Joseph R. Anticaglia MD
Medical Advisory Board
Our body has an early warning system, better than any government’s defense department. Our challenge is to decipher the signals our body transmits to us and to act on this intelligence to remain healthy. We need to decide: “Is this cough a serious problem?” “Is the cough accompanied by other symptoms?” “Can I treat it at home?” “Must I make an appointment to see my doctor or should I go to the emergency room?”
Most coughs are minor and do not need the assistance of a physician. However, any cough with blood is a red flag. Consider Bob, a 47 y/o bus driver who has been a smoker since he was a teenager. He complains of a “cigarette cough” in the morning for years, but now he complains of being tired, of having “a cold that hangs on” and recently coughing up phlegm streaked with blood.
What might these additional signals suggest? He might be examined by a throat specialist to rule out cancer of the voice box (larynx) or perhaps a problem with his lungs. He was finally diagnosed as having tuberculosis.
In the case of Judy, a 42 y/o housewife and mother of two children who woke up one morning complaining of coughing, shortness of breath and spitting up blood tinged foamy mucus. What do these clues urge Judy to do? She should go to the emergency room right away to rule out a life threatening pulmonary embolus.
If one is coughing up blood or if the cough is associated with cyanosis — blue discoloration to the lips or skin — this situation demands immediate care. Cancer, chronic lung conditions and pulmonary embolism are possibilities of the underlying condition. One has to keep in mind that a severe cold can cause a blood vessel in or behind the nose to break open and leak blood in the back of the throat causing you to cough up blood.
Coughing in young children is worrisome because it can be associated with dramatic episodes of shortness of breath. The opening of the vocal cords of the larynx and the space between them in a newborn is about one third the size of the opening in that of an adult — it’s four millimeters by seven millimeters. The width of one millimeter is about the width of a period at the end of a sentence.
A common cold can cause coughing, post nasal drip, and swelling of the air passages. In coughing young children, the swelling can severely narrow the openings of the vocal cords and windpipe (trachea) causing shortness of breath. This combination can swiftly turn into a childhood emergency. Below are some other worrisome situations.
A child who is coughing with a high fever, shortness of breath or noisy breathing needs to be examined right away. A child who is coughing that looks sick and is not eating or drinking needs to be evaluated by the Pediatrician. A youngster, who has been coughing for a few days after choking on food or possibly a toy, needs an examination and a chest X-ray.
If you are coughing with a cold and your immune system is compromised (e.g. receiving chemotherapy for cancer, HIV/Aids), contact your physician. A minor cold can become a severe infection.
If you have a cough associated with weight loss, weakness, night sweats or feel that “something’s not right,” make an appointment to see your doctor. If you have a cough associated with chest pain, go to the emergency room to rule out possible cardiac and pulmonary causes.
It bears repeating — most coughs are benign and do not require urgent care. In children, acute coughs are most commonly due a viral upper respiratory infection (URI). Chronic coughs in children are most often due to asthma, reflux and postnasal drip.
In non-smoking adults with a normal chest X-ray who are not on ACE inhibitors, the great majority of the time, the cause of chronic cough is due to three factors, namely, postnasal drip, cough variant asthma and reflux. However, emergencies happen and a cough can be an early warning sign to prevent a calamity.
References
Robin T. Cotton MD; James S. Reilly, MD. Congenital Malformations of the Larynx Pediatric Otolaryngology; Bluestone/Stool
C. Blake Simpson, MD; Milan R, Amin, MD. Chronic Cough: State-of-the-art Review; Otolaryngology Head and Neck Surgery, 2006
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.