To cough or not to cough?

It appears in autumn or winter when the circulation of respiratory viruses increases. It appears in the late afternoon and at night in people with asthma. It also appears after a fit of laughter or when something we eat or drink goes astray. We mean, of course, cough.

Cough is a reflex that acts as a defense mechanism of the respiratory system. It not only eliminates excess mucus, but also protects our bronchi and lungs from inhaling harmful substances (smoke, irritating chemicals …), from a piece of food that we choke on, or from too cold or hot air.

What happens when we cough?

There are several phases before we hear the characteristic sound of a coughing fit.

1. First, cough receptors are activated at some level (pulmonary, bronchial, tracheal, etc.). This activation produces an impulse that is carried along the vagus nerve to the central nervous system.

2. As a result, we breathe in air. In particular, before coughing, we inhale about half of the total air that fits in our lungs.

3. The air that has reached the lungs is compressed until it reaches a pressure of about 300 mm Hg. To do this, the glottis closes and the vocal cords approach, while the abdominal muscles are strongly contracted.

4. In the last phase, or the expulsion phase, the glottis suddenly opens and allows air to escape at a high rate (360 to 1200 liters per minute in healthy adults), removing anything that irritates or blocks the airways.

Are there several types of cough?

Those who have ever attended a medical consultation for a cough know that one of the first questions doctors ask us is whether we cough or not. This question allows you to divide the cough into two types: productive and dry.

A productive cough is considered when the cough is used to expel secretions (phlegm, phlegm…) or to expel any foreign body (bread crumbs, a piece of nut, a small piece of a toy…).

In contrast, a dry cough is one that is not accompanied by the expulsion of secretions or foreign bodies. It is also called an irritant cough because this type of cough causes severe irritation to the airways, especially in the throat.

In cases of productive cough, it is easy to identify the source that activates the receptors. But with a dry cough, not everything is so simple. In some cases, the trigger is exposure to tobacco smoke in both active and passive smokers. In other cases, it is caused by the high sensitivity of cough receptors, which interpret minimal stimuli as threatening our respiratory system.

Sometimes prolonged attacks of dry cough cause persistent activation of cough receptors located in areas such as the ear, pleura, pericardium, esophagus, etc.

There are also certain types of medications that can cause an annoying cough as a side effect, as is the case with some high blood pressure medications.

What complications can a cough have?

There are times when the cough itself becomes a problem, either because of its intensity, or because of its duration, or because of a combination of both. Between 10 and 20% of the population have a cough lasting more than 8 weeks or a chronic cough.

Some of the side effects that a cough can have include:

• Poor sleep quality.

• Excessive fatigue during the day.

• Urine loss.

• Headache.

• excessive sweating

• Burning sensation and pain in the throat and/or chest.

• Nausea and vomiting.

• Fatigue and/or feeling of stiffness in the muscles of the abdomen and diaphragm.

• The appearance or aggravation of umbilical, inguinal or abdominal hernias.

• fainting.

• Decreased quality of life and social and labor relations.

In some rare cases, people who have recently had surgery have experienced more serious complications such as rib fractures, spleen rupture, eye bleeding, muscle fiber ruptures (both in the abdomen and diaphragm) or scar dehiscence.

Which is better: to cough or not to cough?

Depends on. In the case of a productive cough, you should always cough.

In a dry cough, in which there is secretion or foreign bodies that need to be removed, but they do not appear due to weak abdominal muscles, a small volume of the lungs, or the secretion strongly adheres to the bronchial tree, the answer will be to solve the following problems: conditions for the transformation of this false dry cough to productive cough.

Finally, in cases of clear and severe dry or irritating cough, it is best not to cough. Do not cough to avoid cough complications. This can be achieved:

• With cough suppressants, always by prescription.

• When changing posture and breathing: Sit down, tilt your head, close your mouth, swallow saliva several times, inhale slowly through your nose until it fills your lungs, and exhale very slowly.

• With the help of natural remedies. Taking honey is effective in reducing bouts of irritating nighttime coughs in children. As well as drinking water in small sips, chewing gum or sucking on hard candies.

Of course, be very careful with mints. It has been shown that there are cases where the intensity and duration of the cough can worsen.

Raquel Leiros Rodriguez, Associate Professor of Physiotherapy, University of Leon and Maria José Alvarez-Alvarez, Professor of Physiotherapy. Member of the SALBIS research group., University of Leon

This article was originally published on The Conversation. Read the original.