MANILA, December 9, 2003 (STAR) AN APPLE A DAY By Tyrone M. Reyes, M.D. - Along with the cold weather, the holiday season brings with it an increased incidence of upper respiratory tract infections. Scientists explain that this may be due to stress, which lowers a person’s resistance to infection, or to the crowded shopping malls, which makes transmission of infection easier. Whatever the reason, it does seem like you hear more people coughing during this season than at any other time of the year. So common is it, in fact, that some people have dubbed it the Christmas cough.

You probably associate cough with illness, but coughing is both normal and common. Chances are you cough several times a day without noticing it. Here’s a look at coughs and when they require evaluation.

What Is A Cough?

Several times each day, your normal breathing pattern is interrupted as air rushes out of your lungs at a speed of up to 500 miles an hour. That explosion of exhaled air is a cough – one of the body’s most important defense mechanisms.

The mucus that lines your nose and airways increases in response to irritants and then traps them. The irritants stimulate the cough receptors in your nose, throat or chest, and the receptors send a message to your brain. That signals your body to cough, which helps clear out the irritants by expelling the mucus.

Sometimes, of course, coughing becomes considerably frequent, annoying, and even painful. In fact, an aggravating cough is the second most common reason for a trip to the doctor’s office, right up there behind pain. It is so common that in the United States, the desire to quell a cough drives Americans to cough up more than $350 million each year on over-the-counter remedies that provide prompt relief.

That’s usually not money well spent. A persistent cough is not a medical problem in itself; it’s a symptom of some other problem. Most coughs clear up in a few days but some hang on longer.

Why Are You Coughing?

The cough reflex is usually effective in expelling an intruder or an irritant from the airways. That can be something in the air you breathe, or excess mucus secretion by the cells lining the respiratory tract itself. In fact, even normal amounts of mucus that drain from the nose, sinuses, or windpipe can stimulate those occasional coughs when you’re awake. The cough reflex keeps mucus from getting into the lungs, where it can accumulate and become infected or interfere with breathing.

Usually, it’s not difficult to identify the cause of a cough. In most cases, it’s the postnasal drip from a stuffy or runny nose brought on by the common cold. Postnasal drip is caused by an overproduction of mucus that trickles down your throat and may also be due to allergies, sinusitis (inflamed mucous membranes within sinuses), or other causes. That’s what prompts most people to reach for the cough syrup. But you’d do better to reduce the nasal congestion and perhaps to dry the secretions, which will in turn diminish the cough-causing mucus drip. Cold and flu viruses are the most common causes of cough.

Like the common cold, allergies can also trigger a cough due to postnasal drip. And again, you should aim to control not the cough but in this case, the allergy. Depending on the individual, that might involve an over-the-counter antihistamine, a newer non-sedating prescription variety, or a steroid nasal spray.

Asthma could also cause cough, especially if attacks occur during the night, after exercise or when you’re exposed to irritants. Among the environmental irritants that can cause cough are smog, dust, cigarette smoke, scents, and cold or dry air.

Diseases involving the lower respiratory tract, such as influenza, bronchitis, or pneumonia, can cause a more persistent, hacking cough – sometimes one that’s violent enough to strain the chest muscles or even fracture ribs. Treating the underlying disease will ultimately resolve the cough as well, but a cough suppressant may be necessary in the meantime.

Of course, another cough-causing culprit is smoking, which damages the cells lining the airways. Breaking the addiction can reverse the damage, if it hasn’t progressed too far. However, a chronic cough in a smoker can also signal lung cancer.

Certain antihypertensive drugs are notorious for triggering a chronic cough. Roughly 15 percent of people prescribed ACE inhibitors – captopril (Capoten), enalapril (Renitec), and others – must switch to another class of medication because of that side effect.

A cough that tends to increase with exertion or that occurs at night when you lie down can signal heart disease. Brought on by fluid in the lungs, that symptom demands prompt medical attention.

Coughing can also result from gastroesophageal reflux disorder (GERD). This is the result of acid from the stomach working its way up the esophagus. Although heartburn is the most common symptom of GERD, some people cough instead.

Finally, some people just get into the habit of coughing. Sometimes, they’re not even aware of it.

How Do You Quiet The Common Cough?

Most of the coughing going on, including the so-called Christmas cough at this time of the year, indicates nothing more than a cold.

When you find yourself coughing, drink fluids, especially water, which helps thin and loosen mucus to make your cough more productive. Also taking a shower or using a humidifier or vaporizer can help loosen mucus.

Other things to try:

• Suck on hard candy, cough drops or throat lozenges, or drink lots of tea with honey or salabat to soothe your throat.

• Try not to cough, especially if your cough is dry. If you must cough, do so gently.

• Try an over-the-counter cough medicine. Those that include an expectorant loosen mucus. A cough suppressant will keep you from coughing. But if your cough is bringing up mucus, don’t suppress it. Make sure the medicine you choose doesn’t contain the ingredient phenylpropanolamine, which is deemed unsafe.

If the cough is just due to the common cold, consider the following suggestions and medications:

• If you have a stuffy nose, take decongestant pseudoephedrine (Sudafed) or nose drops or sprays that contain a topical decongestant, such as oxymetazoline (Afrin, Neo-synephrine). (To avoid "rebound congestion," don’t take drops or sprays for more than two or three days.) If you have a runny nose, an over-the-counter antihistamine such as chlorpheneramine (Chlortrimeton) may help ease your cough by drying the nasal secretions.

• If you have a dry, non-productive cough, a suppressant can be useful – especially if the hacking keeps you awake at night. Of the various approved ingredients, dextromethorpan is considered the safest and most effective over-the-counter cough suppressant.

• If you have a thick, stubborn phlegm that’s hard to clear, you might consider using a product containing the expectorant guaifenesin. But avoid remedies that pair an expectorant with a cough suppressant, such as Robitussin-DM, since the ingredients work at cross purposes.

• In using lozenges or candies, don’t bother with medicated cough drops containing dextromethorphan, such as Robitussin Cough Calmers. You’d have to consume four to six drops at one time to get the standard effective dose of the drug.

When Should You See A Doctor?

Coughs are often more annoying than serious. If your cough is the result of a viral infection, chances are it will go away when the infection clears.

If your cough lasts more than two or three weeks, becomes progressively worse, or is accompanied by wheezing, fever, night sweats, weight loss, or bloody mucus, see your doctor.

Hopefully though, we will all be able to avoid the Christmas cough this season!

Reported by: Sol Jose Vanzi

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