What would cause wheezing at night

to cough

Brief overview

  • What is a cough? Rapid, violent exhausting of air; can be acute or chronic, with or without sputum
  • Causes: z. B. cold, flu (influenza), bronchitis, allergy, asthma, Covid-19, pulmonary embolism, tuberculosis, heart failure
  • When to the doctor i.a. for chest pain, shortness of breath, high fever, coughing up large amounts of blood
  • Diagnosis: Discussion with the patient, physical examination, possibly throat swab, blood test, X-ray, lung function test, etc.
  • Treatment: Treat the underlying disease (e.g. pneumonia, asthma), otherwise general measures such as steam inhalation, home remedies such as tea, and possibly antitussive or antitussive medication

Cough: description

Barking, wheezing, painful, excruciating, with or without sputum, occurring all day, only at certain times of the day or when eating certain foods - there are very different types of coughs. It can be divided on the one hand according to the duration (acute and chronic cough) and on the other hand with regard to coughing up secretions (drier, more productive and coughing up blood).

Acute and chronic cough

According to the duration of the cough, doctors differentiate between acute and chronic cough:

  • Acute cough takes up to eight weeks. The causes are mostly respiratory infections (colds, bronchitis, etc.). In addition, acute coughing can occur as a result of an allergy, pulmonary embolism, if a foreign body is swallowed or inhaled, or if there is acute poisoning (such as a fire).
  • Chronic cough lasts longer than eight weeks. Possible causes are, for example, asthma, chronic bronchitis, the chronic lung disease COPD and lung cancer.

Dry cough (dry cough)

Dry cough also means unproductive cough or cough without sputum - and that is exactly what it is: cough without secretion. It is triggered by irritation of the airways. Hence the name dry cough.

  • Acute dry cough can occur at the beginning of acute bronchitis, with small pulmonary embolisms (blockage of a pulmonary blood vessel), pleurisy and when inhaling irritant gases, dust and other foreign bodies.
  • Chronic dry cough For example, it can be traced back to chronic runny nose or chronic sinusitis, reflux disease and asthma. In addition, chronic dry cough can also be a side effect of cardiovascular drugs (ACE inhibitors).

The duration of the cough is more relevant to treatment than whether it is productive or dry.

Productive cough (cough with sputum)

Here the cough is accompanied by a lot of phlegm, hence the name cough with sputum. The slime is usually crystal clear. Yellowish sputum from the lower airways is due to inflammatory cells. Greenish bronchial secretions indicate a bacterial infection.

  • Acute productive cough can occur in the context of pneumonia and in the later stage of acute bronchitis.
  • Chronic productive cough can be an indication of chronic bronchitis or COPD, among other things.

Coughing up blood (hemoptysis)

Cough with bloody sputum is basically a form of productive cough. Common causes of coughing up blood include severe bronchitis, pulmonary embolism, pulmonary tuberculosis, lung cancer, and breathing in foreign objects. It is also possible (albeit rarely) that a left heart failure (a pumping weakness of the left half of the heart) or a blood clotting disorder (congenital or due to the use of anticoagulant medication) is behind coughing up blood.

Cough: causes and possible diseases

Overall, the top causes of cough are:

