Joseph R. Anticaglia MD
Medical Advisory Board
A cough is a protective reflex that works to clear mucus and foreign matter from the back of the throat, the voice box, windpipe and lungs. Although the cough reflex is there to help us — and often the cough is benign — the sound of a cough can be frightening and for good reason.
Something has to trigger the cough reflex and the sounds the cough make can be clues to an underlying problem. Some coughs are dry, others are productive of mucus. Some coughs last less than four weeks while others are chronic, lasting more than a month.
When we’re coughing, people may ask, “What’s the matter? Sounds like you have a terrible cough.” Below are several kinds of cough, some examples of the sounds they make and what it could mean.
Barking Cough
If a child is under three years of age and sounds like a seal when he coughs, this Is referred to as a barking cough. This type of cough is most often due to Croup, a viral infection also known as Laryngotracheitis.
Typically, the viral infection causes swelling and narrowing of the voice box (larynx) and the windpipe (trachea). This narrowing of the upper airways causes the child to have stridor, trouble breathing in, and after several breaths one can listen for the barky cough. Usually, the child can be treated at home with fluids, humidification and, if needed, steroid medication.
Cough and Wheezing
A child who has a cough that is accompanied by a prolonged wheezing, whistling sound, has difficulty breathing out. The lower airways (lungs) are involved and asthma is of particular concern. A foreign body and infection of the small bronchial tubes of the lungs are other causes of cough and wheezing.
Silent Reflux
Michael, an overweight, non-smoking 57 y/o high school teacher complains of a chronic, dry cough for the past eleven months. At times, he has to clear his throat and is bothered by vocal fatigue and hoarseness. He habitually eats snacks late at night and an examination by his internist found no problems with his lungs.
Michael’s cough was due to silent reflux which is reflux without heartburn. It’s also known as laryngopharyngeal reflux and what happens is that stomach acid washes up the esophagus (the tube that connects the back of the throat to the stomach) and irritates the larynx and the cough reflex. He quit snacking at night, was put on a reflux diet, lost weight and these measures resolved his chronic cough.
Postnasal Drip PND
PND is drainage in the back of the throat. Allergies, sinusitis or a cold can provoke the cough reflex which results in a dry or wet cough that can be bothersome during the day or at night.
One needs to treat the cause of the PND. If you are coughing, have postnasal drip and pain over the sinuses with yellow or green discharge lasting more than ten days, your doctor will probably prescribe an antibiotic. If you have allergies and a tickle in the back of the throat along with PND, allergy medication might be all that is needed to resolve the cough. In adults with a common cold, decongestants and nasal irrigations have reduced the swelling in the nose and thinned the mucus, making it easier to breathe and reducing the cough symptoms.
But the symptoms of a cold can be misleading as demonstrated in Melissa’s case below.
Whooping Cough Pertussis
Melissa thought she had a common cold with a runny nose, sneezing and a low grade fever that lasted about a week. Then she experienced terrible coughing spells that took her breath away. At the end of the fits of coughing she took a deep breath which made a whooping sound.
Whooping cough is a highly contagious bacterial infection of particular concern in infants and young children. Anyone can contract this disease and the incidence has risen since some parents have opted not to have their child vaccinated against pertussis. Antibiotics are recommended for anyone who has this disease.
There are many other kinds of cough, but listening to the sounds of a cough is one way to help diagnose the underlying problem.
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.