It's cold season and getting into influenza season too so let's talk about a common thing that happens: Coughing.
About 1/20 people in America gets a bad cough every year. Sometimes this comes along with other upper respiratory infection symptoms (runny nose, sore throat, etc. In which case it's called a post-viral cough) and sometimes it just happens by itself (a.k.a. Bronchitis or inflammation of the lining of the tube going to your lungs). It's amazingly common, oftentimes comes along with these other symptoms I mentioned above, and generally harmless to most people, albeit very annoying. Most of the time this involves mucus collecting and sitting on the lower tube between your mouth and lungs, called the bronchus, and when it gets irritated from the mucus, that equals a bronchitis. This is very different from getting a pneumonia, which I'll touch on a little farther down. Oftentimes, same as with a sore throat, mucus tends to pool and thicken overnight as you're laying down which is why in the morning most people tend to cough up some thicker, darker looking mucus than they do the rest of the day. In and of itself, the cough is not dangerous and for most people will clear up within 14-21 days of getting it, usually not any sooner, and sometimes will last 6 weeks or more. Some people will develop headaches or can strain their back, rib, or abdominal muscles from the coughing if their fits are violent enough.
There is another entity called the chronic cough, which is a cough lasting more than 8 weeks (the other types mentioned above typically "only" last up to 6 weeks). Typically this is due to either smoking, medications, post-nasal drip from allergies and/or ongoing sinus inflammation, "silent" acid reflux from the stomach where you don't have heartburn, or a type of asthma. All pretty harmless for the most part but again, quite annoying. Here is some more information for you about what causes ongoing coughing spells and what we usually do to treat it.
- Coughing so hard that you throw up afterwards, as we worry about pertussis, a.k.a. Whooping cough, which is very contagious, can be very harmful to young kids and older adults, and is something that can actually be prevented by getting your TDaP vaccination.
- Pneumonia: Pneumonia means you have an infection actually inside your lung and usually comes along with high fevers, chest pains, and/or trouble breathing. Most of the time this is due to a bacteria and less commonly from influenza - other viruses are very unlikely to cause pneumonia. Most healthy people do not get pneumonia and usually it's more common in those with chronic medical conditions or with people as they get older (as it has also been called the Old Man's Friend). The idea of a "walking pneumonia" is probably something that should disappear as most people who get pneumonia, are up and walking and it's really more a way of distinguishing most pneumonias from those that are related to the hospital or a healthcare facility, which typically means some more dangerous bacteria can be the cause. Pneumonia can only be definitively diagnosed with an X-ray but sometimes a good guess can be made from a clinical exam. This is something that generally does need antibiotics to get better and avoid any complications.
How to treat a cough cough:
Let me just preface this by saying that if I had a way to quickly cure coughing, you would never hear from me again because I would be retired on my own private island somewhere. Anyone who tells you they have one is trying to be helpful, but just don't dump out your wallet to try it.
- Breathing in warm vapors can help a lot as well - you can do this with a warm shower or bath or sink full of water or deeply breathing in a hot cup of tea (and then drinking the tea). They also sell little water vaporizers at the pharmacy. This is different than a humidifier, which isn't terribly helpful.
- There is no evidence behind this but I feel like it works on a few levels - wear a mask if you're able to. It helps to humidify the air you're breathing in and warm it a little bit, plus it lets others know you're trying your hardest not to cough on them.
- Cough drops are also something that can be very helpful. The ones with menthol seem to help a little more. I personally like Riccola because of their great commercials.
- Any cough medicine with a DM in it (Robitussin-DM or Mucinex-DM or Delsym for example) can help a little bit
- Tessalon Perles (benzonatate) are supposed to numb the area in the back of your throat that gets the tickle that makes you start coughing. This one is a prescription though.
- Cough medicines with codeine have been prescribed for a while but are generally no more effective than placebo. They also come with a host of side effects including nausea, vomiting, constipation, and other reactions, so we try not to prescribe these.
- Most people with a cough do not have bacterial infections that need antibiotics. Unnecessary antibiotics can cause “resistance” in you and others around you. That means the antibiotics won’t work as well when you really need them in the future. Antibiotics may also cause side effects, such as allergic reactions and diarrhea. Some cases of diarrhea can be very harmful, particularly to elderly patients and those who have chronic illnesses. Doctors have been giving these out unnecessarily for years and as a result, they don't work as well anymore, so in general the days of just asking your doctor for a Z-pack are gone.
- Similarly, lots of people are given inhalers for a cough and unless you have asthma, there's no proof that this does anything to help