What is cough?
A cough is the body’s attempt to remove foreign material or mucus from the lungs and upper airway passages.  Coughing also occurs as the body’s reaction to an irritated airway.  A cough is not a disease, but a symptom that holds importance when other symptoms are evaluated.

What is a productive cough?
Productive coughs produce phlegm or mucus (sputum).  This fluid comes up either from the lungs, or from the back of the throat as a result of postnasal drainage.  A productive cough clears mucus from the lungs; therefore, it usually should not be suppressed.  Productive coughs may be present at the time of a viral illness or infection.  In addition, a productive cough could be a sign that a disease (i.e., COPD) or condition (i.e., postnasal drip syndrome) is worsening or causing more damage. 

What is a nonproductive cough?

Unlike a productive cough, a nonproductive cough does not produce sputum.  Viruses as well as exposure to irritants can bring about this dry, hacking cough.  A chronic nonproductive cough may serve as a sign for certain conditions, such as asthma or bronchospasm.  Medications (ACE inhibitors) and reduced exposure to irritants can be used to lessen nonproductive coughs.

How to treat a cough?
Due to the fact that a cough is only a symptom and not a disease, the significance of a cough is determined only when other symptoms are evaluated.  A careful evaluation of health performed by a physician can help identify other symptoms, and ultimately a condition or problem.

Bacterial and viral respiratory infections produce coughs.  However, because antibiotics do not alter the course of viral infections, antibiotics are not used to directly treat coughs.  Other symptoms, such as a sore throat, sinus pressure, or earl pain, may accompany a cough.  In this case, antibiotics may be used.
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ASTHMA

Asthma is a common disorder affecting millions of Americans.  The condition is characterized by a wide variety of symptoms ranging from mild intermittent wheezing to persistent, severe shortness of breath that can be quite disabling. Asthma is primarily an inflammatory disorder affecting the air passages (bronchi).  It can be triggered from exposure to allergens such as pollen, dust, pet dander, etc. These allergens are inhaled during normal breathing.  Asthma  can be brought on by exercise or it can arise without any specific causal factors being identified.

The onset of asthma can range from early childhood through adulthood. There may be a history of seasonal allergies, nasal polyps, nasal congestion, or other forms of allergies (hives, food allergies, etc.). There also may be a family history of asthma or allergies.

Symptoms of asthma range from mild sporadic wheezing which may not significantly affect an individual’s daily life or exercise ability.  If the condition worsens, wheezing becomes more frequent and patients experience shortness of breath, cough and limitation in exercise capacity.  Asthma can worsen very quickly requiring emergency attention, admission to the hospital and institution of respiratory support with a ventilator.  In these cases, death from asthma can occur despite maximal efforts by doctors to reverse the condition.

It is extremely important to control asthma, thereby reducing the risk for hospitalization.  The main control of asthma involves using anti-inflammatory medications on a regular basis, even when one has no symptoms of asthma.  In addition, bronchodilator inhalers are used for symptom control.  Bronchodilators should not be used alone in people with frequent asthma symptoms.  If an individual requires a bronchodilator twice a week or more, it indicates that asthma is poorly controlled, increasing the risk for worsening symptoms and hospitalization.  In this situation, anti-inflammatory medications should be started.

Asthma should be treated aggressively and can be evaluated by a number of studies including taking measurements of lung function (Pulmonary Function Test or PFT).  Usually asthma can be controlled with medication and most people with asthma can enjoy an excellent quality of life.  It is important to discuss the frequency and severity of your symptoms with your doctor so that appropriate treatment can be initiated.
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CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis, emphysema or a combination of both conditions.  COPD is a preventable and treatable disease that makes it difficult to empty air out of the lung. This difficulty in emptying air out of the lung is called airflow obstruction and can lead to shortness of breath. 

EMPHYSEMA
  
Emphysema is a lung disease that involves damage to the walls of the alveoli or air sacks of the lungs. The alveoli are normally stretchy and springy, like little balloons.  Normally, it takes effort to blow up the normal alveoli.   However, it takes no energy to empty the alveoli because they spring back to their original shape. 

In emphysema, the walls of some of the alveoli have been damaged.  When this happens, the alveoli lose their stretchiness and trap air. Since it is difficult to push all the air out of the lungs, the lungs do not empty efficiently and therefore contain more air than normal. This is called air trapping and causes hyperinflation in the lung.  The combination of this hyperinflation and the extra effort needed to breathe results in the person feeling short of breath.  Airway obstruction occurs in emphysema because the alveoli that normally support the airways cannot do so during inhalation or exhalation. Without their support, the breathing tubes collapse, causing obstruction to the flow of air. 

BRONCHITIS

Chronic bronchitis is a lung disease with increased swelling and mucous or sputum production in the breathing tubes or airways.  Airway obstruction occurs in chronic bronchitis because the swelling and extra mucous cause narrowing in the breathing tubes. 

WHAT CAUSES COPD?
           
COPD can be caused by many factors, although the most common cause is cigarette smoke.  Environmental factors and genetics may also cause COPD.  For example, heavy exposure to dust or chemicals, or indoor or outdoor pollution can contribute to COPD.

