Well-Being

That Nagging Cough: What Works, What Doesn’t

July 23, 2018

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YOU HAVE a cold, the flu, or anything that leaves you with a cough, but the cough keeps going, week after week.  You cough, pop cough drops, blow your nose, cough, try Mucinex or Claritin, even the 24-hour Claritin that usually dries you right up, and you still cough.

You can hear noises coming from your chest or feel something down there, suggesting that whatever you had is lingering. The common villain is swollen and oversensitive airways—nose and throat—caused by the cold virus and by the body’s attack on the virus.  Usually called postnasal drip or mucus cough, the cough can take weeks to clear up.

Another category of lingering coughs is post-inflammatory bronchospasm—caused by tightened airways that restrict air flow—which resembles asthma, George Washington medical faculty internist Matthew Mintz told the Washington Post. This cough is often worse at night and can cause shortness of breath, especially during exercise. Although it’s not asthma, bronchodilators and/or steroids can help.

With airways raw and irritated following a cold, bacteria can invade more easily, causing sinus infections and bronchitis as well as pneumonia—mainly signaled by fever and pain along with the cough.

For detecting pneumonia, sputum color turns out to be unreliable.  But two medical devices that can help, if you happen to have one on hand, are the “pulse-ox” and the stethoscope.  The definitive test is a chest x-ray.

The pulse-ox (short for pulse oximeter) is a little finger clip that tests the percent of oxygen in red blood cells.  With healthy oxygen levels starting around 95%, anything lower can suggest pneumonia, but the pulse-ox shouldn’t be used alone to rule it out.  According to a British study led by Michael Moore, primary care researcher at the University of Southampton, nothing replaces clinical judgment, but the pulse-ox can “help pick up pneumonia” when clinical signs are unclear.

In the study of 28,883 patients with signs of infection in the lungs, such as a cough, of 720 who went on to receive chest x-rays, 115 had pneumonia.  Of the 115, 86.1% had exhibited at least one of these signs: a temperature higher than normal, pulse rate over 100 beats/minute and oxygen saturation in the blood less than 95%.

The fourth sign is crackling sounds in the lungs—at one time the cornerstone of clinical diagnosis —which can be detected using a stethoscope, and sometimes by having someone lean their ear against your back.

Symptoms of pneumonia include fatigue, sweating or chills, lower-than-normal body temperature, chest pain and shortness of breath.  Most pneumonia can be spread easily by coughing and sneezing, and by just breathing.  Community-acquired pneumonia refers to that affecting people who have little contact with healthcare—who have not been in hospitals, clinics, etc.

Pneumonia can be mild to life-threatening, depending on age and general health and also on the type of germ—the complicating factor.  Pneumonia most often is caused by a virus, which can be treated with antiviral medication, but often improves in one to three weeks with no treatment at all.

Pneumonia that can be treated with antibiotics include cases caused by bacteria, including strep, staph and legionella, and by bacteria-like organisms such as mycoplasma pneumonia—sometimes called “walking pneumonia.”  A rarer cause is fungi.

A different cause of persistent cough, which even doctors rarely consider, is pertussis.  Symptoms include the familiar “whoop” sounds as well as paroxysms of coughing and vomiting.  For adults, most of whom have been vaccinated (though a booster is recommended), it is not considered dangerous; and it can be treated with antibiotics but only in the early, acute stage.  So, getting this diagnosis after weeks of coughing is useful only to stop using cough and cold remedies.  Pertussis in adults usually runs its course by six weeks, although coughing can persist up to ten.

Most lingering coughs can be attacked with an array of OTC medications.  Steroid nasal sprays like Flonase will calm inflammation in the nasal passages, making it easier to clear the mucus.  But the number-one remedy among healthcare providers is “nasal irrigation twice a day with warm saltwater,” using a neti pot with a saline solution, for example, the NeilMed Sinus Rinse.

To reduce post nasal drip—and in turn lessen throat irritation—two medicines that work well together are the decongestant pseudoephedrine (the one that must be requested with I.D. from the pharmacist, not its less effective substitute phenylephrine); and antihistamines, like Claritin and especially the old-fashioned, drowsy options like Benadryl.

Antihistamines dry up secretions and indirectly decrease congestion, pharmacist Paul O’Reilly writes on Quora.  As for taking Mucinex to loosen chest congestion, writes O’Reilly: “Mucinex is just guaifenesin… also the generic name for plain Robitussin”—while studies show that “drinking lots of fluid loosens chest congestion just as much if not more than Mucinex or Robitussin.”

Because stress can make colds last longer, relaxation, like sleeping 7 to 8 hours a night or longer, is advised.  While most fluids help loosen mucus in the airways which can then be cleared by coughing, alcohol and any drink with caffeine can be dehydrating.  Also, avoid using nasal decongestants for more than three days, which can cause nasal membranes to swell, triggering more congestion, postnasal drip and coughing.

After all possible weapons have been deployed, coughing that continues past eight weeks is considered “chronic”—with a host of other treatments recommended.  Or you could be in the final weeks of pertussis, in which case waiting is the only option.

—Mary Carpenter

Every Tuesday Mary Carpenter reports on the state of our well-being, with her download on topics like new shingle shots, preventing lyme disease and the benefits of strength training. 

 

 



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