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Cough It Out!

By: Darleth Romana-Bantiles, MDCough It Out!

Pesteng ahem’ is the term popularly used for a cough in the vernacular, indicating the disturbance, apart from the discomfort, that the symptom brings to a person. Whether it is acute, lasts for 1-3 weeks, or chronic that may endure for several months; a cough is a cough, is a cough! It is considered annoying.

Too common for your own good

Most of us, if not all, at one time have been affected by cough and the impairment it brings to the quality of daily living. Coughing occurs as a response to an irritant, which may be an external stimulus (like pollen or dust) or an internal physical reaction (like inflamed airways or excessive mucus production). It is the body’s defense to help extract the noxious factor that comes in contact with the airway. It could be voluntary (as in when one is choking) or reflexive (as in when there is an allergic reaction).

The response begins with a gasp to encourage air deep into the lungs. Afterward, the glottis (or opening of the vocal folds) closes over the trachea. Next, the muscles of the chest cage, abdomen, and diaphragm forcefully contract to push air from the lungs, up to the nose and mouth. Finally, high pressure is produced in the air passages before the glottis opens and the air rushes out that produces the sound (or bark of the cough!).

Zero in on the cause

As cough is a symptom, it is a signal for a condition that may need to be addressed. Sometimes, it comes with a respiratory tract infection like flu, pneumonia or bronchitis. The bad news is that a person may continue to cough even after the infection has resolved. Some complications of this symptom are sleep disturbance, night-time awakening, and chest or rib pain. Physical consequences of prolonged coughing could be fatigue, urinary incontinence, fainting or even broken ribs.

It cannot be overemphasized that identifying the cause is the efficient way to handle a fit of cough. Only when the etiology of this symptom has been pinpointed can it be addressed effectively. The most common among causes of chronic cough are as follows:

1. Postnasal drip – when cough comes with colds, there is usually mucus accumulated in the nasal area. The nose, as the entryway to the lower respiratory passages, conditions the air before it goes in any further. It is also the first-liner for germs that cause infection and membrane inflammation, leading to the production of watery and runny mucus. Sometimes, this thin mucus drips down to the throat and further irritates the respiratory linings.

2. Bronchial asthma – spasms of the airways produce a wheeze, but some people with asthma have cough instead. This type of chronic cough accounts for 25% of cases.  It is characterized as dry and persistent and may be confirmed through a pulmonary function test.

3. Reflux disease – the stomach produces acid and when it travels upstream to the esophagus rather than its usual flow to the intestines, it produces symptoms. When gastroesophageal reflux disease (GERD) does not cause heartburn or chest pain, it may induce coughing via nerves in the esophageal area. In a third of GERD patients, there is no pain whatsoever but only cough and recurrent sore throat.

4. Bronchitis – this persistent inflammation of bronchial passages may be due to smoking or prolonged exposure to air pollutants; excessive mucus production results from the chronic inflammation and leads to coughing.

5. Antihypertensive medicine – Angiotensin-converting enzyme inhibitors, a class of medications for blood pressure control, may induce cough as a side effect in some patients. Enalapril, lisinopril, or any medication ending in –pril are examples of this drug group. Shifting to other classes of anti-hypertensive medication may be the solution in this instance. Evaluation and management of cough in children slightly differ since environmental factors and parental habits should also be assessed. Often, viral infection or prolonged bacterial bronchitis or asthma is the culprit in the pediatric age group.

Don’t let it linger

Truly, a cough is a symptom that cannot be ignored both by the patient or the people around them. However, there’s no reason to panic since a prolonged fit can be solved with specific diagnostics and treatments. In most instances, an appointment with the doctor will aid in proper health history assessment and determination of the cause that is a crucial step in cough management.

Having prolonged cough, because of its complications and physical effects, also has cost implications. Productivity may be decreased, so it may be more cost-efficient to purchase a soothing medication and hasten its resolution. Just remember before you suppress it that having cough may also be a defense mechanism of the body and it need not be controlled all the time.

However, if the cause is an infection and it has already been addressed or another physical condition that has been managed, consider an expectorant or drink enough liquids to mechanically facilitate exit of the mucus from the body.

If mucus passage is taking a toll on you or the cough is nagging due to scanty phlegm, a suppressant for it may really be necessary. Two types of cough suppressants are available: the centrally-acting opioid and non-opioid medications, and the peripherally-acting antitussive. While the former is more popular, they may have more side effects and tend to induce habitual consumption. Some examples of centrally-acting agents are codeine and dextromethorphan. On the other hand, levodropropizine, a peripheral antitussive, may be effective for both pediatric and adult patients without intolerable effects like drowsiness, lethargy or difficulty in breathing. Research has shown that it reduces cough intensity and frequency, and also lessens awakening episodes at night. Supplementing a cough medication with lozenges or gargling solutions will also help soothe throat irritation.

After everything has been done about it, and the cough persists, some notable symptoms that should prompt medical consult are as follows: fever, coughing out blood, weight loss, fatigue, loss of appetite, recurring chest pain, and shortness of breath.

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