Although coughing is a reflex that protects the lungs and the entire respiratory system from the accumulation of secretions or the inhalation of foreign bodies, it can also be a symptom of disorders of the pulmonary system or it can be suppressed in other disorders. The cough reflex may be impaired by weakness or paralysis of the respiratory muscles, prolonged inactivity, the presence of a foreign object such as a nasogastric tube, or depressed function of the medullary centers of the brain.
Coughing results from irritation of the mucous membranes anywhere in the respiratory tract. The stimulus that produces a cough may arise from an infectious process or from an airborne irritant such as smoke, smog, dust or gas. A persistent and frequent cough can be exhausting and can cause debilitating pain and discomfort. Cough, in general may indicate a serious pulmonary disease, although it may be caused by a variety of other problems as well including cardiac disease, medications, chronic smoking and gastro-esophageal reflux disease.
Clinical Significance of Cough
To help determine the cause of the cough, the health professional such as the nurse should be able to effectively assess the description of the kind of cough the individual may be experiencing. The nurse should be able to describe the cough whether is dry, hacking, brassy, wheezing, loose, persistent or severe. A dry, irritating cough is characteristic of an upper respiratory tract infection that would suggest a viral cause of origin, or it may be a side effect of a special kind of medication. Tracheal lesions produce a brassy cough. A severe or constantly changing cough may indicate malignant tumor growth along the tracheal lining. Pleuritic chest pain that accompanies coughing may indicate pleural or chest wall involvement of the musculoskeletal system.
Other Serious Medical Conditions Associated with Coughing
Persistent cough at night may herald symptoms of a possible left-sided heart failure or bronchial asthma. A cough in the morning with sputum production may indicate bronchitis. A cough that worsens when the patient is lying supine may also suggest post nasal drip (sinusitis). Coughing after food intake may indicate aspiration of food material into the tracheobronchial tree. A cough of recent onset is usually indicative of an acute respiratory infection which can be either viral or bacterial in nature.
A persistent cough can adversely affect an individual’s quality of life and may produce embarrassment, exhaustion, inability to sleep and discomfort. The effect of chronic cough on the patient and the patient’s view regarding the significance of the coughing episode especially the accompanying effects can be better appreciated during an intensive assessment of the individual’s health history.
Relief Measures for Coughing
Cough suppressants must be used in moderation and caution because they may relieve cough but do not address the primary cause of the cough. If used inappropriately, they may prevent the patient from clearing mucus from the airways and result in a delay in seeking indicated health care. If the cause of the cough has been properly diagnosed and addressed, it is only then coughing suppressants may be prescribed. If the cough is a result of irritation from smoke, pollution, and other air irritants strategies that limit exposure to the environment is encouraged.