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Coughing

Scenario: John is 35, and you've been helping him sort out a few problems to do with booze, accommodation and general coping skills. He is doing fairly well, but unfortunately he doesn't share your concern about his hacking cough. It's been worsening over the last four months. 'Don't worry, ya know. I get asthma, and I've been eatin' the cigs. Reckon it's better than me drinking aye!'

This hacking cough could be due to:

• Lung disease due to smoking (chronic bronchitis and/or emphysema).
• Asthma.
• A chest infection (viral bronchitis or pneumonia).
• TB (tuberculosis).
• Lung cancer.
• Heart failure (causing fluid on the lungs).

Advice:

Arrange for John to be urgently medically examined. Although chronic bronchitis due to smoking is the most likely possibility, other causes must be excluded. One such cause is tuberculosis (TB), a slow but persistent infection. TB requires prompt and prolonged antibiotic treatment to prevent lung destruction. It is contagious and close contacts should be tested.