SYMPTOMS
     
The common symptoms of chronic obstructive pulmonary disease include shortness of breath, cough, and/or mucous production that does not resolve.  These symptoms indicate the need for evaluation of your breathing with pulmonary function tests. 
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INTERSTITIAL FIBROSIS

One of the causes of shortness of breath or abnormal chest x-rays is a group of lung diseases called “interstitial lung diseases”.  These illnesses cause scarring at the area of the lung, called the interstitium, where gas exchange takes place – where oxygen goes from the lung into the blood, and carbon dioxide goes in the reverse direction.  There are many causes of these diseases, ranging from occupational exposures, especially silica and asbestos, to various inflammatory problems such as lupus, sarcoidosis and rheumatoid arthritis.  Rarely, this may be a primary lung problem without any clear-cut cause, something we call idiopathic pulmonary fibrosis.  Even more rarely, certain drugs may cause this disease.
           
Diagnosis is made in three ways.  The first is by x-rays, including chest x-ray and chest CT scans.  Lab work is also drawn to look for underlying causes.  Breathing tests (PFT) are often performed to help confirm that this is the problem. Often, a biopsy from the lung will be needed to help identify the problem.  This biopsy may be done by bronchoscopy or even surgically.
           
Treatment can be difficult.  If an underlying cause can be identified, then treatment of the lung scarring should improve.  Treatment of the idiopathic form is extremely difficult, as it does not always respond to medications.
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LUNG CANCER

Lung cancer for years has been the #1 cause of cancer deaths in men in the United States, and now is also the #1 cause of cancer in women in the U.S., overtaking breast cancer for this dubious distinction.
           
While lung cancers can and do occur in patients with no risk factors, tobacco in general and cigarettes in particular are THE single biggest risks for developing lung cancer.  Secondhand smoke has been shown to be a risk, and exposure to certain toxins such as to asbestos and radiation also increases risk of lung cancer.  A genetic predisposition to lung cancer is now apparent, as well. 
           
Unlike certain cancers where symptoms may help lead to early detection, lung cancer remains a largely silent disease.  Cough, hemoptysis (coughing up blood), chest wall pain, and weight loss can and often do occur, but just as often cancers develop and grow undetected.
           
There is controversy regarding the safety, wisdom, and utility of obtaining x-rays or CAT scans to screen for lung cancer.  As of 2007 there is no consensus regarding the value of screening x-rays, who should get them, and for how long they should be monitored.
           
Treatment of lung cancer depends on the size, cellular composition, and location of the cancer.  Surgical removal offers the best chance at cure in the proper scenario. Smoking cessation and avoidance of tobacco products and environmental hazards are the best preventive measures one can take.
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PLEURAL EFFUSION

A pleural effusion is when fluid accumulates surrounding the lung under the rib cage.  Fluid can accumulate in this space because there is a space between the covering of the lung and the covering of the rib cage.  The most common causes of pleural effusion are cancer, cardiac disease including congestive heart failure, infections, asbestos exposure, abdominal disorders, and related to drugs.  There are many other causes of pleural effusion that are not listed.

To determine the cause of pleural effusions, a thoracentesis is performed to remove fluid and to try to analyze the cause of the effusion.  Pleural effusions can be drained by thoracentesis.  If they are related to infection, occasionally a chest tube is required to drain the fluid.  In the case of cancer causing the effusion, the fluid can reaccumulate.  In that situation, the fluid is drained and the material is instilled into the space around the lung to try to prevent further fluid accumulation.
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PULMONARY HYPERTENSION

A condition defined by elevated pressure in the heart chambers responsible for pumping blood from the heart to the lungs.  This is different and more dangerous condition than regular hypertension, also known as high blood pressure or systemic hypertension, which relates to elevated pressure from the heart to our body’s muscles and vital organs other than the lungs.  Pulmonary hypertension can come about as a consequence of another condition (for example, emphysema or other forms of chronic lung disease, sleep apnea, certain forms of heart disease, or medications) or it can come about seemingly in the absence of any other disease, in which it is referred to as Primary Pulmonary Hypertension.  The condition is usually manifested by symptoms of shortness of breath, dizziness and chest pain.  If your physician is concerned about the possibility of pulmonary hypertension, it is likely you will undergo an echocardiogram, a non-invasive test that measures the pressures in the affected heart chambers indirectly.  When pulmonary hypertension is strongly suggested by one’s symptoms and echocardiogram, a cardiac catheterization is often helpful to more accurately define its severity and cause.  Several new medications have been developed recently which significantly slow the disease’s progression and prolong survival.
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SARCOIDOSIS

Sarcoidosis is a chronic disease of unknown cause which can affect virtually any organ, but often involves the lungs. The hallmark of the disease is a particular kind of inflammation defined by the presence of “granulomas” in affected body parts. Presenting symptoms can be very nonspecific and include shortness of breath, cough, chest pain, fevers, joint pains and neurologic symptoms. When the disease is suspected to involve the lungs, the most typically ordered tests include chest x-rays, computed tomographic (CT) scans, blood tests and tests of pulmonary function.  To prove the disease with certainty often requires a biopsy but this can usually be done on an outpatient basis.  Correct diagnosis is important because therapy is available that can alleviate most if not all the symptoms.  New therapies are becoming available with fewer side effects than traditional medicines.
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