Things that go cough in the night

One of the most common complaints that we see in a primary care practice is a cough. Often the result of a common cold or allergy, there is nothing more annoying than a persistent cough (Although diarrhea, vomiting, headaches, itching, sore throat, ear pain, abdominal cramps, backache, neck ache, runny nose, and sore feet also compete for that "Most Annoying" category.)

First, why do we cough? Coughing is important to remove unwanted secretions in our airway, whether it is from postnasal mucous, saliva, water, food, or whatever. If it doesn't belong in there, it needs to move out. There are sensitive cough receptors located throughout our airway, including the back of our throats and sinuses, and even in our stomachs and ear canal. Many Q-tip users have experienced a strange, reactive cough spasm when swabbing out earwax. And, as strange is sounds, a wax impaction is one potential cause of a chronic cough. Every time we cough, we irritate those cough receptors, and of course, every time those cough receptors are irritated we cough.

Probably the most common cause of an acute cough in all age groups is a viral infection...a cold. Allergies, including asthma (reactive airway disease) are a close second. Environmental insults such as second-hand cigarette smoke, fumes, and dust can also trigger a cough response. There are literally hundreds of causes of cough, from the more common ones that I just mentioned to some more serious medical problems. Any cough that persists or fails to respond to treatment should be carefully and thoroughly investigated until a cause is determined.

Last Mother's Day, we took my wife, kids, and grandchildren out to breakfast at a popular local restaurant. Needless to say, the place was packed, with people standing outside waiting for tables. Several folding chairs were made available for the more-elderly Moms. The area by the door is also a popular place for smokers, including some of those elderly Moms. I guess it is inappropriate to come down on those smoking Moms on Mother's Day. Apparently, one little child did not know this.

One elderly woman was puffin' away on her cigarette when she was noticed by a little boy about four or five years old, coming out the restaurant. He stopped in his tracks, stared at her for a moment, and then pointed his little finger sternly at her.

"You are going to DIE," he proclaimed. "You should NOT be smoking!" Grandma coughed a few times and smiled. The little anti-smoking advocate was quickly shuffled away into a waiting car. Happy Mother's Day!

Several years ago, my PA wife was working in a family practice clinic. She was seeing a two-year-old girl who had been coughing for nearly a month. Prior treatments for bronchitis and pneumonia were unsuccessful. The child continued to cough.

By taking a careful history of this cough, my wife determined that the cough started suddenly while the child was just sitting on the floor coloring. To make a long story short, a piece of blue crayon was surgically removed from her lungs a few days later.

On both the WebMD Ear Disorders board and the General Health board, we often get questions concerning the relationship of cough to gastroesophageal reflux (GERD). I can tell you by experience, including my own bout last night, that GERD definately causes a cough. As a matter of fact, several years ago I had to stop my ACE inhibitor (blood pressure medication) because of a cough -- a common side effect of this pharmaceutical class.

Children in day-care and schools are exposed to an astronomical amount of diseases that can result in cough. In children, a cough from a common cold can last weeks. When another viral infection jumps in during this period, the cough may be extended for much longer periods of time. These back-to-back viral infections are very common in my clinic setting.

There is a term in medicine called zoonosis, meaning a disease caused by animals. I often see Mominosis, a new medical term that I coined referring to a disease caused by the mother. There is a universal misunderstanding of cold medications: decongestants, antihistamines, cough expectorants, and cough suppressants.

If you give a stuffy child a decongestant (a medication that loosens and drains mucous) at bedtime, when the child is asleep and lying supine you will most definitely cause them to cough. If you also give them a cough expectorant (another drug that encourages you to cough), you are going to be in for a noisy night.

Although cough is medically beneficial, so is sleep...for everyone. In most cases, there is nothing wrong with giving a cough suppressant at bedtime, even though studies have proven them worthless, not much better than a placebo, in children under the age of five. Placebo or not, I let the parents make that decision.

Since colds last a week if you aggressively treat them and about seven days if you leave them alone, anything you are doing is only supportive. Perhaps I am just buying some time to allow the healing process to continue. I do try and make a person feel better while nature does the curing. However, the real goal is to treat the underlying cause of the cough, not necessarily the cough itself.

The last comment that I would like to make is about spitting out mucous. Why is it that men and boys develop this distasteful skill to a high degree? If there was an Olympic Loogie-Hocking Team, it would all be guys. It is important to try and make a productive cough worthwhile, so ladies, please, it is okay to hack up a big one once in a while...in private of course (and not aiming at a tree from a moving car). If you don't cough it UP and OUT, or successfully swallow it, the mucous will come back and bother you again and again.

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