When Is A Cough Serious And Needs Medical Attention?

A little sniffle, slight cough or a mild sore throat are some of the common symptoms we tend to ignore at the outset. But just when do we take these symptoms seriously? In the ideal situation, we should seek immediate medical care but this is not always necessary or feasible in the current economic environment. Therefore some degree of individual discretion is necessary. S0metimes a mild cough can be due to a serious life threatening disease while a severe cough may be a symptom of a mild acute infection that will pass on its own. It is difficult to say when exactly a cough should be considered serious enough to warrant medical attention.

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Why do we cough?

The cough reflex is one of the body’s protective mechanisms. It is similar to a sneeze. Both these events are intended to clear the airways – sneezing for the upper passages like the nose and a cough for the passages from the throat (pharynx) and voice box (larynx) to the lower airways like the trachea, bronchi and bronchioles. Any irritation from the pharynx to the bronchioles will elicit a cough. It is the body’s attempt to push out the irritant from the airways. Once the airways are clear, the cough should subside.

But the coughing process and the factors that trigger it are not always this simple. Some triggers cannot be immediately removed with sneezing. And sometimes the irritant has been removed but inflammation of the air passages continues to trigger a cough. The passages from the trachea to the bronchi have specialized receptors in its lining that can initiate coughing. These receptors are known as the pulmonary irritant receptors and can be stimulated by a host of factors, and not only by smoke or dust that enters the air passages.

So when is a cough serious? When should you seek medical attention? Every cough should be considered as a symptom of some underlying irritation or disease. It therefore warrants medical attention. But a cough that just lasts for a few minutes and eases a short while later without returning may not be too much of a problem.

Dry or Wet Cough

pneumonia sputum

Picture of sputum (microscopic)

There is a misconception that a non-productive cough is less serious than a productive cough. A non-productive cough, or dry cough, simply means that you are coughing without any mucus being expelled. Nor is there the sound of any phlegm in the air passages or chest. A productive cough, or wet cough, is when there is mucus or sputum expelled with the cough. Sometimes the mucus is not easily expelled but can be heard in the air passages and chest during breathing or coughing.

Both a dry and wet cough may be due to a serious disease. The lack of phlegm or sputum should not be relied upon as an indication of how serious the condition may or may not be. A condition like cancer of the lining around the lung (pleural mesothelioma) may present with a dry painful cough. Similarly a person with the common cold can have a wet cough.

Short Or Long Term Cough

The duration of the cough is not always a reliable indicator of the seriousness of the cause. But long term persistent coughing (chronic cough) is usually more serious. There are many causes of an acute cough (a short term cough) that is a result of common and often not serious diseases. For example, viral respiratory tract infections like the common cold and flu are the most likely cause of a cough that starts up suddenly especially when there are associated symptoms like a fever, runny nose and malaise.

The cough tends to persist for a few days or weeks after the other viral infection symptoms subside but it is rarely serious. There are instances where bronchitis may set in thereafter and the cough lasts for longer but here as well it can be easily treated. However, there are instances when a sudden cough can be a symptom of a deadly condition like a pulmonary embolism (blood clot in the lung).

Blood In Cough Sputum

One of the main symptoms of a serious cough is if you cough up blood. It may not just be whole blood but rather you may be coughing up bloody mucus. Even slight streaks of blood in mucus should be seen in a very serious light. You need immediate medical attention. The blood is most likely originating from your air passages or lung itself. This primarily occurs with serious respiratory diseases ranging from infections like tuberculosis (TB) to lung cancer.

Your doctor will need to immediately run a series of tests to confirm a diagnosis and the earlier that medical treatment commences, the better the outcome.With some conditions like a pulmonary embolism, a bloody cough may appear suddenly and the condition can be fatal within a short period of time – in minutes or hours. It is possible for conditions like bronchitis and pneumonia to result in a blood cough sputum, yet both conditions can be easily treated in most cases.

Cough With Breathing Difficulty

asthma children

Some degree of breathing difficult may be seen even with relatively minor conditions that cause a cough, like the common cold. But here the difficulty in breathing (dyspnea) is very mild and more prominent during strenuous physical activity. When a cough accompanies severe dyspnea then it is a cause for concern. This means that the respiratory passages are narrowed or that gas exchange in the air sacs of the lungs are not occurring as it should.

Coughing and prominent dyspnea can be seen with more slow progressing but very serious conditions like tuberculosis (TB) or lung cancer or with very rapidly developing conditions like a pulmonary embolism. It is not so much about the severity of the cough in these cases. While blood streaked sputum is serious, the more labored the breathing the more serious the condition is in most instances. Coughing with difficulty breathing can be seen in a host of other conditions such as asthma, bronchitis and pneumonia. Cigarette smokers may experience a cough with breathing difficulty on a daily basis.

Cough With Fever And Night Sweats

A host of conditions that can present with a cough may also cause fever and night sweats yet are not serious. The seasonal flu (influenza) is one such condition. But a fever and/or night sweats with coughing may also be signs of much more serious conditions like tuberculosis (TB) and lung cancer. Sometimes the fever and night sweats may be the first signs along with malaise and weight loss. It can persist for weeks or months before a cough or other more definitive symptoms develop that indicate a respiratory condition arises.

With a pulmonary embolism, a patient may experience difficulty breathing, with wheezing or other abnormal breathing sounds and excessive sweating which may be mistaken for night sweats. Therefore it is difficult to identify whether a cough with fever and/or night sweats are definitely due to a serious condition. However, if you have a history of a fever of unknown origin (FUO) and night sweats for several weeks, you should speak to your doctor as soon as possible even if you do not have a cough as yet.

Cough And Different Colored Sputum

tb sputum

The mucus that you cough up is known as sputum. Normally mucus is slightly thicker than water and is clear to slightly white in color. Copious amounts of clear sputum or completely white mucus is also seen with a host of conditions like the common cold, flu and even in asthma. But when mucus is of different colors then it may be a sign of a more serious problem. At times sputum may be pink, red, orange, yellow, brown and even green in color. It is important to understand the causes and meaning of sputum color.

Pink and red sputum is more likely a consequence of bleeding in the respiratory tract. Brown or black sputum may also be due to blood in the sputum but in these instances the blood is ‘old’ and has degraded. Black sputum is also seen with coal inhalation. White to gray sputum is more often seen in acute respiratory infections or certain chronic non-infectious respiratory illnesses. Yellow to green sputum may occur with chronic infections. Orange to rust colored sputum may also be partly due to the presence of blood but certain bacteria may produce orange pigments.

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