Paroxysmal Cough

Signs and symptoms of a paroxysmal cough include an intense, sudden onset of dry cough (i.e., cough without sputum production) or wet cough (e.g., cough with sputum production) which resolves spontaneously. In the case of Bordetella pertussis infection, individuals may experience coughing fits consisting of high-pitched cough sounds, which is how it gets its colloquial name: whooping cough. In some instances, these coughing episodes may involve prolonged use of the intercostal muscles, leaving individuals feeling fatigued. Other systemic symptoms of Bordetella pertussis infection may include myalgias (i.e., body aches), fever, fatigue, and malaise.     

In COPD, individuals may experience breathlessness, increased sputum production, and worsened cough. Finally, in the case of allergies, individuals may also experience red, itchy, and watery eyes; and a cough which occurs as a result of persistent irritation of the lungs from allergens and triggers.  

A paroxysmal cough is treated based on addressing the underlying etiology and with supportive care measures to improve the individual’s symptoms. Supportive care measures include hydration with oral fluids, the use of a humidifier to soothe irritated airways, and avoidance of triggers (e.g., smoking, allergens). In the case of bacterial respiratory infections such as whooping cough, oral antibiotics (e.g., azithromycin) may be prescribed. After the acute infection subsides, routine vaccinations should be kept up to date to prevent further episodes. Viral respiratory infections are often self-resolving; however, individuals should avoid close contact with friends and family in the infectious stage to prevent the spread of the infection.   

Medications such as dextromethorphan or codeine can suppress the cough reflex and prevent severe coughing episodes. If phlegm is present, mucolytic medications, like guaifenesin, can break up and loosen mucus so it can be expectorated properly. If the underlying etiology is asthma or chronic obstructive pulmonary disease, then bronchodilators (e.g., albuterol) and inhaled corticosteroids (e.g., fluticasone) can be used for maintenance therapy. Individuals who are missing routine vaccinations should be encouraged to receive appropriate vaccinations to prevent disease development and transmission.