If you’re old enough to read this column, it’s a safe bet that you’ve had a cough. It’s also a safe bet that everyone you live with has had a cough too. You can’t get this far without knowing what a cough is.
Knowing what a cough does, however, is a different matter. So here is the answer (which won’t come as a surprise to most farmers). A cough is your body’s way of clearing material from your airways. It’s a sudden expiration that expels mucous, dust, or other irritants, and that prevents this material from being aspirated or breathed into your lungs and clogging your breathing system.
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Coughs vary in type and intensity based on where the stimulus originates. In general, receptors in the head, neck and chest are stimulated and then send the information to the cough centre in the part of the brain called the medulla. The medulla then sends messages through your nervous system to trigger a cough response by the muscles that control your breathing. That response is what you call a cough.
As a reaction, a cough is substantial enough that you would think we would always be aware that we are coughing. Indeed, this is often true. With a cough that accompanies a cold or the flu, it is the viral infection and excess mucous that produces the cough, and you certainly notice the cough as one of your symptoms. As well, if you inhale a substance such as an irritating chemical, you’ll likely notice the episode of coughing which stops once your exposure ceases.
These may be bothersome coughs, but they do resolve. However, sometimes a cough develops over decades — such as a smoker with a cough — and not only may the coughing not attract much attention, it may come to be regarded as “normal” by the individual. Sometimes too, a cough comes and goes, for example a cough that occurs with seasonal hay fever.
Good advice is that if a cough lasts for more than three weeks, it should be checked. It may be a symptom of some other condition. Asthma, chronic bronchitis, emphysema, gastroesophageal reflux or heartburn, and even congestive heart failure may be accompanied by a cough. Good control of the underlying condition can stop this type of cough.
Sometimes, too, a cough can result from the way your doctor treats a different condition. For instance, cough can be a side effect of a group of drugs called the angiotensin converting enzyme (ACE) inhibitors. These drugs, used to treat cardiovascular conditions like high blood pressure, seem to affect substances known as bradykinins which in turn stimulate the cough centre. About 20 per cent of people taking ACE inhibitors experience this dry, hacking cough and need to be switched to another type of drug such as an ARB, or angiotensin II receptor blocker.
Respiratory tract infections such as the flu and common cold account for the majority of coughs, although sinusitis and post-nasal drip can also be implicated. Sometimes these coughs can be productive, and a productive cough should not be suppressed because you want to “get rid” of the secretions that are causing the cough.
Ideally, you want to save cough suppressants such as dextromethorphan for dry, hacking coughs, not for the productive coughs.
For children with coughs, there is little evidence that cough and cold products work, and in some instances they cause unwanted side effects. In fact, Health Canada has advised parents against using these products for children aged six and under. Instead, increased fluids, increased humidity, and adequate rest are recommended. However, if thick secretions or a temperature of 38 C is seen, medical attention is needed.
When you are coughing up blood or thick, malodorous mucous, you need to get your cough checked. As well, if your cough begins suddenly without any other symptoms, if you also experience shortness of breath or a high-pitched sound called stridor when coughing, or if you also have abdominal swelling or a high fever, you also need to call your doctor.
If you are bothered by a persistent cough, first check to see if any other condition could be causing the cough. Treatment of this underlying cause will help get rid of your cough. If not, then it’s bed rest, increased fluid intake, increased humidity, and patience.
Marie Berry is a lawyer/pharmacist interested in health care and education.
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Of course you have never experienced a hangover yourself! Just in case you know someone who has, however, you may be interested in how hangovers happen and how to relieve some of the symptoms. Next month we’ll talk about alcohol and why, when you say “the morning after the night before,” everyone knows what you mean.
