry, non-productive cough among the patients that was linked to ACE inhibitors.
No patient with a troublesome cough should be placed or be continued on ACE inhibitors.
Workers in certain industries may be exposed to harmful substances that can lead to occupational diseases and persistent coughs
Several heart disorders like congestive heart failure, are associated with chronic cough.
Psychosocial stressors and other behavioural and mental health issues like anxiety may cause what is known as Habit or Psychogenic cough. This type of cough is typically harsh, barking and dry. It is common in children, adolescents, and rarely adults and it typically disappears during sleep and distractions.
The symptoms of a cough can vary depending on its underlying cause. In most cases, there will not be anything serious underlying the cough, but in some cases, a long-term cough can be a sign of something that needs treatment, such as lung cancer, chest infections, or heart failure.
Cough symptoms that require medical attention include:
Cough can be classified in different ways as follows:
Duration: An acute cough is typically short-lived and can last for up to three weeks. Most acute coughs resolve within a few days to a week.
Characteristics: Acute cough is usually accompanied by other symptoms like runny nose, sore throat, fever, and general malaise. It tends to improve as the underlying infection resolves.
This falls between acute and chronic coughs in terms of duration. Sub-acute cough is defined as lasting between three and eight weeks. If the cough persists or worsens beyond the eight-week mark, it may transition into a chronic cough, and further evaluation and management may be necessary to identify and address any underlying chronic conditions.
This type of cough persists for an extended period and is typically defined as lasting for eight weeks or longer in adults. In children, it may be defined as lasting for four weeks or more.
Characteristics: Chronic cough may be dry or productive (producing mucus), and may occur throughout the day and night. It can be associated with other symptoms related to the underlying condition such as lung cancer.
Distinguishing between acute and chronic coughs is crucial for determining appropriate treatment and management. Chronic coughs often require more in-depth investigation and management due to their association with underlying health conditions.
Table 1 below summarises the characteristics of chronic cough and their indicative causes.
Click on image to enlarge
The diagnosis and treatment of cough depend on its underlying cause.
Physicians may take medical histories, conduct physical examinations, and order diagnostic tests such as chest X-rays, pulmonary function tests, or blood tests to determine the cause of the cough.
Here are some treatment options for a cough:
A recent study revealed that the risk of coughing increases with tobacco smoking and the number of sticks smoked per day.4
If you experience a bad cough, it is important to take prompt action to reduce your discomfort and promote healing. Here are some recommendations:
Dry air can worsen coughing. Using a humidifier or taking a steamy shower can help moisten the airways, providing relief and reducing coughing fits.
Smoke, strong perfumes, and other irritants can trigger or worsen coughing.
Give your body ample time to rest and recover.
Cough is a common occurrence, and in most cases, it is harmless and resolves on its own. However, persistent or severe coughing should not be ignored, as it can indicate underlying health issues.
If you or your loved one is experiencing a prolonged or troubling cough, it is essential to consult a healthcare provider for a proper diagnosis and appropriate treatment.
Taking steps to prevent respiratory infections and minimise exposure to environmental irritants can also help reduce the risk of developing a troublesome cough, especially in regions where these factors are more prevalent.
1. Desalu OO, Ojuawo OB,, Aladesanmi AO, Adeoti AO, Opeyemi CM, Oloyede T, Afolayan OJ, and Fawibe AE. Etiology and Clinical Patterns of Chronic Cough in the Chest Clinic of a Tertiary Hospital in Nigeria. Int J Gen Med. 2022 May 27;15:5285-5296. doi: 10.2147/IJGM.S363326.
2. World Health Organization Tuberculosis in the WHO Africa Region - September 2023 Progress Report. Accessed October 11, 2023.
3. Morice AH, McGarvey L, and Pavord I, British Thoracic Society Cough Guideline Group Recommendations for the management of cough in adults. Thorax. 2006 Sep;61 Suppl 1(Suppl 1):i1-24. doi: 10.1136/thx.2006.065144.
4. Desalu OO, Salami AK, Fawibe AE. Prevalence of cough among adults in an urban community in Nigeria. West Afr J Med. 2011 Sep-Oct;30(5):337-41.
5. World Health Organization Advice for the public: Coronavirus disease (COVID-19) updated March 18, 2023. Accessed October 10. 2023.
6. A. K. Salami and I. A. Katibi. Angiotensin Converting Enzyme-Inhibitors Associated With Cough: A Prospective Evaluation In Hypertensives. Annals of Africans Medicine Vol. 4, No 3, 2005, p118 - 121
Published: October 12, 2023
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