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Paging Dr. Frischer - Tussis
WRITTEN BY :   Dr. Alan Frischer

Tussis: It’s Latin for cough; a bodily function we can all relate to. Typically it’s merely a simple reflex due to allergies, a cold, or asthma, but it can unfortunately be one of the symptoms of something much worse, like pneumonia or lung cancer. Coughing can be voluntary or involuntary. It is a sudden and often repetitive reflux, and it helps to clear our large breathing passages from secretions, irritants, foreign particles and microbes.
Allergies account for nearly 90% of coughs. Those with allergy cough typically have clear phlegm and some fatigue, but otherwise feel normal. These coughs are triggered by postnasal drip, and may be seasonal (typically mold in the fall, or pollen in the spring). Alternatively, allergies may be a response to specific exposures such as dogs or cats, and occur throughout the year. It often takes extensive testing to determine which specific allergens are responsible. Asthma, which may or may not be accompanied by allergies, leads to a productive or non-productive cough, often with wheezing and shortness of breath. The airways become overly reactive, inflamed, and spasm, which triggers these symptoms.
Coughing is also caused either by a viral or bacterial infection. This is actually an evolutionary advantage for germs, since coughing helps to spread them! Although a cough is frequently caused by viral or bacterial bronchitis, the most likely infection to cause a cough are the common cold viruses. The common cold resolves in a matter of days to a few weeks, after the viral infection has cleared. However, the infected person may be left with a residual dry, non-productive cough that can last up to six weeks. The irritating cough can cause inflammation, which leads to discomfort, and in turn causes yet more coughing. Helpful remedies include drinking lots of water and other fluids to loosen up the phlegm, gargling with salt water to relieve a sore or scratchy throat, saltwater nasal sprays to decongest, and of course, chicken soup.
Generations of parents have fed chicken soup to their sick children without really understanding why. Now scientists have put chicken soup to the test, and discovered that it does help relieve cold and flu symptoms in two ways. First, it acts as an anti-inflammatory by slowing the movement of neutrophils (immune system cells that aid in the body’s inflammatory response). Second, because it is a warm liquid, it temporarily speeds up the movement of mucus, which helps to relieve congestion and limits the amount of time viruses are in contact with the nose lining.
Over-the-counter cold and cough medications do help to relieve symptoms when a cough is caused by the common cold. Note, however, that acetaminophen (Tylenol) can cause liver damage when taken in excessive doses, so it is dangerous to take Tylenol alongside cold medicines that also include Tylenol. Zinc lozenges have been heavily marketed as a cold-fighting medication, but recent studies don’t support these claims (in fact, intra-nasal zinc may result in permanent damage to the sense of smell). Antibiotics are effective at treating bacterial infections but are of no help whatsoever in fighting a cold virus.
When Gastro esophageal Reflux Disease (GERD) is the cause of a cough, it can be difficult to make the diagnosis. The acidic contents of the stomach come back up into the esophagus and the patient can feel heartburn, a sour taste in the mouth, or a feeling of acid reflux in the chest. Unfortunately, more than half of those with cough from GERD do not have any other symptoms, so doctors sometimes try treating GERD when no other solution has worked.
Other causes of cough include smoking, air pollution, emphysema, lung tumors, heart failure, choking, and medications (a cough is, for example, a frequent side effect of ACE inhibitors, commonly used to control blood pressure). Generally, when more serious diseases cause cough, we find other significant symptoms present as well.
Keep in mind that any persistent cough warrants a proper work-up. Seek the advice of your doctor.
I hope you had a warm and joyous Thanksgiving. Good health to you all!
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: November 25, 2010 – Volume 9 – Issue 32



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