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Coughing- If it persists, seek medical care

By Vision Reporter

Added 24th August 2008 03:00 AM

THE past few weeks have seen several people heading to the drug shops to pick up cough and cold remedies. “Is the dry season here, again?” some ask in wheezy voices.

THE past few weeks have seen several people heading to the drug shops to pick up cough and cold remedies. “Is the dry season here, again?” some ask in wheezy voices.

By Fred Ouma

THE past few weeks have seen several people heading to the drug shops to pick up cough and cold remedies. “Is the dry season here, again?” some ask in wheezy voices.

The latest data from the Ministry of Health shows that respiratory diseases are the second leading cause of death and illness in Uganda after malaria. They are followed by diarrhoeal diseases, HIV/AIDS and reproductive health-related complications.

But how are seasons related to coughing?
Uganda experiences two weather seasons: the rain and dry seasons. According to weather experts, the rainy season runs from April to June and then September to November while dry spell sets off in December to March and July to September when the air is most polluted.

Dr. Noleb Mugisha-Mugume of Makerere University’s department of family medicine says everyone coughs but the reasons are numerous.

“A cough is simply a reflex action to keep breathing passages (the tubes that carry air into and out of the lungs) open,” he says. “Causes can range from irritants in the air, especially during the dry spell, to influenza or can be as serious as pneumonia.”

Mugume, however, adds that a cough can be a symptom of a chronic condition or indicate the onset of illness. “Anyone with a chronic cough or increased coughing needs to determine what causes it,” he says.

Some coughs can be serious so it is vital that the doctor determines the cause and prescribes proper treatment.

A cough alone does not indicate illness although many illnesses are characterised by coughing. Dr. Aggrey Dhabangi of Child Health and Development Centre, Makerere University, says a chronic cough can indicate a medical condition that may require treatment. Some of the more common causes of chronic or frequent cough include:

Postnasal drip
Everyone’s nose and throat makes mucus daily. But when it collects in the throat and becomes a constant drip, the body responds by trying to cough it out and clear the breathing passage. Reasons for postnasal drip include colds, allergies, spicy foods, hormonal changes as well as weather changes.

Smoker’s cough
Tobacco smoke is an irritant. It causes the body to cough in an effort to clear the airways. Over time, smoker’s cough can become more serious as chronic obstructive pulmonary disease CORP.

This includes diseases like emphysema and chronic bronchitis. Chronic or acute coughs in smokers can also indicate lung cancer, says Dr. Sheila Ndyanabangi, the in-charge of alcohol and drugs at the health ministry.

Allergies can be caused by anything from polluted air to pollen and pet dust or chemical fumes. A dry cough caused by allergies often comes with sneezing, itchy eyes, watery eyes and a runny nose. Dry coughs can be very tiring and it is advisable to seek treatment to find relief.

“Children younger than three years tend to cough because their windpipes are narrow. They may swell making it harder to breathe,” says Dr. Grace Kabahiha of Makerere University Medical School.

Although often characterised by wheezing or inability to breathe, asthma can also cause a dry cough. Only a doctor can make an asthma diagnosis and suggest the proper treatment.

Acid reflux disease
Although this condition involves the gastric system and not the bronchial system, stomach acid that rises into the throat can cause coughing. This requires medical treatment says Dr. Kabahiha.

Tickle or frog in the throat
No medical names exist for this common sensation, but a feeling of something in the throat triggers a dry cough.
Dr. Gregory Tumweheirwe, an Ear, Nose and Throat specialist at Mulago Hospital says there are ways to help chronic coughs that are not a symptom of illness.

Coughs that come from an illness
Whether an individual is too sick to get out of bed or just does not feel well, cough is often an indication of illness. It could be whooping cough, also known as pertussis.

Tumweheirwe says pertussis is an infection of the respiratory tract caused by the bacteria bordetella pertussis. The illness is marked by severe coughing spells with a whooping sound when you breathe in. Other symptoms are a runny nose, sneezing, mild cough and mild fever.

The disease is highly contagious and is spread through tiny drops of fluid in the air from an infected person’s nose or mouth, which are propelled by sneezes, coughs, or laughs.

Other people can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses.

Although pertussis can occur at any age, experts say it is most severe in infants under one year old who are not immunised. The pertussis vaccine, which is part of the DTP (diphtheria, tetanus, acellular pertussis) immunisation, is routinely given in five doses before a child’s sixth birthday.