  • Cold: A cold is an upper respiratory infection with viruses. It is typically accompanied by a cough, runny nose, nasal congestion, and a general feeling of illness.
  • Influenza: The real flu is also a viral infection of the respiratory tract. While a cold can be different pathogens, these are so-called influenza viruses. The real flu is more severe than the common cold. The illness begins very suddenly with a high fever, headache, muscle and limb aches, sore throat and difficulty swallowing, and a dry cough (often changing to one with thick phlegm). Sometimes patients also experience nausea.
  • Chronic sinusitis: Chronic sinusitis is accompanied by a mostly dry cough (dry cough), which is often aggravated when lying down. Incidentally, the inflammation often extends to the mucous membrane of the nasal cavity, so it is associated with a chronic runny nose (chronic rhinitis). Doctors therefore often speak of chronic rhinosinusitis as a whole.
  • Bronchitis: Bronchitis is an inflammation of the airways that is often accompanied by an excruciating cough. With acute bronchitis, a dry cough occurs at first, later productive cough. They also have a runny nose and a sore throat. Doctors speak of chronic bronchitis when someone has had coughs and sputum (productive cough) every day for at least three consecutive months for at least two consecutive years. Smoking is very often the cause of chronic bronchitis.
  • Inflammation of the lungs (pneumonia): Coughing can also indicate pneumonia. At first it is mostly dry; later the patient coughs up mucus. Other symptoms of pneumonia include shortness of breath, high fever, sudden chills, and feeling very sick.
  • Inflammation of the pleurisy (pleurisy): Doctors understand this to mean an acute inflammation of the pleura and / or pleura. Possible causes are infection, cancer, and pulmonary embolism. The dry form of pleurisy (pleurisy sicca) is associated with a dry, irritating cough, severe, one-sided and breath-dependent chest pain and shallow breathing.
  • Ingestion or inhalation of irritant gases, dust etc .: If food or liquid accidentally ends up in the windpipe instead of the esophagus, a dry, tickly cough occurs - the body tries to cough the foreign bodies back up towards the oral cavity. The same thing happens when inhaling (inhalation) or swallowing (aspiration) irritant gases, dust or other foreign bodies.
  • Allergy: Allergic cough can occur, for example, with a mold allergy, food allergy and house dust mite allergy. People with a pollen allergy (hay fever) often also develop asthma later on, which is why coughing and shortness of breath are the first signs.
  • Bronchial asthma: Asthma is a common, chronic disease that causes inflammation and narrowing of the airways. The patients suffer from a predominantly dry cough (also at night) and attacks of breathlessness. A wheezing noise (wheezing) is also typical.
  • Chronic obstructive pulmonary disease (COPD): Even with COPD, the airways in the lungs are chronically inflamed and narrowed. The resulting complaints are primarily a chronic cough with sputum (productive cough) and shortness of breath during exertion. The main cause of COPD is smoking.
  • Lung collapse (pneumothorax): This leads to a pathological accumulation of air between the inner and outer lungs, where there is normally no air. The reason for this is, for example, the bursting of alveoli or an injury to the lungs. The lung in question collapses, recognizable by the sudden onset of pain in the chest area, which can radiate into the back. In addition, a dry cough, breathing-dependent pain and increasing shortness of breath with shallow breathing often develop.
  • Pulmonary embolism: Coughing can also be a sign of pulmonary embolism, which is a blockage of a blood vessel in the lungs with a blood clot. Smaller pulmonary embolisms sometimes cause no discomfort or only brief coughs. With larger blood clots, on the other hand, symptoms such as coughing (possibly bloody), shortness of breath, chest pain, palpitations, dizziness, unconsciousness and bluish discoloration of the skin and mucous membranes occur suddenly.
  • Lung cancer (lung and bronchial carcinoma): The term lung cancer includes various malignant growths of the lungs. Persistent cough is a relatively early symptom of such cancers, but it can indicate many other diseases as well. Some patients also cough up blood. The main cause of lung cancer is smoking.
  • Interstitial lung diseases: The term encompasses more than 200 different lung diseases that are caused by damage to the alveoli. As a result, there is inflammation and a pathological increase in connective tissue (fibrosis) in the area of ​​the pulmonary interstitium, i.e. the thin tissue wall between the alveoli. Interstitial lung diseases are accompanied by shortness of breath under exertion (exertional dyspnea) and attack-wise, dry coughing.
  • Whooping cough (pertussis): Whooping cough is a serious respiratory infection caused by bacteria and is very contagious. The patients suffer from convulsive coughing attacks followed by gasping for breath (hence the name whooping cough).
  • Diphtheria: Diphtheria is also a severe, acute bacterial respiratory infection. The pathogens produce toxins that damage the mucous membranes and, rarely, the heart, liver and kidneys. The disease usually begins with a sore throat, difficulty swallowing and a slight fever. If the larynx is affected, a barking cough, hoarseness and shortness of breath develop (due to swelling of the mucous membranes). Typical of diphtheria is also a putrid, sweetish bad breath. Without treatment, there is a mortal danger, but thanks to vaccination, the disease has become rare.
  • Pseudo croup: Typical of this virus-related inflammation of the upper respiratory tract is a dry, barking cough. Further symptoms are hoarseness, whistling or squeaking breathing noises when inhaling and no or only a slight increase in temperature. Difficulty breathing can also occur. Small children in particular develop pseudo croup.
  • Tuberculosis (consumption): Tuberculosis (TB) is a chronic bacterial infectious disease that mostly affects the lungs and, less often, other organs of the body. Characteristic symptoms of pulmonary tuberculosis include persistent cough, either with (productive cough) or without sputum (dry cough). In the advanced stages of the disease, bloody sputum is coughed up (coughing up blood).
  • Bronchiectasis: Doctors refer to permanent expansion of bronchial branches in the lungs as bronchiectasis. These bulges are either congenital or acquired (for example, from bronchitis, cystic fibrosis). Symptoms of bronchiectasis include a chronic, productive cough with a lot of sputum, which is often yellow-green in color.
  • Cystic fibrosis (cystic fibrosis): In this congenital metabolic disease, the secretion of various body secretions such as mucus and sweat is disturbed. For example, thick mucus forms in the airways, which increasingly causes shortness of breath. A chronic cough often develops (usually with mucus production, sometimes mixed with blood).
  • Heart failure: If the heart is weak (heart failure), the heart can no longer supply the body with sufficient blood and oxygen. The organ weakness can affect the left half of the heart (left heart failure), the right half of the heart (right heart failure) or both halves (global heart failure). A chronic dry cough can occur with both left and bilateral (global) cardiac insufficiency, especially at night (the cough increases when lying down).
  • Reflux Disease: It is characterized by the reflux of stomach acid or acidic stomach contents into the esophagus and is also called (gastroesophageal reflux). Those affected suffer from a chronic dry cough (with and without heartburn), which often increases when you lie down. When the rising stomach contents get into the respiratory tract (pulmonary aspiration), the body reacts with a cough all the more. In addition, inflammation of the airways (such as sinusitis or chronic bronchitis) and asthma can develop.
  • Side effect of medication: Some medications can cause a chronic dry cough as a side effect, which often occurs in attacks. These drugs include, for example, ACE inhibitors and beta blockers. Both are used as cardiovascular drugs, for example for heart failure and high blood pressure. In addition, taking the anti-inflammatory cortisone (in spray form) can cause a cough.

