The anatomy of a cough - (12/7/2021)

By Dr. Ron Gasbarro

In the same way a fortune-teller can read tea leaves to predict the future, the pharmacist could tell what type of cough any given patient had. For example, Mrs. Murphy, a 40-year smoker, had the deep wheezing, crackling cough of someone who went through 2 packs a day. The pharmacist has noticed that her type of cough is worse in the morning and then levels off as the day goes on. Unfortunately, smoker's cough results from damage to the airways caused by toxins in cigarette smoke. Over time, smoker's cough can lead to hoarseness and chest pain. It can also be among the signs and symptoms of lung cancer.

Compare Mrs. Murphy's cough to that of Beth's, who is a non-smoker. She recently developed a head cold. Unlike a smoker's cough that originates in the lungs and lower respiratory tract, a cough caused by a cold is typically confined to the throat and upper airways. Beth's cough is a wet cough, also called a productive cough, in that it usually brings up mucus. Whether caused by a virus – like a cold or influenza – the coughs are generally accompanied by a runny nose or postnasal drip. 

Wet coughs involve the entire respiratory system – from the nose to the throat to the lungs – because the body needs to clear away the mucus so one can breathe. This type of cough can hang on for weeks, and its duration is a big clue as to its cause. Besides being viral, a wet cough can be caused by bacterial pneumonia, chronic obstructive pulmonary disease (COPD), emphysema, bronchitis, and asthma. These are cases where medical intervention is essential. 

And then there is whooping cough. While a person of any age can get this bacterial infection, it can hit babies particularly hard. The condition starts out as a "cold," with a runny nose, sore throat, red, watery eyes, and elevated temperature. After about a week, the characteristic "whoop" appears in about half the cases. This barking sound is a sign that the child is trying to suck air through the thick mucus that coats the lungs. Note that vomiting may occur as well as a deep red or purple face as the patient struggles to breathe. Some antibiotics will tame whooping cough. However, anyone who comes in contact with children should get the pertussis vaccine so that it does not spread. 

Now, the pharmacist likes to sell his products as any other merchant does. But he often steers his patients away from cough syrups. "Unless you want a particular kind of cough medicine, they tend not to work," he has said on more than one occasion. Do you want something specific? Dextromethorphan reduces the cough reflex. Expectorants loosen mucus. Decongestants cause the blood vessels in the lungs and nose to narrow to reduce congestion. Antihistamines reduce the amount of secretions made in the lungs. They are often combined into an overpriced concoction that is not guaranteed to alleviate your misery. 

Who should not get an over-the-counter cough product? Children under 2 years of age can experience seizures and heart problems. Even kids 3 to 6 should not get cough syrups as the risks – example: getting dizzy and falling – outweigh any benefits from the product. In the pharmacist's opinion, the best cough medicine is a couple of teaspoonsful of honey stirred into herbal tea. It's inexpensive and does the job just as well as any commercial product. Only don't tell anyone because then everyone will be doing it and think of the sales the pharmacist will be losing! 

Ron Gasbarro, PharmD, is a recovering pharmacist and writer-in-residence at Rx-Press.


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