North Jefferson News, Gardendale, AL

November 16, 2011

Health Watch: Coughing is only symptom, not disease

By Steve Mullenix, R. Ph.
North Jefferson News

— We are having a lot of customers come in this and last week with a common complaint. Nothing out of the norm for this time of year, but nevertheless it can be irritating.

What I’m describing is a sudden, often repetitive, spasmodic contraction of the thoracic cavity, resulting in a violent release of air from the lungs, accompanied by a distinctive and characteristic sound.

Sounds pretty bad doesn’t it? Well, really, this is the description of a cough.

Coughing is an action the body initiates to remove irritating substances from the air passages. A cough is really a protective and primitive reflex of the body. Coughing is the body’s way of removing foreign materials or mucus from the lungs or upper airway passages. Coughing can be triggered by a bolus of food entering the trachea rather than the esophagus when eating or drinking. Frequent or chronic coughing is often an indication of the presence of some acute or chronic disease. A cough is only a symptom, not a disease, and often the importance of a cough can be determined only when other symptoms are evaluated.

Coughs are generally classified as being productive or non-productive. A productive cough produces phlegm or mucus (sputum). A non-productive cough is dry and does not product sputum.



Productive cough

A dry, hacking cough may develop toward the end of a cold or after exposure to an irritant, such as smoke or dust. Each type of cough may have many other potential causes such as protective coughs:

• Viral illnesses – It’s normal to have a productive cough when you have a cold. The coughing is often triggered by mucus that drains down the back of the throat

• Infection – An infection of the lungs and upper respiratory passages can cause a cough. This can be a symptom of pneumonia, bronchitis, sinusitis or tuberculosis.

• Chronic lung disease – A productive cough can be a sign of chronic obstructive pulmonary disease (COPD).

• Stomach Acid – Stomach acid can back up into the esophagus. This type of cough can be a symptom of gastroesophageal reflux disease (GERD), and may awaken you during sleep.

Smoking or other tobacco use can cause a productive cough. This type of cough may be the sign of lung damage or irritation of the throat or esophagus.

Nasal discharge draining down the throat (postnasal drip) can cause a productive cough, and the feeling that you need to constantly clear your throat.



Nonproductive cough

Non-productive coughs include:

• Viral illnesses – After a common cold, a dry hacking cough may last for several weeks, with the symptoms being worse at night.

• Bronchospasm – This type of cough is worse at night, and may indicate spasms in the bronchial tubes caused by irritation.

• Allergies – Frequent sneezing related to allergies is also accompanied with this type of cough.

• Medications – Medications such as Angiotensin Converting Enzyme (ACE) inhibitors (used to treat elevated blood pressure) often cause a non-productive cough.

• Exposure to dust, fumes, and chemicals in a work environment can produce this cough.

• Asthma – A chronic dry cough may be a sign of mild asthma

• Airway blockage – Blocking the airway can also product a non-productive cough.



What to do?

So you ask: “Do cough medicines work?” Based on the billions of dollars spent each year on them one would think so, but the experts are not so sure.

In a 2006 study, the American College of Chest Physicians (ACCP) reviewed a number of cough medication studies used over the last decade. They studied cough medications such as dextromethorphan (DM), as well as expectorants such as guaifenesin. There was no evidence that these medications helped people with run-of-the-mill coughs caused by viruses.

It is important to understand these studies have not proven that the cough medications are ineffective. Rather, they have shown that there is not good evidence they are effective.  

Many of these medications have a long history behind them. If they were being submitted to the FDA for approval today, there most likely would not be enough data to approve them.  The good news about cough medicines is that while they may not be the most helpful, they are unlikely to hurt you. If you take the cough medicine as directed, there is little chance of having any problems with them.

To effectively treat a cough it is important to get to the root of the problem, remembering that a cough is only a symptom and not a disease.

If the cough persists or has major effects on your life activities, a physician should be consulted to determine the cause of the cough and provide appropriate treatment. The common cough resulting from a common cold or upper respiratory infection is often self-limiting with little or no drug treatment.

Steve Mullenix (R.Ph) co-owns The Pharmacy in Mount Olive with his wife, Sherry Mullenix (J.D., R.N.). They can be reached at 631-1201.