Published on January 30, 2017

The number one reason people seek a doctorThe number one reason people seek a doctor

Do you know the number one illness-related reason why people see their doctor? It’s coughing, according to the Centers for Disease Control and Prevention.

Most of us cough at least a few times every day, but a cough can be a minor irritant or one of the signs of a major illness. We asked Mashpee otolaryngologist Craig Jones, MD, to tell us more about coughing.

“In theory, what a cough is supposed to do is clear the airway of any foreign material, whether it’s a foreign body in the windpipe because you’re choking or because there’s mucus there or a germ there.

“When a cough is triggered, the vocal cords close, the chest contracts to build up pressure, and the vocal cords then open to release the pressurized air and expel anything blocking the airway,” he said.

The reasons for a cough can be complicated, and there are multiple receptors in the body that can trigger a cough, he added.

“You have cough receptors in the upper and lower airway,” Dr. Jones said. “You have them in the stomach, around the heart, in the ear. When any of those cough receptors is triggered, it initiates the reflex to cough.”

The Duration of a Cough is Key

A few coughs a day is just the body’s normal way of removing irritants in the throat, but frequent coughing means something else is going on. At midwinter gatherings, you’re likely to hear plenty of coughing, most of it from the common cold, he said.

When looking to diagnose the cause of a heavy cough, one of the key things Dr. Jones considers is the duration.

“With the common cold you’re looking for it to last less than a week,” he said. “Anything lasting longer than a week, we would label something else.”

Factors that suggest the flu rather than a cold include a sudden onset of a fever over 100, muscle aches and fatigue.

Even with a cold, coughing can continue for up to eight weeks after other symptoms subside.

“A cough lasting more than a week and less than 8 weeks is most commonly viral bronchitis or acute bronchitis,” he said.

Any cough that has gone on more than three weeks should be assessed by a healthcare provider, Dr. Jones said.

“If there are associated symptoms like coughing up blood, fever, feeling short of breath or chest pains, you’d want to get that assessed sooner rather than later.”

It May Be Asthma

Chronic cough can be a sign of asthma (which will usually be associated with wheezing, but in the case of cough-variant asthma can occur with cough alone).

Acid reflux may also produce a chronic cough.

“A lot of people have silent reflux, so they’re not aware of it,” he said. “They don’t get heartburn. They tend to frequently clear their throat and sometimes lose their voice.”

When Dr. Jones sees a patient with a persistent cough, he begins with a history to determine the nature and duration of the cough. He listens to the lungs for signs of asthma or pneumonia. He then performs a fiberoptic endoscopy of the nose and throat to assess for sinusitis, allergic post nasal drip, signs of silent reflux or lesions on the vocal cords. Based on this he will advise treatment or further testing.

Testing may include breathing testing to assess for asthma or COPD, Niox testing to assess for allergic inflammation in the airway, pH probe testing to document the degree of acid reflux, a chest X-Ray for any cough lasting longer than eight weeks, a swallow study if the cough is associated with eating, or allergy testing if the history and exam suggest allergies.

While allergies, reflux or the flu can be treated, there’s not a lot that can be done to help with the common cold, according to Dr. Jones. It’s mostly a matter of healing with rest and time, although he said a decongestant helps many people breathe better.

“The important thing is that if a cough’s been going on for a while, you want to get it checked out, especially smokers,” he said. “If there are any unusual symptoms – shortness of breath, trouble breathing, chest pains, coughing up blood – those are things you really want to get checked out. Don’t ignore it.”