Dr. Denis Grillo, Ear, Nose & Throat, 02/05/13

Coughing is a reflex characterized by a deep inspiration and buildup of pressure in our throat, followed by a forceful expulsion of that built-up air.

The pressure is so great in the chest that the velocity of the air coming out can reach 500 miles per hour.

The purpose of the cough is multifaceted. It is a protective reflex. It is a first-line body defense mechanism, and, it helps rid the body of unwanted secretions, foreign matter, viruses and bacteria that are entering the respiratory tract, and can prevent these bacteria and viruses from invading the lungs.

Coughing is a wonderful thing. However, when it is persistent, it can really affect a patient’s quality of life. And, if it is persistent, and becomes impaired in some way, such as fluid in the windpipe or fluid in the lungs, it can become a health problem, and can cause infections such as bronchitis and pneumonia.

U.S. Department of Health surveys suggest a cough is probably one of the most common reasons for a doctor visit, and may account for up to 20 million office visits a year. Taking into account the average cost for an office visit, the tally comes up to about $1 billion a year spent in the United States alone treating coughs. This includes prescription and nonprescription treatments.

The way a cough works is there are stretch receptors in the airway that become stimulated when irritated, and as a result, produce the cough reflex. There are even cough receptors located outside of the airway (which consists of the nose all the way down to the very bottom of the lung). These two extra sites are the ear canal and the stomach. As a matter of fact, there are many times when I am examining a patient’s ear, or cleaning the ear of wax, that we can elicit a cough-reflex, simply from doing that activity.

About three conditions, including postnasal drip, asthma and reflux disease, account for about 86 percent of patients presenting with a cough to their doctor. If you have emphysema and/or take certain blood pressure medications in the category of angiotensin converting enzyme (ACE) inhibitors, the percentage jumps up to about the mid-90 percentile. There is also a long list of unusual causes for coughing that I will not bother to get into at this point in time, because they are so unusual and rare.

Management of cough can be quite challenging and difficult. If you know, for example, that it is either postnasal drip, asthma or reflux disease, you can target the treatment towards the underlying problem. But sometimes effective cough therapy cannot be done, and sometimes you need to treat the symptoms of cough.

Case in point might be a virus, and also, what we call “post-viral” coughing. When you have a virus, of course, everybody knows that you do not need antibiotics, because viruses are going to run their course and get better, in most instances, within a few days. The coughing tends to last a little bit longer, but it too will eventually clear up.

In this situation, if the cough is preventing the patient from functioning normally, or resting properly, a cough medicine, either nonprescription or prescription, might be the treatment of choice, as opposed to targeting the underlying problem, as in the other causes of cough. This is a kind of nonspecific therapy, simply trying to suppress the coughing reflex so the patient can enjoy the better quality of life. Nonspecific cough therapy includes medications such as codeine or hydrocodone, which are in the opioid family, and require a prescription.

Non-prescription cough medicine includes dextromethorphan, and it too can be an effective anti-cough medication if dosed properly.

There is a third medication that is used in cough control: Guaifenesin. It is an expectorant and mucous-thinning agent that creates an effect of increasing mucous secretions, thus hydrating mucous membranes, and decreasing the irritation, which results in improved cough control. It seems to work well when cough receptor sensitivity is enhanced.

Effective cough control must be targeted at the underlying cause of the cough to get the optimal result. As you can see, there are many aspects that must be considered and checked out thoroughly.

Denis Grillo, D.O., FOCOO, is an ear, nose and throat specialist in Crystal River. Call him at 352-795-0011 or visit CrystalCommunityENT.com.