Epidemiology & Management of Cough in Smaller Settings-An Indian Case Study

Abstract

Nearly every person experiences at least one episode of cough every year in their lifetime. Most, people seek care outside home only after trying known home remedies, especially when cough disturbs their sleep due to postnasal drip. Available data suggest that an average Indian adult has 3 episodes of cough per year, while an average child has 7-10 such episodes every year. The COVID-19 pandemic has increased the magnitude of cough across the world since early 2020. The most annoying part about a cough is “phlegm or mucus.” Mucus forms a protective lining in certain parts of our body, protects our body from foreign invaders by trapping the irritants and expel them in a cough. Excessive Phlegm or mucus is produced as a response to an irritant from the environment like allergies, smoke, smoking, dust, and infections. Excess phlegm or difficulty to expel phlegm can be tackled as per its cause or origin. No doctor or a health care worker, in his/her clinical practice has a day without seeing a patient with cough. The diagnostic tests are either not available, or unaffordable, if available and used take a long time for definitive diagnosis. Another problem is of self-medication with innumerable number of over-the-counter cough syrups. Most practitioners know about the types of coughs, their symptomatic treatment and over the counter cough syrups and mucolytics, but very few know, the Ideal rationale of managing cough. Having analysed six varieties of coughs namely i) Cough due to postnasal drip in an elderly person ii & iii) Cough of Community acquired Pneumonia in a child and an adult by antibiotics iv) Cough in an elderly person managed by traditional approach of using roasted Guava fruit v) A case of Cough variant Asthma vi) Cough among Covid 19 cases and vii) Cough in COPD case in an elderly, the author is recommending a simple symptoms based logarithmic approach for differentiating various conditions causing cough and managing them empirically. This article highlights the need for a rational approach for small settings or individual practitioners. Materials & Methodology: This review is based on the review of literature on the ideal rationale of managing cough, own learning from personal practice and practices observed among colleagues, in public sector teaching institutes and private sector hospitals. The article addresses the general practitioner’s dilemma of diagnosis and management by simple symptoms based logarithmic approach and managing empirically.