How to Deal with a Persistent Cough

By David Baron

Excuse me, exactly how long have you had that cough? That’s probably the most important question you can ask yourself about a common symptom that can mean anything from allergies to bronchitis, acid reflux, tuberculosis, or cancer. If your cough has been going on for two weeks or more, that’s a pretty good reason to get some medical attention and figure out the cause of the cough so you can resolve it.

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Probably the most common cough that prompts most people to ultimately see a health care provider is the one that just lingers and lingers in the wake of what we thought was

“just a bad cold.” And oftentimes, it seems to be worst at night, when you most want it to go away.

It’s worst at night, partly due to the simple mechanical effects that lying down does to your anatomy, and partly as a result of the normal, daily chemical and hormonal cycles in your body. Some people cough so hard they may cause painful strains in muscles in the chest, back, neck, or abdomen, headaches, or vomiting.

In these cases, you can understand why someone would ask for a prescription for antibiotics or at least a prescription cough medicine. But in most such cases, a clinician may tell you that your lungs sound clear and antibiotics won’t help.

So what’s going on here? Well, when you get a typical upper respiratory infection, primarily caused by a class of viruses called “rhinoviruses,” you’ll be sick with the acute phase of the illness (the fever, aches, sore throat, nasal congestion, etc.) for four to six days. After those first few days, you will gradually improve, with the whole thing lasting on average about seven to ten days. Your immune system does a pretty amazing job of mobilizing, attacking, and eliminating the viral invaders during that period. But what’s left in the aftermath is a bit like a house with termites. Even after you get rid of the bugs, you realize the wood framing has been damaged and still needs to be repaired.

In the course of certain upper respiratory infections, the moist pink tissues that line your nose, throat, sinuses, and bronchial tubes get irritated, inflamed, swollen, and hypersensitive, damage your body must work to repair once the bugs have been eliminated.

It’s during that repair period, which sometimes lasts a month or more when mucus membranes continue to crank out mucus. During this time your natural cough reflex, which is there to help you expel unwanted materials from your respiratory tract, is seriously overactive. Sometimes it is triggered even when there’s nothing there to expel!

Cold or dry air, wind, dust, a little droplet of saliva, exercise, laughing, or just lying down can trigger a coughing fit which, once it starts, perpetuates itself by further irritating your airways. As you probably know from some experience of your own, it can be painful, exhausting, frightening, and at the very least, annoying, not only to you but to the people you are with during the day, such as your family, friends, work colleagues, roommates, or classmates.

It gets better slowly. And what helps most is avoiding irritants (like smoking – any kind of smoking), good hydration, and humidification. During this stage of your recovery, you’re generally not contagious. But “cover your cough” anyway, please. And if you have a cough lasting more than two weeks, or one that is associated with persistent fevers, chills, sweats, shortness of breath, chest pain, substantial weight loss, or coughing up blood, get yourself checked out by a health care professional.

You may or may not need antibiotics. But if you have any of these “associated symptoms,” it’s important to rule out more serious conditions (like pneumonia). And even if you just need some reassurance, that’s definitely what I’m here for.

At Primary Caring of Malibu, we have returned to old-fashioned style family medicine to bring our patients the personal care and attention they deserve. It’s not a new idea — it’s just an old concept brought up to date, with modern methods and technology making it even better.

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