STILL Coughing? Will Anything Help?

Is your cough driving you (and everyone around you) nuts? If your purse, coat or pant pockets are overflowing with empty cough drop wrappers and tissues, than you’ve dealt with that cough on your own long enough. Whether the original culprit was a common cold, the flu, or “just” seasonal allergies, coughs can take on a life of their own as our lungs gear up mucus production and airway spasm. My rule of thumb is that lingering coughs should be on a clear decrescendo- getting slowly but steadily better each day. If your cough is getting worse by increasing in frequency, intensity (like those fits of coughing hard enough to make you leak urine), or preventing sleep, then it’s time to let a doctor listen to your lungs and take a full look at you.

But what can be done for a cough that wont go away? Do I need antibiotics?
The vast majority of persistent coughs do NOT need an antibiotic, because they are typically a left over reaction from a respiratory virus. However, if you are a week or more into your symptoms and things seem to be improving, but then suddenly you feel a ton worse and develop chills, sweats and fever as your cough worsens, this might be a bacterial infection setting up shop AFTER the virus cleared the way past your body’s defenses.- possibly even pneumonia. For this scenario, yes, you often do need an antibiotic. More commonly, though, frustrating coughs are the result of developing some over-reactive airways and therefore, you may benefit from inhalers or other asthma-style medications. Not uncommonly we prescribe a very brief course of oral steroids (prednisone) for someone who develops wheezing and airway spasm after a viral respiratory infections.

But I don’t HAVE asthma- so why am I coughing? People who did not grow up with the diagnosis of asthma can still have an asthma response to a respiratory tract infection or seasonal allergies- we call this “reactive airways disease”. Your lungs make extra mucus and have more inflammation, together causes airway spasm- audible to the examiner and sometimes to the patient themselves as a “wheeze”. The asthma inhalers or breathing treatments through a nebulizer (machines that deliver the asthma medication as a fine mist that is inhaled through a mask or mouthpiece) work to pop open those airways, stopping the wheeze that was caused from the airway spasming shut in areas. That relief is temporary, however, because it fixes the problem and not the cause. The steroids are the real “fix” because they decrease the inflammatory response that started the whole cycle.

What else might my doctor give me?
There are a variety of cough suppressant combinations that include dextromethorphan, which is in most over the counter cough and cold products. Some persistent coughs without the reactive airway component will respond to a prescription cough suppressant called benzoate (brand name tessalon perles.) Additionally, a prescription narcotic cough syrup may help you sleep at night and reduce the nighttime exacerbations. Finally, your doctor can remind you of some traditional home remedies such as cool mist humidifiers and topical menthol products that may help your symptoms. Finally, sometimes a cough comes from other sources, such as acid reflux or sinus drainage, which require different treatments.

BOTTOM LINE: See your doctor to evaluate coughs that get worse after a respiratory illness, or that wont go away – don’t expect antibiotics, but know there are other treatment options!!

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