A persistent cough with mucus or blood is an alarming situation. A cough syrup or an expectorant is not the solution. Here, I discuss some important symptoms which could be a clue to an underlying serious problem.
A cough is a protective mechanism of the respiratory tract. It can be acute or chronic. An acute cough is usually secondary to inhaled allergens or respiratory tract infections.
A persistent cough with mucus or a chronic cough which lasts for weeks or months should be alarming. A persistent cough should always be investigated and treated timely and never be ignored.
Which symptoms and signs should alarm you?
The following is a brief discussion on some danger and alarming signs in patients with a persistent cough with mucus. A timely diagnosis and treatment may lead to early recovery and avoid long-term disabilities.
A persistent cough with mucus and hemoptysis.
Hemoptysis is coughing out blood. Persistent coughing may be dry or associated with sputum production. Blood stained sputum is called hemoptysis.
Hemoptysis can be associated with bronchitis after a severe paroxysm of coughing. Rusty sputum can be seen in pneumococcal pneumonia. Hemoptysis can also be seen in pulmonary tuberculosis and necrotizing pneumonia.
In patients with bronchiectasis (permanent dilation of airways), persistent coughing may be complicated by massive life-threatening hemoptysis. It can be the only presentation of bronchogenic carcinoma (lung cancer), especially in chronic smokers.
Coughing out blood can also be seen in some systemic disorders like Goodpasture’s syndrome which is a small vessel vasculitis involving the kidneys and lungs.
In bed bound, immobile and hospitalized patients, clot formation in deep veins of legs occurs. This clot can dislodge and enters the systemic circulation. This leads to blockage of pulmonary arteries causing sudden shortness of breath and hemoptysis.
Frothy blood-stained mucus can also be seen in patients with heart failure and mitral stenosis.
A persistent cough with mucus and weight loss.
Weight loss is a non-specific symptom of a variety of disease. In patients with a persistent coughing, it can be caused by pulmonary tuberculosis, lung cancer or emphysema.
All these diseases are also associated with anorexia and depression. Comorbid depression further complicates the disease. This further causes weight loss.
A persistent cough with mucus and shortness of breath.
Shortness of breath or dyspnea is another symptom which should never be overlooked. Shortness of breath in a patient with persistent coughing could be a sign of respiratory failure.
Uncontrolled asthma or infective exacerbations in patients with chronic bronchitis can also present with a persistent cough with mucus and shortness of breath. It can be directly or indirectly associated with the extent and severity of the disease.
Pulmonary embolism, tuberculosis, interstitial lung disease, and occupational lung diseases can all present with shortness of a breath and chronic cough. Heart failure should always be kept in mind in elderly patients and those with coronary artery disease.
Fever with a chronic cough and mucus.
Fever is again a very nonspecific symptom. In a patient with a chronic cough, fever may indicate infection. This may be accompanied by night sweats, weight loss, and sputum production.
Fever can sometimes be associated with malignancies like lung cancer. It may be also be seen in autoimmune rheumatic diseases.
A persistent cough with chest pain.
Chest pain is another dangerous symptom and always needs to be investigated. Infections of the lung like pneumonia can present with chest pain. Pain in chest conditions is specifically worse when the patient breathes in. This is called pleuritic chest pain.
Pleuritic chest pain is usually sharp and localized to a specific part of the chest. This is in contrast to cardiac pain which is diffuse and cannot be localized.
Lung puncture also called as pneumothorax can complicate various diseases like tuberculosis and lung cancer. Pneumothorax is also associated with severe chest pain and shortness of breath. Pneumothorax can sometimes be deadly. This condition should be dealt with urgency and never delayed.
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