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IT starts with a little tickle. From the back of the throat, it creeps up. And then it comes out, a great hacking that shakes your entire body.
“I have a bit of a cough, doctor,” you say, when you go to the clinic. “Can you make it go away?”
That’s usually the problem when it comes to a cough, says Dr Ashoka Menon, a respiratory medicine specialist.
“People think they come and see a doctor, and wham! The cough should immediately stop.”
“While the medicine might help to ameliorate the cough and lessen the irritation, it will not settle the cough immediately,” says Dr Menon. What’s more, if the underlying reason for the irritation is not addressed, that cough will be here to stay.
A protective mechanism
Annoying as it may be, the cough actually serves a useful purpose in our bodies.
“The cough is intended as a protective reflex, to (safeguard) the respiratory tract from some injurious material,” explains Dr Menon. When you cough, it is your body’s way of expelling food that has gone down the wrong way, inhaled toxins, mucous that has trickled from the back of nose into the throat, or phlegm in the lungs.
As long as these foreign bodies are not cleared from the respiratory tract, they will either affect the ventilation of the lungs or cause an infection in the tract.
When you have a cough without much phlegm, it is known as a “dry cough”, which occurs because something is irritating the respiratory tract.
However, if you bring up a great deal of phlegm during those hacking sessions, then you have a “productive cough”.
Observe the nature of the phlegm, says Dr Menon, for clues to the cause of the cough. “If the phlegm is yellowish-greenish, then it could be an infection. If it is bloody, we have to think of pneumonia, tuberculosis or cancer. If there are large quantities of dirty-looking phlegm, we might suspect bronchiectasis (an abnormal destruction and widening of the large airways in the lung).”
An irritated respiratory tract
“Ah, these cigarettes! They are pernicious, positively pernicious, and yet I can’t give them up! I cough, I begin to have tickling in my throat and a difficulty in breathing,” exclaims Porfiry Petrovitch in Fyodor Dostoevsky’s Crime and Punishment.
Cigarettes aren’t the only culprits, although they can certainly aggravate the condition. A cough is a response to some abnormality or disease in any part of the respiratory tract, starting from the tip of the nose right into the substance of the lungs itself.
Infections, inhaling smoke, fumes, toxins or allergens, lung tumours, fluid accumulation in the lung and even heart disease are among the conditions that can cause a cough.
Of course, there is the ordinary viral infection, which is the most common cause of a cough.
“Cough can also be due to diseases that do not arise from the lung itself, for instance, heart failure, reflux or certain medications, like the anti-hypertensives ACE inhibitors,” says Dr Menon.
A cough in a child is most often attributed to a viral infection, asthma or an allergic reaction. Whooping cough (which produces spasms of coughing that may end in a high-pitched, deep inspiration, the “whoop”) and croup (which produces a “barking” cough) are rare in Malaysia, with children receiving vaccination for pertussis and diphteria during infancy.
“In adults, you have to worry about chronic bronchitis from smoking, tuberculosis or cancer. We’re a bit more cautious with those above the age of 40 or 50, especially if they are smokers ? we don’t want to miss a tumour somewhere.”
While a cough is a sign that something is wrong, it is not a useful indicator of the severity of the disease.
“People tend to get agitated when someone coughs violently. But some of the most horrendous, horrible, troublesome coughs are frequently due to the most benign disease,” he points out.
Conversely, some of the most benign-sounding coughs can be due to a very malignant disease like cancer.
Some chronic coughs may even be absolutely benign, such as the quirkily named 100-day cough. “It develops after someone has the flu and the cough continues for three months after that. There is usually no fever, hardly any phlegm or just small amounts of whitish mucous, and the patient is quite well.”
This prolonged cough becomes a recurrent pattern, cropping up every year or so. Antibiotics have no place here, as it is caused by a combination of genes and an overly sensitive respiratory tract.
Cough and complications
“A cough on its own is not necessarily something to be looked at with great fear,” says Dr Menon, although he adds that “there are some situations where a cough can cause some alarm.”
For instance, a prolonged cough, particularly in pregnant women, can lead to a lot of aches and pains all over the body. “This is because of the recurrent, violent contractions,” he says, gesturing to the chest area.
Although rare, but not unheard of, elderly osteoporotic people can actually fracture their ribs with prolonged coughing.
Some people cough so much that they vomit, faint or fall down repeatedly. When they contract their chest and abdominal wall, the intra-abdominal pressure increases, causing the abdominal contents to be thrown out or temporarily impeding blood flow to the brain. These are not as worrying as they sound, being temporary conditions.
Headaches or involuntary urination (more common in women) may also occur as a result of cough.
Pregnant women who have an incompetent cervix should be aware that violent, prolonged coughing may lead them to lose their baby.
Nonetheless, Dr Menon assures that most of these complications are, although sometimes disabling, quite benign.
Treat the cause
People with a cough tend to seek very predictable solutions.
“Everybody wants cough syrup the moment they start coughing,” says Dr Menon. What they do not realise is that cough syrup only treats the symptom, but does not address the underlying cause of the cough.
Make no mistake, cough syrups are still useful, particularly with a benign, self-limiting, transient condition like the ordinary cough-cold flu. “In that situation, you just give something to relieve the symptom, like antihistamines.”
Cough syrups are also helpful when the cough itself has become a very disabling symptom, plaguing a person all day long or keeping him awake at night.
According to Dr Menon, different causes of cough require different treatments, for example:
If the patient is not responding to the medication, it generally means that the treatment is not addressing the underlying problem.
Often, people worry too much about the cough itself, in a way, missing the forest for the trees.
“A cough doesn’t kill anybody,” Dr Menon points out. It’s what’s causing that cough that should be investigated.
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