Types of cough
Different types of cough are classified based on their duration and whether they are associated with mucus being cleared from the lungs.
Duration
A cough lasting less than three weeks is termed 'acute'. This is usually associated with a viral upper respiratory tract infection (e.g. cold or flu), and is self-limiting and benign. However, occasionally, an acute cough can be the first indication of a more serious underlying condition.
A cough lasting between three and eight weeks is called a 'subacute' cough. It is usually associated with a cold or other respiratory infection, but the cough continues after the initial infection has cleared up.
If a cough persists for longer than eight weeks, it is termed 'chronic' and is usually an indication of an underlying condition, e.g. asthma. However, many chronic coughs are 'idiopathic', meaning their cause is unknown. A chronic cough may interfere with sleep, work or socialising. If severe, it can also lead to headache, chest pain, urinary incontinence, sweating or, in rare cases, even fractured ribs.
Symptoms
Coughs are often described as either 'chesty' or 'dry'. A dry cough is non-productive, meaning it doesn't cause coughing up of any mucus or phlegm. Dry coughs are usually felt as a tickle in the throat when the upper airways are inflamed, which triggers coughing. The common cold or flu often causes a dry cough as the brain mistakes inflammation in the throat and upper airways as a foreign object and therefore tries to remove it by coughing.
Chesty coughs are usually productive and produce phlegm. This type of cough can be helpful as it clears phlegm from the lung passages. Sometimes, a chesty cough can be non-productive if the phlegm is too sticky to cough up.
Reflection exercise
Sally brings her four-year-old grandson Thomas to the pharmacy. Thomas is complaining of a tickly cough and a runny nose, but is not showing any other symptoms. Sally asks you for a bottle of children's codeine linctus, which she used to buy for her daughter when she had similar symptoms.
What would you recommend?
Explain to Sally that OTC liquid medication containing codeine is no longer considered suitable for people under the age of 18 years for the treatment of coughs. Dextromethorphan and pholcodine are also no longer licensed for children under six years old. Based on the description of Thomas' symptoms, he seems to be suffering from an acute non-complicated, tickly cough. However, all requests for young children should be referred to the pharmacist, who will probably recommend a remedy such as simple linctus, or a product based on glycerin or honey to help relieve Thomas' symptoms. To help make him more comfortable and speed up his recovery, recommend that Sally gives him plenty of warm drinks. Thomas should also cover his mouth when he coughs and wash his hands regularly to help prevent the spread of infection.
What if:
Sally mentions that Thomas is occasionally a bit breathless and often suffers from a dry cough that keeps him awake at night. She also says that he often stays at the house of a friend whose mother smokes. These symptoms suggest that Thomas may be suffering from undiagnosed asthma and he should be referred to the pharmacist, who will likely then refer him to a doctor. A dry cough at night is a common symptom of asthma, which often worsens when exposed to a smoky atmosphere. Advise Sally that Thomas should try to avoid exposure to smoke, as well as dust and other air pollutants.
What if:
Sally mentions that she would also like a cough medicine for herself as she has been suffering from nasal congestion with a tickly cough for the past few weeks. Sally's symptoms sound like the result of a viral infection, such as a cold. Post nasal drip often occurs while suffering from a cold as mucus or phlegm drips from the nasal passages into the throat, which triggers coughing. Reassure Sally that the symptoms should disappear within a few weeks as the initial infection clears, but in the meantime, a product containing a cough suppressant and decongestant (e.g. pseudoephedrine or phenylpropanolamine) could help to relieve her annoying symptoms.
What if:
Sally complains of a cough with congestion and also suffers from diabetes. Decongestants such as pseudoephedrine are not suitable for people with diabetes and therefore Sally should be referred to the pharmacist. He or she may recommend a cough suppressant and an inhalant or vapour rub to help ease the congestion.