Expat Life

When suppressing a cough is a bad idea

A recent discussion on an expat social media website had me worrying.  One expat asked where they could find a certain cough suppressant for a chronic cough that had lasted a “few weeks.” Another expat recommended honey and herbs. I added my two cents and said that honey, while it could be soothing, is not a “cough suppressant,” and by the way, a cough lasting more than a couple of weeks should be addressed by a physician. After all, a cough resulting from a cold shouldn’t last that long, and certain coughs need attention.

But suppressing a cough could be harmful.

Pediatrician Roy Benaroch, MD, writes in KevinMD.com, “Coughing is there, usually for a reason.” He notes that almost all coughs result from upper respiratory infections caused by common, ordinary viruses like the common cold. Viral infections cause excess mucus to form throughout your “respiratory tree” — from your nose, down your throat, and deep into your airways and lungs. He says if that “warm sticky mucus” isn’t expelled by coughing it’s likely to attract bacteria, which reproduce easily and cause more inflammation and even more mucus.

He says, “Coughing is good, and brings the mucus up and out of the lungs and respiratory tract (it’s usually swallowed, which is harmless — respiratory bacteria cannot survive in your stomach). Coughing also agitates the mucus, preventing bacteria from developing their defensive biofilm and creating a huge colony of pus-filled goo.”

Dr. Benaroch says that most coughs last longer than we think, and that only 50% improve within 10 days, with many lasting up to three weeks.

And a cough not a disease, it is only a symptom of an illness.  Besides upper respiratory infections, irritations from smoke, fumes, and allergies such as to pollen, animals, dust and even certain chemicals or perfumes can cause coughing.  Some people have a nervous habit of coughing.

Others may have other medical conditions such as gastro-esophageal reflux disease (GERD), heart disease, or even a lung tumor.  Some medications cause coughing, such as angiotensin converting enzyme (ACE) inhibitors for high blood pressure.

Asthma, which constricts breathing tubes and causes them to collect mucus, is a frequent cause of chronic cough.

Though most coughing is ordinary and benign and viral, a severe, lasting or troublesome cough should be evaluated by a doctor to determine the cause.

Dr. Benaroch writes that although there are hundreds of “cough medicines” on the pharmacy shelves, none have been shown to reduce a cough “in any meaningful way.” Consumers may still want to take them, but always take as instructed, and not for longer than recommended.  Know that “suppressing” a cough could backfire.

According to Livestrong.com, Mucinex, whose generic name is guaifenesin, loosens up phlegm or mucus in your chest and throat, making it easier to cough it out. The expectorant is used to treat congestion due to infection, allergies or colds. Many different versions of medications contain the active ingredient guaifenesin, and sometimes guaifenesin is found in combination with antihistamines, cough suppressants or decongestants.

Dr. Benaroch points to the “adorable mucus-monster guy,” the medicine’s mascot, and calls it “ironic” that a version of Mucinex contains a cough suppressant as well as an expectorant, which means that although coughing is the only way to get rid of that little pest, it’s being suppressed!

It’s important to note that any other drugs used in combination with guaifenesin can have side effects themselves, but the side effects associated with guaifenesin itself might include nausea, dizziness or drowsiness, or rash.

Unfortunately, some people ignore package warnings and double up on dosage, or mix medications, which could cause dangerous side effects. Cough syrups and common cold medicines may contain dextromethorphan (a cough suppressant) and excessive consumption of this ingredient can lead to euphoria, constipation, dizziness, drowsiness, panic attacks and even psychosis.

Shen-nong.com writes, “When coughing is your main symptom, a multi-symptom medicine that contains other ingredients like antihistamines and decongestants can make your sputum thicker and harder, and your cough may become worse…side effects may be a concern for those with health problems, such as asthma, heart failure, hypertension, glaucoma and urinary problems.

