How to Discuss Cough with Your Patient
Coughing is our body’s way of preventing foreign substances from reaching our lungs. Without this reflex, we would probably get sick often. Cough is not necessarily an illness in itself but a symptom of an underlying condition. There are many ways to discuss cough. Here are just some of the important points you may cover with your patient when they consult you about their cough.
Describing a Cough
Your patient can describe their cough in several ways. As a doctor, an important clue is whether the cough is productive or non-productive. A productive or “wet” cough is often accompanied by phlegm. This produces a gurgly or “wet” sound whenever the patient coughs. In contrast, a non-productive or “dry” cough does not involve any mucus coming from your throat and often sounds scratchy. Pertinent details to ask your patient also include whether symptoms accompany the patient’s cough like fever, headache, nausea, or vomiting. The timing and duration of the cough should also be asked. Lung diseases can be differentiated depending on how long they last. Here are some examples:
- Acute cough — Most often caused by the common cold and usually does not last longer than 14 days. Pollen, smoke, and strong fumes can cause colds. Common symptoms include a runny nose, sore throat, and clogged nose.
- Subacute cough — Its duration encompasses few weeks and usually happens after the patient has experienced a viral respiratory infection. Whooping cough (pertussis), asthma flares, and bronchiectasis may manifest subacutely.
- Chronic cough — This cough usually lasts for weeks to months. Common conditions include poorly controlled asthma, bronchitis, and gastroesophageal reflux disease (GERD).
Performing a complete history and physical examination of the patient may aid you in arriving at the correct diagnosis. While there are many ways your patient may describe their cough, knowing these essential points could narrow down your list of differential diagnoses.
Common Causes of Cough
Cough can just be one symptom in a constellation of diseases. A patient who has had a cough for a few days may not be a cause for alarm, but it is a different story if it lasts for weeks or gets worse over time. Here are the most common causes of cough:
- Acute cough
- Common cold
- Influenza (flu)
- Pneumonia
- Whooping cough
- Chronic cough
- Allergies
- Asthma
- Bronchitis
- Gastroesophageal reflux disease (GERD)
- Postnasal drip
- Other causes
- Acute sinusitis
- Bronchiolitis
- Chronic obstructive pulmonary disease (COPD)
- COVID-19
- Croup
- Lung cancer
- Heart failure
- Tuberculosis
The above list is by no means exhaustive, but these are just some of the common conditions you may encounter in the clinic. Remember to get into the nitty-gritty of the patient’s symptoms, as this will help you in clinching the diagnosis.
What Diagnostic Tests Should be Done?
Testing will depend on your primary impression (what you think is the most likely cause) and differential diagnoses (other likely causes). Lung imaging is a helpful tool that will aid in diagnosis. Lung conditions may appear differently once seen through a chest X-ray or CT scan. Lung function tests are also important in determining the diagnosis as they can measure the pattern of air flowing into and out of the lungs. Spirometry or plethysmography may be necessary because certain diseases have a specific pattern of airflow once measured.
After thorough testing, you may then explain the diagnosis to the patient. It is important to discuss what is going on at a level that your patient will understand. This can greatly affect their compliance to the medication you will prescribe, as well as their overall satisfaction with their healthcare experience. Present the data clearly and in small, easily digestible chunks. A rule of thumb is usually to share only as much as the patient is willing to know while still covering the essentials. Be sensitive and assess the patient’s comfort level before disclosing any information. Some important points you may want to cover include how the disease came about, how it will affect the patient’s day-to-day life, treatment options, and expected costs. At the end of the consultation, you can ask the patient to summarize what they learned so you can assess their comprehension and recall. Fill in or clarify any details as needed. This may be a lot of information for your patient to take in, so do not forget to assure your patient that you and the rest of the team are their partners. Remind them that you are always ready and willing to support the patient through your diagnosis and treatment, and maybe even well after.
Home care for your patient’s cough
Apart from medication, there are some home remedies that you can recommend to your patient that will help relieve their discomfort. Here are some helpful ways on how your patient can alleviate their symptoms at home:
- Drink plenty of fluids and get plenty of rest.
- Inhale moist air by using a humidifier or taking a steamy shower.
- Consume warm liquids like soup or tea, which can relieve a stuffy nose and loosen phlegm.
- Eat a well-balanced diet rich in fruits and vegetables to provide the body with adequate nutrients and vitamins to boost the immune system.
- Avoid dairy products as these can thicken phlegm.
- Avoid alcohol as it impairs the immune system.
- Use pillows to prop the head up; this will decongest the airways and make breathing easier.
- Cough drops may also help soothe a sore throat. While they will not stop the patient from coughing, they do provide a cooling and soothing effect.
- Do not smoke and do your best to avoid second-hand smoke. Avoiding tobacco smoke can prevent worsening symptoms and help a disease to resolve sooner..
These tips and the prescribed medication can improve your patient’s symptoms, and lessen the duration of their illness. However, if the symptoms persist despite these measures, consider shifting medication or possibly a different condition.
How to instruct your patient to prevent spreading infections when they cough
In this time of pandemic, coughing is one way infections can spread. Diseases like the flu, tuberculosis, and COVID-19 are just some of the diseases that spread through cough. The droplets containing the virus stay suspended in the air and can infect anyone who breathes them in. To lessen the spread of infection, it is essential to counsel your patient on cough etiquette:
- Cover your mouth and nose when you cough or sneeze. Use a tissue or the crook of your elbow to prevent spreading disease.
- Dispose of used tissues and masks in appropriate waste bins.
- Wear a mask whenever you leave the house.
- Wash your hands thoroughly and frequently for at least 20 seconds with soap and water.
- Use an alcohol-based sanitizer if there is no soap and water available.
These are simple but effective ways your patient can prevent others in their home and community from getting sick. In addition, the little efforts taken in their daily routine can help curb the spread of disease, especially in this time of pandemic.
When your help is needed
While we would want all our patients to get better, sometimes lung conditions can worsen. Educate your patient to watch out for red flags and to call you immediately if they experience any of the following symptoms:
- Coughing up blood
- Chest pain or difficulty breathing
- Coughing that makes them vomit
- Unexplained or unintentional weight loss
- The cough began after exposure to another individual who was coughing
- Cough lasts for more than eight weeks
- The cough gets better then worse
These are just some of the red flags the patient should watch out for when dealing with a cough. Provide the patient with your number or the local emergency unit just in case anything happens. In this time of COVID-19, it is important to be vigilant and sensitive to the conditions we are experiencing both at the individual and community level. Emphasize to the patient the importance of reporting their symptoms early. This can mean the difference between an easily treated disease versus a more chronic and debilitating condition.
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