If anyone has the following symptoms, they should seek medical help immediately:
A cough that has lasted for two or more weeks without improvement.

A cough that lasts more than few days and is accompanied by fever.
A cough that brings up mucus that is green or yellow or is streaked with blood.

If coughing keeps sleep away.
Anyone with a harsh, barking cough requires immediate medical attention.
In children, a harsh, barking cough may indicate an inflammation or swelling in the upper part of the airways.

Anyone who coughs up blood, pink froth, or feels short of breath should skip the office appointment and head for the emergency room.

Dr. Tumweheirwe says common illnesses characterised by coughing include acute bronchitis, influenza, pneumonia, the common cold and tuberculosis.

Acute bronchitis, he says, has symptoms that include tightness in the chest, cough that produces green or yellow mucus, and a low-grade fever. Acute bronchitis responds quickly to antibiotics, but without treatment it can worsen.

Flu sufferers feel ill, have headaches and body aches, and feel exhausted, run a high fever, and have a dry cough.
To prevent influenza, experts advise having an annual flu shot. If influenza strikes, ask a doctor about anti-viral treatments that can minimise flu.

Pneumonia is an infection of the lungs. If left untreated, says Dr. Dhabangi, it can lead to complications or death in elderly patients. Symptoms of viral pneumonia include feeling sick, an achy body, sore throat, coughing up green or yellow mucus and low fever.

Bacterial pneumonia makes patients feel very sick with pain in the chest, high fever and chills, and shortness of breath.
Common colds are also something everyone suffers.

A cold should run its course in a week or 10 days, have no fever, and include both cough and a stuffy or runny nose.

Dr. Emmanuel Sekasanvu, a specialist in internal medicine at Mulago Hospital, says many over-the-counter products are available for cold relief but warns against self-medication.

“Some drugs can interact with prescription medicines. It is wise to read any warnings and follow doctor’s instructions before taking a new product. Some are not advisable for pregnant women, high blood pressure patients and heart patients.”

Tuberculosis is common among those with impaired immune systems.
Dr. Francis Adatu, the national director of Tuberculosis and Leprosy Programme, says: “A positive skin test can mean a patient has either an active infection or the disease.”

Other symptoms include coughs with bloody mucus, night sweats, weight loss and intermittent fever. Unless your cough is preventing sleep, experts say, cough medicines are usually unnecessary.

The two most common cough treatments are either expectorants (bring up thick mucous) or suppressants (quiet the cough and can make dry coughs less harsh).

Most patients will require the expertise of a specialist to determine the cause of coughs and the appropriate medication. And as a general rule: Never use a cough medicine or product for more than a week.

“Every cough has a cause and it’s best to let the doctor determine that cause,” says Dr. Sam Okware, the commissioner for communicable diseases with the health ministry.

“With the right treatment, most coughs can be ended or managed.”

Remedies and prevention
Wash your hands frequently during the cold and flu season. This helps prevent the spread of a virus that may cause a cold or influenza.

Always hold disposable tissue onto your nose and mouth when coughing or sneezing. Flush it down the toilet or dump it in the garbage outside of the living quarters to prevent spreading the germs.

Avoid people who have a cold or influenza.

Don’t smoke or use other forms of tobacco. Avoid exposure to second-hand smoke.

Increase your fluid intake. Juice mixed with honey and herbal tea keep the mucus thin making it easy to cough up. Enough fluid also helps prevent dehydration.

Get a flu shot (influenza vaccine) if you are older than 50 or are at high risk.

Get a pneumonia shot (pneumococcal vaccine) if you are older than 65 or if you have a chronic lung disease.

If you have asthma, make sure to receive asthma-management instructions from your doctor.

Ensure that your immunisations are current, such as pertussis to reduce your risk of getting whooping cough.

Regular brushing of the teeth and mouth rinsing, wearing dry shoes and plenty of fresh air will help to prevent infections.

If your child goes to a daycare centre, ask the staff to wash their hands often to prevent the spread of infection.

Make sure your child gets all vaccinations, especially for Diptheria, Tetanus, acelular Pertussis) and for Haemophilus influenzae type B.

If one of your children is sick, separate him or her from other children in the home.

You should not give your children over-the-counter cough medicine without instructions from your doctor.

Smear olive oil on the chest to help with the cough.

Coughing- If it persists, seek medical care

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