Cough: Chronic illness

Asthma, chronic bronchitis, cystic fibrosis - as can be seen from the list above, cough can also be a symptom of various chronic diseases.

Chronic cough in children

In children, chronic cough often results from:

  • Airway hypersensitivity after a viral infection
  • bronchial asthma
  • Backflow of acidic stomach contents into the esophagus (gastroesophageal reflux) or inhalation of the stomach contents (pulmonary aspiration)
  • Overproduction of mucus in the nose and paranasal sinuses with mucus drainage into the throat ("post-nasal drip")

Rare causes of chronic cough in children are, for example, breathing in foreign bodies, cystic fibrosis and inflammation of the smallest airways in the lungs (bronchiolitis) after a viral infection.

Chronic cough in adults

Common causes of chronic cough in adults include:

  • chronic bronchitis (as a result of smoking)
  • bronchial asthma
  • Backflow of acidic stomach contents into the esophagus (gastroesophageal reflux)
  • Overproduction of mucus in the nose and paranasal sinuses with mucus drainage into the throat ("post-nasal drip")
  • Left-sided heart failure (left heart failure)

In rare cases, for example, pneumonia, tuberculosis, lung cancer or the use of ACE inhibitors (cardiovascular agents) are responsible for the chronic cough in adults, or the chronic cough is psychological.

