Why your cough gets worse at night
Is it whooping cough or just a cold?
Whooping cough is a highly contagious bacterial infection of the lungs and airways that causes repeated bouts of coughing. It can affect anyone of any age, but is a particularly horrible condition for babies and young children. But how do you spot the signs?
Whooping cough is caused by the bacterium Bordetella pertussis, and its early symptoms are very similar to those of a cold - runny nose, red watery eyes, a sore throat and raised temperature. Around a week later, the characteristic cough - including the whoop caused by the individual gasping for air - follows.
"Many symptoms of whooping cough are similar to cold symptoms in the first six to seven days," explains pharmacist Marvin Munzu from Jakemans. "However, the coughs become more intense later and more frequent at night."
Signs it's whooping cough
At first, whooping cough may seem like a normal cough but it is differentiated with time by the following characteristics:
- Whooping cough lasts longer; where a normal cough may last just a few days or weeks, whooping cough may last several months.
- Whooping cough usually has several uncontrolled coughing spasms which can be quite severe and cause vomiting.
- There is a 'whooping' sound when inhaling compared to normal coughs (although this only happens in about half of cases).
- Choking and face colour changes (red or blue) are more common with whooping cough than with normal coughs.
- Breathing difficulties are also more common with whooping cough than with normal cough.
"The coughs are usually productive or phlegmy with thick mucus and can cause vomiting," states Munzu. "The intensity of the cough can often lead to slight bleeding under the whites of the eyes and skin. Children may also have red faces from the strain, may experience periods of shortness of breath and may briefly turn blue, but this is restored shortly."
The symptoms will become less severe and occur less frequently over time, but it can take months to stop completely.
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When is it contagious?
Whooping cough is spread in the drops of coughs and sneezes, and individuals can be infectious for around three weeks from the time they develop the 'catarrhal' phase before the bouts of severe coughing start.
Treatment depends on age and how long the infection has been present; children under six months and people with severe symptoms or who are very ill will usually be admitted to hospital for treatment, says Munzu.
"Antibiotics may also be given within the first few weeks to reduce the spread of the infection. Most people are no longer infectious after three weeks and may not need any treatment or antibiotics. Drinking plenty of fluids, resting, general hygiene and taking painkillers such as paracetamol or ibuprofen may speed up recovering as well as reduce signs of the infection such as fever."
It's important to be aware that while antibiotics should reduce spread, they don't speed up recovery, or reduce the severity of symptoms, for the patient taking them.
"Cough medicines are not generally recommended as they are not suitable for young children and are of little or no benefit in whooping cough," Munzu adds.
To stop the infection spreading, the National Institute for Health and Care Excellence (NICE) suggests keeping the infected child off nursery, school or work until 48 hours after starting antibiotics, or three weeks after coughing starts, whichever is sooner; to cover their mouth and nose when coughing and sneezing and dispose of tissues immediately; and to wash hands with soap and water regularly.
What about the vaccine?
Routine vaccinations are offered as part of the NHS childhood vaccination programme to protect babies and young children from whooping cough. Pregnant women are advised to be vaccinated around the 20th week of pregnancy to protect the baby within its first few weeks of life.
Once born, the baby will receive a 6-in-1 vaccine at eight, 12 and 16 weeks; this vaccine protects against diphtheria, tetanus, polio, Haemophilus influenzae type B and hepatitis B, as well as pertussis (whooping cough). At three years and four months, children are given a 4-in-1 preschool booster, and although this doesn't offer lifelong protection, it can help prevent children getting whooping cough when young and vulnerable to the effect of infection.
American scientists recently suggested that the whooping cough vaccine isn't as effective as it used to be because the bacteria it fights have undergone genetic changes. The Center for Disease Control and Prevention analysed samples from patients with whooping cough between 2000 and 2013 and found the bacteria had mutated over time, meaning the current vaccine is no longer a perfect match.
"There have been reports of recent outbreaks, especially in the USA. The exact reason has not yet been identified and may be due to several factors including children not vaccinated, time since last vaccination and possibilities of a mutation of the Bordetella pertussis bacterium which causes whooping cough," states Munzu.
"Several studies are currently being carried out to determine the exact reasons for the outbreak and to improve the effectiveness of current whooping cough vaccines. However, the current vaccines are still the most effective prevention for whooping cough with several benefits and should be recommended especially for babies, young children and vulnerable patients.”
Whooping cough is a nasty condition, particularly for babies and young children. Good hygiene can help prevent the spread of the disease. Vaccination, although perhaps not as effective as it once was, is still the best line of defence against this contagious infection.