WHEN SHOULD I BE WORRIED ABOUT SYMPTOMS OF RESPIRATORY DISEASE?

Most symptoms of benign respiratory disease are self�limiting, that is, they last no more than a few days and then go away.
Symptoms lasting longer than a few days should probably be investigated, especially if they limit you in any way. Certain symptoms should be investigated immediately. These include:

• Severe or crushing chest pain. This may reflect a heart attack or other serious problem .
• Gross hemoptysis. This is more than simple blood�streaking of sputum; it means coughing up at least a teaspoon of bright red blood.
• Sudden shortness of breath at rest. This may be due to sudden development, or worsening, of heart or lung failure.
• Sudden deterioration of mental status. Although this is usually not due to respiratory causes, it may be, and demands immediate evaluation.
• Any symptom accompanied by incapacitating apprehension. This is another way of saying that if a symptom bothers you to the point you cannot function from worrying about it, you should probably have it investigated immediately.
• Your apprehension may be warranted.

WHAT CAUSES COUGH?
We all cough at times. It is a natural and normal protective mechanism to clear our airways of particulate matter that doesn't belong there. Cough is due to irritation of the airway lining by something, usually mucus, dust, secretions, or blood. The underlying condition may range from a simple cold or a mild asthma attack to heart failure or lung cancer.
When a cough lasts only a few minutes we think no more about it. However, many times, particularly after a cold or virus infection, the cough persists. Because it is so commonly associated with colds and upper respiratory infections, coughing is one of the most frequent respiratory complaints. Whenever a cough is associated with high fever, shortness of breath, production of foul smelling sputum, or severe chest pain, it should be evaluated by a physician. These all point to potentially serious but treatable causes. Beyond these associated symptoms, it is convenient to discuss the symptom of cough based on its time span.

Acute Cough: Lasts only a few minutes; it is a universal experience and is a normal protective mechanism.
Cough of Short Duration: This is a self�limited cough lasting less than three weeks, usually due to colds or upper respiratory infections. It may also be due to asthma, bacterial infections, or limited exposure to noxious material.
Chronic Cough: Lasts longer than three weeks; this is a time beyond which a cough can no longer be simply attributed to colds or viral infections.

MOST COMMON CAUSES OF A CHRONIC COUGH
Cigarette smoking
Chronic bronchitis
Emphysema
Asthma
Lung Cancer
Chronic post�nasal drip due to sinusitis or allergy
Tuberculosis
Chronic viral infection of the airways

WHAT IS HEMOPTYSIS?
Hemoptysis is the coughing up of blood. Many physicians distinguish between blood streaking and gross hemoptysis. In the former a few streaks of blood can be seen in a sea of otherwise whitish or grayish mucus; it is a common (but not to be ignored) finding in chronic bronchitis and in protracted coughs from any reason. Gross hemoptysis is when the majority of what is coughed up is blood. Although this may also be found in patients with chronic bronchitis, it usually demands a thorough evaluation for lung cancer or other serious illnesses.

MAJOR CAUSES OF HEMOPTYSIS
Bronchiectasis (chronic infection of the airways that leads to weak and dilated bronchial tubes)
Tuberculosis
Lung cancer
Pulmonary embolism
Pneumonia
Some forms of heart disease
Blood arising from anywhere in the mouth or nose
Chronic bronchitis (chronic inflammation of the airways associated with chronic cough)

WHAT IS THE BEST TREATMENT FOR A COUGH?
For a cough of short duration the best treatment is no treatment. Most cough medicines are really expectorants, designed to help you mobilize secretions, not prevent the cough. Although many times it may be helpful to give an expectorant, this cannot be considered "treating the cough." True cough suppressants, such as codeine, are related to narcotics and potentially harmful if they suppress the coughing of mucus or other irritating material. If a cough is truly non�productive of mucus and suppression is desired, one of the many codeine�containing compounds may be tried for a short period of time.
When a cough is due to a limited condition such as a cold, it will disappear when the patient improves. A chronic cough demands investigation for the underlying cause that, if found and treated, will also do away with the cough. If a thorough investigation does not reveal a specific cause, a trial of bronchodilators and/or corticosteroids may be helpful However, it cannot be overemphasized that treatment of a chronic cough is not the same as treating the underlying condition. Cough is a symptom and not a disease: treating only the symptom may miss the disease.