Diseases with this symptom

Find out here about the diseases that can cause the symptom:

Cough: treatment

If a disease such as asthma, COPD, pneumonia, lung cancer or cystic fibrosis is responsible for the cough, the doctor will treat these diseases accordingly. As a result, the cough usually disappears.

In the case of uncomplicated acute coughing as a result of a cold, general measures are usually sufficient to alleviate the symptoms, for example drinking enough water, inhaling steam (20 minutes at 43 ° C water temperature) and refraining from (active and passive) smoking.

Cough medication

Medication is only given for a cough if it is absolutely necessary or if the symptoms severely affect the patient (such as an agonizing cough). A cough remover or cough blocker is used as required.

Sometimes such cough medications are also used for severe advanced diseases such as lung cancer when a cure is no longer possible.

Cough remover

If a lot of viscous mucus blocks the airways and is difficult to cough up, cough removers (expectorants) can provide relief: They liquefy the mucus and thus make it easier to cough up. This not only improves breathing, but also prevents pathogenic bacteria from nestling in the stuck mucus. The active ingredients acetylcysteine ​​(ACC), bromhexine and ambroxol are mainly used as cough relievers.

Cough suppressants

Cough blockers (cough suppressants, antitussives) are used for excruciating, dry, irritating coughs - i.e. unproductive coughs without sputum. They dampen the urge to cough and allow the irritated mucous membrane in the airways to recover. Often, cough suppressants are also given in the evening so that coughing attacks do not repeatedly wake the patient out of sleep.

The cough suppressants in drugs include codeine, dihydrocodeine, pentoxyverine, and dextromethorphan. Some of them (codeine, a substance related to opium) can be addictive; in addition, cough suppressants can cause constipation and poor concentration as side effects. Those affected should therefore not take antitussives for more than a week. Particular care should be taken with these drugs when operating machines or actively driving.

In addition, it should be noted that cough blockers must never be used if the cough is productive! By suppressing the coughing stimulus, the mucus in the airways is no longer coughed up, which can hinder breathing and encourage bacteria to settle in the stuck mucus. For the same reason, an expectorant (cough remover) and a cough blocker should not be used at the same time when coughing.

Antibiotics

If the cough is indicative of an acute bacterial infection, the doctor may prescribe antibiotics. Patients should consistently take these for as long as recommended by the doctor, even if the symptoms disappear beforehand.If the antibiotic therapy is stopped prematurely, there is a risk that some bacteria will survive in the body and become insensitive (resistant) to the antibiotic. In the event of a renewed infection, the drug would no longer work. In the case of viral infections of the respiratory tract, such as those that occur with a cold or flu, antibiotics are not effective.

Homeopathy for coughs

If you want to try homeopathy for dry coughs, you should resort to Bryonia (for dry, irritable cough, headache and body aches) or Drosera (dry, barking cough and shivering fever). You can find out from a naturopath or experienced pharmacist which potency of the homeopathic remedy is best suited in each individual case and how the preparation is used correctly.

Home remedies for coughs

Herbal tea is a natural help with coughs - if you prepare it with the right medicinal plants: If you have a dry cough, you should choose medicinal plants containing mucus to soothe the irritated mucous membranes, for example lime blossom, ribwort or marshmallow. In the case of a productive cough, on the other hand, expectorant herbs are helpful, such as mullein, primrose or thyme.

In addition, warm wraps or compresses for the chest and back are ideal home remedies for coughing - for example a mustard flour compress for a dry cough and a ginger wrap for a productive cough. Inhaling is another good tip, especially in the latter case: deep breathing in warm vapors makes it easier to loosen stuck mucus in the airways.

Cough: When should you see a doctor?

If you have a persistent, prolonged cough, you should consult a doctor to be on the safe side - especially if you have no suspicions about the possible cause (such as bronchitis, asthma).

