What is Paroxysmal Coughing? How is it Diagnosed & Treated?
What are the common signs and symptoms of paroxysmal coughing? And how is this violent, uncontrollable cough diagnosed, treated and prevented?
8 minute read What is paroxysmal coughing?
Coughing is a reflex action. It helps clear your throat, windpipe, and lungs of foreign substances like mucus and bacteria. It also protects you from dust, smoke, and pollen. However, it can also indicate mild to severe health conditions.
There are four types of cough - wet, dry, croup, and paroxysmal. Bouts of violent, uncontrollable coughing characterise paroxysmal cough. During these bouts, you can find it hard to breathe and can even vomit. Recurring coughing episodes can feel painful and tiring. This type of coughing is highly contagious and typically lasts 1-6 weeks.
What causes paroxysmal coughing?
The bacterium Bordetella pertussis is the leading cause of paroxysmal coughing. It infects your respiratory tract (nose, throat, windpipe, and lungs), resulting in pertussis, commonly known as whooping cough. Paroxysmal coughing is the second stage of pertussis.
When an infected person sneezes, they release germ-laden droplets into the air. If anyone nearby breathes in these droplets, they contract pertussis as well. Other illnesses that can cause paroxysmal coughing include:
Asthma
Tuberculosis
Gastroesophageal reflux disease (GER)
Chronic obstructive pulmonary disease (COPD)
What are the symptoms of paroxysmal coughing?
Typically, symptoms of paroxysmal cough develop within 5-10 days of you coming in touch with the bacteria. However, in some cases, it might take as long as three weeks for the signs to show. The symptoms of paroxysmal cough can be divided into two stages - early and late.
Early symptoms last for 1-2 weeks. These include:
Runny or blocked nose
Mild cough (present only in adults)
Low-grade fever, with the body temperature not rising above 100.4°F
Apnea (a sleep disorder where your breathing abruptly stops and starts, resulting in a drop in your oxygen levels) and cyanosis (when your skin, lips, or nails turn blue due to insufficient oxygen in the blood) in children and teenagers
Late symptoms occur 1-2 weeks after contracting the infection and can last as long as 10 weeks. Some of these symptoms are:
Difficulty breathing
Vomiting during or after bouts of coughing
Making a ‘whoop’ sound when you catch your breath after coughing
Feeling tired and worn-out after coughing fits despite feeling alright in between the fits
What are the risk factors of paroxysmal coughing?
Listed below are the risk factors for paroxysmal cough:
Age: Paroxysmal cough is most common among children under 5, as they have narrower respiratory tracts. Any inflammation or infection in the tract further narrows it down, making it hard for them to breathe.
Vaccination: If infants and children are not vaccinated against whooping cough, the condition can be fatal for them.
Medical history: A history of respiratory diseases, such as asthma, bronchitis, and COPD, makes you more prone to a paroxysmal cough. A weak immune system, which can result from past illnesses, medications, and family history, further increases your chances of developing this condition.
How is paroxysmal coughing diagnosed?
When a doctor notices signs of whooping or paroxysmal cough, they might order one or more of the following tests to pinpoint the condition:
X-ray of the chest and sinuses: To identify symptoms of respiratory infections or damage
Blood test: To examine your white blood cell levels; a high count can indicate infections
Nose or throat culture: To test if any infectious bacteria are present
Spirometry: To assess how your body takes in and exhales air and to diagnose asthma
Bronchoscopy: To see and inspect real-time images of the insides of your lungs
Rhinoscopy: To get a real-time view of the insides of your nose and nasal passage
Endoscopy: To check your upper digestive tract for signs of GERD
How is paroxysmal coughing treated?
Once your doctor makes a diagnosis, they can prescribe various treatments, which include:
Antibiotics: Antibiotics like azithromycin can help your immune system fight the infection-causing bacteria.
Antihistamines: Antihistamines (anti-allergy medications) like cetirizine reduce allergy symptoms - congestion, sneezing, etc. - that can trigger frequent coughing fits.
Decongestants: Decongestants are medicines that offer temporary relief for stuffy and blocked noses. They can also reduce mucus buildup and other cough-related symptoms.
Antacids: Antacids minimise or cure the symptoms of GERD. If GERD triggers your coughing, these medicines can be a game-changer!
Inhalers: Inhalers help by opening the airways during coughing bouts. They are especially beneficial for asthma patients. Inhalers can provide instant relief, so you must always carry it if your doctor prescribes one.
Proton pump inhibitors: Proton pump inhalers like omeprazole reduce the acid production in your stomach, which helps your oesophagus heal from GERD and subsequent coughing.
Along with medicines, doctors can also suggest breathing exercises. Some exercises that can help reduce paroxysmal cough are deep breathing, belly breathing, and pursed lip breathing.
Additionally, some home remedies can offer you relief and reduce coughing fits. These include:
Drink at least two litres of water daily.
Shower and wash your hands regularly to limit the spread of bacteria.
If you are vomiting, stick to eating small portions of soft, easily chewable foods.
Avoid using heavily scented products like candles, room freshener sprays, colognes, etc., as they can irritate your airways.
How can paroxysmal coughing be prevented?
The DTaP vaccine protects you from whooping cough, diphtheria, and tetanus. Doctors recommend getting this vaccine during infancy. Side effects of this vaccine include mild fever, headache, fatigue, and soreness in the injected area. DTaP consists of five injections, which are administered at the following ages:
2 months
4 months
6 months
15-18 months
4-6 years
You need to take three booster shots to retain the efficiency of the vaccine:
Adolescence: The preventive effects of the vaccine start wearing off around the age of 11. Around this time, you must take your first booster shot.
Adulthood: Adults should take a booster to prevent tetanus and diphtheria every 10 years. Some variants of this vaccine can protect you from whooping cough as well.
Pregnancy: Pregnant persons should take the pertussis vaccine between 27 and 36 weeks of conception. This protects their children from this disease during the first few months of their lives.
Statistics about paroxysmal coughing
Here are some interesting details on the prevalence of acute and paroxysmal cough in the UK:
According to a 2006 study published in the Thorax Journal, the UK registers around 48 million cases of acute cough (cough present for 3 weeks or longer, which includes paroxysmal cough) every year. Acute cough costs the UK economy at least £979 million. Out of this, £875 million is the approximate cost incurred due to loss of productivity. £104 million makes up the cost of treatment and non-prescription medicines. The majority of this amount (almost 92%) is spent buying liquid cough medicines.
The Public Health Department of England published the annual Health Protection Report in April 2020. It analysed all confirmed cases of pertussis in the previous year. The report stated that in 2019, there were 3681 instances of pertussis confirmed in the laboratory. This was about 25% more than the number of cases recorded in 2018, 2948.
Vaccine coverage refers to the estimated percentage of people who have received a specific vaccine. According to the Health Protection Report, the UK’s vaccine coverage for pertussis during the financial year 2018-9 was 68.8%.
Additionally, the 2020 report noted an increase in pertussis cases among infants under 1 year and a decline in cases recorded among children aged between 1-3.