Cough

Coughing is a protective mechanism of the body to clear the airway of irritants and mucus. ^[1] Cough is broadly classified as acute, subacute or chronic. It is considered acute when it is present for less than 3 weeks. When it lasts 3 to 8 weeks, then it is regarded as subacute. Longer than this period is already chronic type. ^[2]       

Causes

The most common cause is respiratory tract infection due to a virus like in colds. ^[1] Chronic cough may be due to a more serious medical condition such as chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD) and lung infections like tuberculosis. Cough may also be classified as productive or nonproductive. If there is phlegm or mucus production, it is called productive cough whereas if there is none, then it is nonproductive. Productive cough may be caused by viral illnesses, infections such as pneumonia and bronchitis and chronic diseases like COPD. Nonproductive cough is often present in allergies, asthma and airway blockage. Certain drugs may cause cough like ACE inhibitors which are used for hypertensive patients. Among these drugs are captopril (Capoten) and enalapril maleate (Vasotec). Other frequent causes of cough include cigarette smoking, exposure to secondhand smoke and sinusitis resulting to postnasal drip.  ^{[1] [3]}

When to Seek Medical Care

Certain symptoms that accompany cough may point out to an underlying medical condition that warrants further investigation. Among these are unexplained weight loss, night sweats, coughing up blood, fever and difficulty of breathing. ^{[4] [5]}

Diagnosis

Cough is a symptom. The diagnosis of the underlying disease relies for the most part on the medical history of the patient. Information that are important to point out the probable cause include the cough’s duration, character, aggravating and relieving factors, patient’s past medical history, social history and the symptoms that goes with the cough. Physical examination is essential. It often includes checking the patient’s lung sounds. Chest X-rays are often ordered to check for possible infection and other causes. ^[4]

Treatment

Treatment depends on the cause of cough. Drinking plenty of fluids and smoking cessation help a lot. Antibiotics are given if there is bacterial infection. Inhalers are usually given for asthmatic patients. Those with severe cases, immunocompromised or elderly patients may need hospitalization. ^[4]

References:

1.      http://www.nhs.uk/conditions/cough/pages/introduction.aspx

2.      http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm

3.      http://www.webmd.com/cold-and-flu/tc/coughs-topic-overview

4.      http://www.emedicinehealth.com/coughs/page4_em.htm#when_to_seek_medical_care

5.      http://www.patient.co.uk/health/cough

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Thuja (Eastern White Cedar, Thuja Occidentalis) [1, 22, 23, 24]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Little is known about the full effects of Thuja, so it is not recommended for medicinal use. Thuja can be poisonous if ingested in large amounts.

Recommendation: no recommendation (There is insufficient evidence to support claims that Thuja helps to treat coughs)

Grade of Evidence: very low quality of evidence

Red Clover (Trifolium Pratense) [1, 15, 16, 17, 18, 19, 20, 21]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that Red Clover helps to treat coughs)

Grade of Evidence: very low quality of evidence

Peppermint Oil [1, 9, 10, 11, 12, 13, 14]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that peppermint helps to treat coughs)

Grade of Evidence: very low of evidence

Larch (Larix Occidentalis)  [1, 5, 6, 7, 8]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (Although approved for external use in Germany, available evidence does not support claims that Larch helps to treat coughs)

Grade of Evidence: low quality of evidence

Comfrey (Blackwort, Symphytum Officinale)  [1, 2, 3, 4]:

Please note, this herb is TOXIC IF TAKEN ORALLY, OR IF APPLIED TO AN OPEN WOUND. Can cause severe liver or kidney damage and lead to death. May ONLY be used as a cream over intact skin, and does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Strongly Against  (ONLY TO BE USED AS A CREAM OVER HEALTHY SKIN. If taken orally to treat a cough, Comfrey can lead to severe liver and kidney damage, and can even lead to death.)

Grade of Evidence: low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.ncbi.nlm.nih.gov/pubmed/19460762

3. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/comfrey

4. http://www.ncbi.nlm.nih.gov/pubmed/2103401

5. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/larch

6. http://www.dermnetnz.org/dermatitis/plants/lichen.html

7. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin, TX: American Botanical Council; 1998.

8. Bown D. New Encyclopedia of Herbs & Their Uses. New York, NY: DK Publishing Inc; 2001.

9. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/peppermint

10. http://www.ncbi.nlm.nih.gov/pubmed/17420159

11. http://www.ncbi.nlm.nih.gov/pubmed/19507027

12. http://www.medicine.ox.ac.uk/bandolier/booth/alternat/AT022.html

13. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-peppermint.html

14. http://nccam.nih.gov/health/peppermintoil/index.htm

15. http://nccam.nih.gov/health/redclover/

16. http://www.ncbi.nlm.nih.gov/pubmed/19609225

17. http://www.babyhopes.com/articles/natural-fertility-boosters.html

18. http://indigo-herbs.co.uk/acatalog/Red_Clover_Flowers_Info.html

19. http://www.hort.purdue.edu/newcrop/duke_energy/trifolium_pratense.html

20. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/red-clover

21. http://www.mskcc.org/mskcc/html/69350.cfm

22. http://www.nlm.nih.gov/medlineplus/ency/article/002769.htm

23. http://plants.usda.gov/plantguide/pdf/cs_thoc2.pdf

24. http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=thuja&x=0&y=0