Maintaining Your Health on Mackinac

Coughing is an important reflex, a defensive response to irritation or inflammation in the airways between the mouth and nose and the bronchial system in the lungs.

A cough helps to release and clear the airways of excessive mucus and other irritant substances.

A cough reflex starts from a signal in the brain and involves muscles in the throat, chest, and abdomen. In a rapid sequence, the musculature contracts to release air compressed in the lungs and bronchi at very high pressure and at speeds of more than 400 miles per hour.

Repeated, chronic coughing can become bothersome, resulting in physical complications and an adverse impact on the quality of life.

When chronic cough continues for three weeks or longer, it may signal underlying problems.

People with chronic cough become embarrassed when their coughing draws attention from others. There is difficulty in social circumstances, as others fear the spread of infection. Frequently there is frustration when the cause of the cough is not easily identified and methods to stop it are not successful.

Sleep disturbances occur with nighttime coughing, leading to tiredness and difficulty concentrating.

Repeated coughing can cause fainting spells owing to increases in chest and abdominal pressures that affect heart rhythm. In older people, rib fractures can occur from frequent aggressive coughing, along with continuing soreness of chest wall muscles. Also, urinary incontinence and fecal incontinence can ensue owing to severe increases in abdominal pressures.

In addition to damage to the vocal cords, cells lining the airways can become inflamed, causing streaks of blood to appear in the sputum and, over a period of time, severe pain in the throat and chest.

Although lung cancer can cause coughing, it is present in less than two percent of all cases of chronic cough. More often than not, the causes are benign, and often the cause or causes are not easily identifiable.

Stomach reflux (GERD - gastro esophageal reflux disease) is a common condition in adults, and especially older people.

Reflux causes heartburn by acid entering the esophagus and damaging the lining. Some people with GERD, however, reflux stomach acid more predominantly into the mouth and larynx - the voice box. The so termed laryngo pharyngeal reflux can occur silently, and causes continuing irritation leading to hoarseness of voice, coughing, and repeated clearing of the throat; these symptoms can persist for a long time before discovery. Coughing and reflux can continue in a vicious cycle, one provoking the other as the lining is chronically affected by stomach acid.

Examination of the ears, nose, and throat with a scope is helpful in locating the damage and the extent so that treatment with acid-suppressing medication can be instituted.

Postnasal drip is caused by overproduction of mucus that trickles down the back of the pharynx from the nasal passages downward to the larynx. Postnasal drip can be owing to allergies, the flu, the common cold, or chronic inflammation of the nasal sinuses that overproduce mucus that drains into the pharynx.

It is perhaps the most common cause of chronic cough or cough that recurs in cycles.

Chronic cough can continue, while a low-grade infection remains chronic in the upper respiratory tract.

Certain medications can cause severe dryness of the mouth and throat, leading to chronic cough. Medications taken to lower blood pressure have side effects - 10 to 20 percent of people who take ACE (angiotension-convertingenzyme) inhibitors have this side effect.

Chronic bronchitis is a persistent inflammation of the main airways and is seen in chronic smokers and people exposed to irritants in inhaled air, or with chronic lung infections like tuberculosis. Bronchiectasis is a chronic condition of the lungs that results in stasis of mucus collections in the lung that can remain infected.

These conditions, as well as lung cancer, especially when there are voice changes, hoarseness, or coughing up blood, obviously require medical evaluation.

Asthma inflames and constricts the bronchial passages and is known to cause wheezing. Asthma also causes cough, especially when there is exposure to chemicals or inhaled irritants, after exercise, during the night, and also during exposure to cold.

Lung infections, such as pleurisy and pneumonia, are associated with cough, and cough usually continues until the infections are resolved with treatment.

Rarely, the presence of a foreign body in the lungs or aspirated material from regurgitation or vomiting may act as a focus of irritation or infection and cause chronic cough.

Finding the cause and managing this condition yields the most success when the patient and physician work closely.

It is important to keep a record of when the coughing occurs, the factors that seem to be related to the incidence, the frequency, duration, and the nature of material that is coughed up.

After the common reasons are ruled out, and if the cough continues for three weeks or more, a thorough work-up is indicated.

A chest X-ray should be done to rule out pneumonia or other causes in the lungs and chest.

About 90 percent of all cases of chronic cough are caused by three conditions - postnasal drip, stomach reflux, and asthma.

When the lungs are not thought to be causative, a thorough examination by an otolaryngologist, an ears, nose, and throat (ENT) specialist, is recommended.

Chronic cough is rare, and finding a satisfactory solution is sometimes difficult and frustrating. You can help yourself by playing an active role with your physician in seeking out the diagnosis, and getting efficient treatment.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.