“Cough medicines also cause problems with other medicines such as sedatives and certain antidepressants. If you have a chronic respiratory problem, pregnant or breast-feeding or are older than 60, use the medicine with caution. Always read the “Warning” section on the label to see the possible side effects. Some cough preparations are rich in sugar; diabetic patients should look for a sugar-free one.”

If you have a cough due to a cold, feel more comfortable by:

Resting
Drink lots of warm beverages: broth, tea with honey can soothe your throat
Gargle frequently with warm salt water
Suck on cough lozenges or hard candy to soothe an irritated throat
Massage the chest with aromatic rubbing ointments or creams.
    Vicks can be soothing.
Steam helps relax airways: take a steamy shower
Avoid smoke and smoking: smoking is the most common cause of chronic cough. Avoid dust, fumes, and aerosols
Sleep with your head raised, or if you cough at night, on your side.

But, if you have an unexplained cough for more than 3 weeks (you didn’t have a cold; you haven’t been diagnosed with allergies, for example) see your physician.

According to Harvard Health, seek medical help for a cough when you have:

Fever, especially high or prolonged
Copious sputum production
Coughing up blood
Shortness of breath
Weight loss
Weakness, loss of appetite, fatigue
Chest pain not caused by the cough itself
Night sweats
Wheezing

Most colds are viral, and will go away on their own, but if your sputum is thick, yellowish-green and you have a fever that persists, it’s possible the infection is bacterial and requires antibiotics. Avoid taking antibiotics unless your doctor checks your sputum and confirms.

Sources

Harvard Health. That nagging cough.

http://www.health.harvard.edu/staying-healthy/that-nagging-cough?utm_source=mens&utm_medium=pressrelease&utm_campaign=heart0910

Livestrong.com. Bad side effects of Mucinex. http://www.livestrong.com/article/34836-bad-side-effects-mucinex/

KevinMD.com. There’s absolutely no way to stop a cough. Here’s why. http://www.kevinmd.com/blog/2017/01/theres-absolutely-no-way-stop-cough-heres.html

Shen-Nong.com. Things You Need to Know About Cough. http://www.shen-nong.com/eng/exam/cough_about.html

UpToDate.com. Patient education: Chronic cough in adults.  Beyond the basics. http://www.uptodate.com/contents/chronic-cough-in-adults-beyond-the-basics

Wikipedia.org. Cough medicine. https://en.wikipedia.org/wiki/Cough_medicine

________________

Susan Burke March

Susan Burke March

Susan Burke March, a Cuenca expat, is a Registered and Licensed Dietitian, a Certified Diabetes Educator who specializes in smart solutions for weight loss and diabetes-related weight management. She is... Read More

  • baba free

    There is a resurgence of an old cause of chronic coughs, TB, especially in poor areas of the third world. It’s making a comeback in other places too….

    • You are unfortunately so right. I just ‘googled’ TB rates and here’s a partial paragraph from the Pew Charitable Trust,

      TB is an airborne infectious disease caused by bacteria that spreads through the air, person to person, when someone coughs or sneezes. One in three people worldwide have latent TB, according to the World Health Organization. In the United States, up to 13 million people have been exposed to TB and could develop the disease.

      Every year, tuberculosis claims 1.5 million lives worldwide and 500 to 600 in this country.

      http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/05/12/is-tuberculosis-making-a-comeback

  • LadyMoon

    Another mistake people make with ANY medication is drinking while taking the medication. A friend had a ‘bad’ reaction with a sleeping medication (which is notorious for having bad side effects solo)….but mentioned she took the pill and drank two glasses of wine! It really is a wonder she didn’t kill herself…just almost bled to death. I think cough suppressants would be high on the list of no-nos with booze.

    • Good point! ANY medication has the potential to negatively interact with alcohol, so be sure to read the package label. For example, I just looked at the medication that I mentioned, ‘Mucinex’, and everydayhealth.com says “Mucinex and Alcohol
      Some forms of Mucinex can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
      Avoid drinking alcohol while you are taking Mucinex as it can worsen some of the side effects.”