HACK ATTACK
What could be causing that cough that won’t quit — and how to tell when it’s time to seek help,
It starts with a tickle deep inside the chest. Then an aggravating sensation — the product of mucus dripping from a clogged nose — creeps through the inner cavities. Breathe in, the lungs tighten and the body seizes, anticipating the inevitable: A hacking, sputtering, phlegm-producing, coworker-annoying cough.
We’ve all experienced this once — probably thousands of times. Coughing is one of the most common reasons people visit their doctor. It’s estimated that adults catch two to five colds every year, or upwards of 200 cough-inducing colds throughout a lifetime. There are also numerous other conditions — everything from asthma to lung cancer — that can cause that powerful expulsion of junk from inside your irritated chest.
But what purpose does coughing serve, besides keeping families up at night and aggravating colleagues? Questions like these pop up every year around this time — the winter cold and flu season — as workplaces, homes and doctor’s offices fill up with coughers.
Typically, coughing is the result of postnasal drip from head colds or bronchitis, says Dr. Arthur Vanek, a respirologist at St. Joseph’s Health Centre. But more generally speaking, it’s a way for your body to get rid of things that don’t belong in your lungs or windpipe, whether that’s mucus, food, dust or other irritants.
It’s also the symptom of a long list of conditions, ranging from the mildly annoying head cold to lung diseases that cause progressive scarring and inflammation of the lung tissue, such as asthma, allergies, acid reflux and lung cancer.
Some of the worst coughs doctors see stem from pertussis, also called whooping cough, says Vanek. The disease, which has been on an upsurge in recent years, likely because of a drop in vaccination rates, leads to a dramatic, severe, dry cough in adults that can last months. Around 20 to 30 per cent of patients with a cough have pertussis, Vanek says. Unfortunately there’s no treatment for it. “You can’t sleep, you’re vomiting, you can’t work,” he says. “They’re by far the worst coughs we see, and there’s nothing we can do.”
Vanek still remembers a teenage patient he saw two decades ago with whooping cough. “This kid was coughing once a minute, all day long,” Vanek says. He was keeping his family up at night and disturbing his classes at school thanks to the distinctive “whoop” sound.
That’s just one memorable case. Vanek has seen the whole gamut of horrible hacking. Some people throw up, wet their pants or even pass out from coughing. “If you cough hard enough, you block the blood to your heart and can actually faint,” Vanek says.
In many cases, coughing can be managed with lifestyle changes, says Chris Haromy, a registered respiratory therapist with the Lung Association. When it comes to asthma, for instance, people reduce their exposure to certain triggers, while those coping with acid reflux avoid eating late at night or having acidic foods.
“But if you leave them, there can sometimes be long-term consequences like worsening health,” he says.
The cough that lingers Health professionals divide coughing into two main categories: Acute and chronic. Haromy says acute coughs last less than three weeks — with coughs from a common cold generally lasting only a few days — while chronic coughs linger for eight weeks or longer.
“It doesn’t mean a chronic cough will be with you forever,” he says. You can have a bad infection and the cough will last for months — long after you’re feeling otherwise better — since it won’t go away until the inflammation is gone.
Ladies, let it out In certain cases, stifling a cough — as etiquette norms might dictate — can actually make things worse, leading to an unusual condition known as Lady Windermere Syndrome. A 2015 paper in the Cleveland Clinic Journal of Medicine says typical patients with the condition are thin, wellmannered elderly women who suppress their cough “out of politeness.”
The result is a syndrome involving fatigue, the production of saliva and mucus from the respiratory tract, and occasionally fever, trouble breathing, and coughing up blood. The name comes from Oscar Wilde’s play Lady Windermere’s Fan — a satire of the strict-mannered Victorian era.
A cough, or a tic? Coughing can also stem from a seemingly unrelated condition: Tourette’s syndrome. Along with sniffing, throat-clearing and eye-blinking, coughing is among the many tics associated with this neurological condition affecting the brain and nervous systems that typically starts during childhood.
When to visit a doctor Generally, coughing isn’t much to worry about — particularly if it goes away quickly. But experts say in certain cases a lingering cough may hint at bigger health problems and should mean a trip to your family doctor. Sometimes, a cough is coupled with other breathing symptoms, such as wheezing or shortness of breath. Those could be signs of a viral respiratory tract infection or asthma, says Vanek. There are also a few other key signs indicating a potentially serious condition, including the following:
Mucus changes. If you’re producing a lot of mucus, or if the mucus has turned from white-ish to another colour like yellow or brown, Haromy says it could signal something more serious than a cold. Green-tinged mucus, for instance, could indicate a bacterial infection. And if there’s blood in it, see a doctor immediately, Haromy says. Coughing up blood could indicate tuberculosis or even certain types of cancer, says pediatrician Dr. Dina Kulik, an assistant professor at the University of Toronto.
Feeling feverish. A fever acts as a warning sign of something more serious, such as pneumonia. “Most people over the age of 50 won’t get a fever with typical respiratory tract infection,” says Vanek, but could have a fever with influenza.
A smoker’s cough. Doctors pay close attention to the connection between smoking and coughing. “If someone is a cigarette smoker or has been in the past for more than five to 10 years, then a chronic cough has a different connotation completely, because then we’re always concerned about lung cancer,” says respirologist Dr. Paul O’Byrne, professor and chair of McMaster University’s Department of Medicine.