You should see a doctor immediately in the following cases of cough:

  • Cough with chest pain
  • Cough with shortness of breath (and possibly also bluish discoloration of the skin, e.g. on the lips)
  • Cough with a high fever
  • Coughing up large amounts of blood (haemoptysis)
  • Cough during / after stay in countries where tuberculosis is widespread
  • Cough after contact with tuberculosis patients
  • Cough if you have a history of known cancer
  • Cough in people with immunodeficiency, HIV infection or immunosuppressive therapy (treatment that suppresses the immune system)
  • Cough in extremely heavy smokers

If the cough is accompanied by other possible symptoms of Covid-19 (such as loss or impairment of the sense of taste and smell or shortness of breath), you should call the responsible health department to discuss how to proceed. If you have possible Covid-19 symptoms, do not go to the doctor on your own, otherwise you may infect other people on the way there or in the doctor's office.

Cough: diagnosis

First, the doctor has a detailed discussion with the patient about the medical history (anamnesis). Important information is for example:

  • How long has the cough existed?
  • Does the cough occur in connection with other events, for example with physical exertion or after contact with allergenic substances?
  • Are there any accompanying symptoms such as fever or shortness of breath?
  • Is it a cough with sputum? If so, how much secretion is coughed up and what is it like (color, smell, consistency)?
  • Are there any special risk factors such as underlying diseases, smoking, swallowing disorders?
  • Are you taking any medication?

From this information, the doctor can often make assumptions about the possible cause of a cough. Further investigations then bring clarity:

  • Physical examination: When listening to the chest (auscultation), the doctor can recognize any breathing noises - important information for the diagnosis. For example, pseudo croup can usually be diagnosed on the basis of secondary breathing noises, barking cough and hoarseness.
  • Throat swab: If diphtheria is causing the cough, the doctor will swab the throat. After creating a bacterial culture, it is examined for diphtheria pathogens under the microscope. The doctor can also take a throat swab (or nasal swab) to detect a possible infection with the novel coronavirus.
  • Examination of the sputum (sputum examination): An examination of the sputum during a productive cough can identify, for example, tuberculosis or pleurisy as a trigger of a cough.
  • Blood tests: A blood sample from the patient is helpful if, for example, a cold or the real flu (influenza) could be causing the cough. An analysis of the blood gases (oxygen, carbon dioxide) can also show whether the gas exchange in the lungs is disrupted, as is the case with asthma and COPD, for example.
  • Roentgen: An X-ray examination is indicated as a possible cause of cough if bronchitis, pneumonia, COPD, tuberculosis or cystic fibrosis are suspected.
  • Pulmonary function test: The doctor examines whether the cough is due to narrowing of the airways, such as in asthma, COPD or bronchiectasis. Various examination methods are available, including spirometry and body plethysmography.
  • Bronchoscopy: The doctor inserts a tiny camera, which is attached to a thin tube or a kind of metal tube, through the windpipe to take a look into the lungs. This examination is indicated when a swallowed foreign body or lung cancer could trigger the cough. The examiner can also use the bronchoscope to obtain specific secretion or tissue samples for further examination.
  • Prick test: This skin test is used to clarify allergies. By applying various test substances, it is possible to check whether, for example, house dust mites, molds or certain foods cause allergic coughs and other allergy symptoms.
  • Nasoscopy: It is indicated when a chronic runny nose / chronic sinus infection is responsible for the cough.
  • Sweat test: It is useful if cystic fibrosis is suspected to trigger a cough. Because the disease not only changes the composition of the mucus in the respiratory tract, but also that of sweat, among other things.
  • Gastroscopy: If the cough could be due to the backflow of stomach contents into the esophagus (reflux disease), this can be determined by gastoscopy.
  • Computed Tomography (CT): CT can clarify whether the cough is caused by chronic sinusitis, lung cancer or pulmonary embolism, for example.
  • Heart ultrasound (echocardiography): The heart ultrasound shows whether a heart failure is behind the to cough plugged.

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