The symptoms of cough, sputum and breathlessness, either alone or in combinations are almost “normally” present in milder forms. It is not uncommon for a healthy individual to cough and even produce some degree of sputum on a winter morning. All of us also get breathless on exertion when an unaccustomed activity is performed. One generally tends to ignore these symptoms attributing their origin to a seasonal change, inhalation of dust and smoke; old age or cold exposure. But these symptoms may reflect the status of the respiratory health – normal or abnormal.

Cough of common cold is of short duration and often accompanied with symptoms of coryza such as malaise, fever, sneezing and running nose. It is usually of viral aetiology and needs no specific treatment.

When accompanied with sputum production (expectoration), cough is said to be productive while small quantities of sputum may arise from hyper-secretion of mucous glands, large, thick or tenacious sputum is more serious. This may follow an episode of severe pneumonia or other lung infections. Formation of a cavity or a lung abscess is a common sequala of a poorly or inappropriately treated lung infection. A severe childhood infection can damage the airways and become a chronic source of cough and expectoration – a condition known as bronchiectasis. Tuberculosis is an important cause of unrelieved cough persisting for several weeks. But all cough is not tuberculosis and also tuberculosis may not manifest with cough.

Tobacco smoke is one of the most important cause of chronic cough. It induces cough by both irritant and chemical actions. Smokers’ cough is a nuisance symptom. It is common to see a smoker inhaling smoke and coughing repeatedly.

In fact both the smoker and those in his close company get so habituated to the noise that it is unnoticed and denied. Chronic cough may indicate the presence of chronic bronchitis (chronic inflammation of the airways) and emphysema which are about 10 to 20 times more often seen in smokers. Collectively called as chronic obstructive lung disease, it is an important cause of chronic respiratory disability, failure and death.

Another mechanisms of smoking causing coughing is even more ominous. It is the lung cancer which occurs in smokers, more than 20 times more often than nonsmokers. Any aggravation as change in behaviour of cough in a smoker should always alarm the patient, as well as the doctor about the possibility of a complication.

Patients with bronchial asthma may also complain of cough with or without breathlessness and wheezing. This shall obviously not respond to treatment with cough sedatives and expectorants unless anti-asthmatic drugs are also instituted.

Asthma remains an important cause of episodic breathlessness throughout life. In middle aged and old people however attacks of breathlessness can occur in the presence of heart failure or other serious problems. The subject is obviously more ill in such a condition. Chronic obstructive lung disease is another common problem which causes difficulty in breathing in adults. It is 20 to 40 times more common in smokers. Often ignored in the beginning, it gradually progresses and leads to early respiratory disability and failure. In latter stages it makes the person a respiratory cripple who is constantly gasping for breaths. Most other diffuse lung diseases also advance similarly. In fact it presents one of those helpless situations for a doctor wherever palliation cannot be offered. There is no way to slow down the fast respiration which every moment may seem to end.

Breathlessness need not be associated with serious illnesses even if it be chronic. Simple obesity is an important cause. Breathlessness of obesity is akin to that of a person with an optimum weight carrying an extra load of a person with an optimum weight carrying an extra load all the time. Besides posing limitation on activities, it does lead to serious health problems after some years. Marked obesity is a recognized cause of respiratory failure which again, is preventable and partially reversible.

Breathlessness may also occur due to deficiency of blood in conditions of anaemia. Improvement of haemoglobin will therefore be associated with relief from dyspnoea.

In the absence of an organic illness, breathlessness may occur in highly anxious and tend individuals. Getting out of breath during an acute anxiety is experienced by every individual. But it may manifest as a symptom of hidden anxiety. Some hysterical individuals, especially children, are known to develop episodes of fast and apparently laboured respiration. Like most other hysterical phenomenon this is generally meant to achieve a secondary gain and relatively easily handled.

It is a common misconception that all types of breathing difficulties are potentially treatable by exercise. It is a tricky situation. Exercise, no doubt, is of paramount importance for a healthy, sedentary or obese individual who needs to increase his breathing capacity. On the other hand, any undue exertion for a person with an underlying cardiac or lung disease should be undertaken only under caution. It may not over burden the already strained system. Even the breathing exercises may compromise the lung function and aggravate the problem.

Treatment of any or all of these symptoms depends upon the underlying cause. Their presence need not cause panic but persistence should certainly signal the need to seek medical attention.