FIVE THINGS YOU SHOULD KNOW ABOUT THAT WINTER COUGH
It’s the soundtrack to a Pittsburgh winter: the drumbeat of coughing all day and all night. And with high rates of COVID-19 and flu this winter, coughs are particularly prevalent.
But coughs aren’t as straightforward as they may seem. Here are five things you should know:
Don’t reach for that cough medicine
Once a staple of childhood illnesses, cough medicines have largely fallen out of favor with doctors. It’s partially because overthe-counter cough medicines aren’t terribly effective, especially for children. And it’s also that a cough isn’t something to be suppressed.
“These are protective immune responses,” said Sunjay Mannan, a family medicine physician with Allegheny Health Network based in Butler. “Coughs are annoying, but your body is trying to get stuff out of the lungs.”
For relief from cough symptoms, Mannan recommends hot water with honey for adults and children over a year old. Overthe-counter Mucinex, along with plenty of fluids, can also be effective to thin mucus and help the body move it out of the lungs. But to do that, patients need to cough.
Coughs can last long after the initial virus clears
After a virus, a cough may take a long time — weeks or even a month — to go away. And while that cough may be annoying, it’s not necessarily a sign that something is wrong. There’s a 12-week window after a virus where a patient can have a “post-viral tussive syndrome,” otherwise known as a cough that keeps going after a cold clears up.
“If your doctor recommends not doing anything, that isn’t out of normal for the standards of care,” said José Francisco Abad, vice chair for clinical operations in the department of family medicine at UPMC. “We know that ultimately the body is the best healer, and physicians facilitate the body to heal itself.”
Look outside the lungs
If a cough lasts longer than eight to 12 weeks, it’s considered a chronic cough, and there are a few possibilities as to what could be causing it.
It could be a form of asthma, or a type of bronchitis. But frequently, there’s a problem outside the lungs, such as upper airway cough syndrome, otherwise known as postnasal drip, or acid reflux that presents with a cough instead of heartburn. Both of those conditions are treatable, but patients often give up on the treatments too soon.
Flonase is effective for post-nasal drip, but “it takes two to three weeks to turn off that leaky faucet,” said Mannan. Many patients use it for a few days and then stop, incorrectly assuming it isn’t working.
An acid reflux treatment also takes some patience.
“For acid reflux, start something like Prilosec over the counter,” said Mannan. “If the cough gets better in two weeks, they have their answer.”
Chronic coughs are also a side effect of ACE inhibitors — that stands for angiotensin-converting enzyme inhibitors — which are medications used to treat high blood pressure and heart disease.
Chronic coughs are more common in women
Chronic coughs are two times more common among women than men. And scientists believe that menopause may have something to do with it. One 2023 study of 200 generally healthy menopausal women found that 33% of them had a chronic cough with an average duration of 4.7 years.
At the Cleveland Clinic’s Chronic Cough Clinic, the typical patient is a woman in her 50s or 60s, with an average cough duration of 8 years, said Rachel Taliercio, the clinic’s founder and director, on the Respiratory Inspirations podcast. While the association with menopause isn’t exactly clear, researchers think it may have something to do with decreased estrogen production.
A cough can be a sign of a larger problem
While many coughs are annoying but not serious, there are some coughs that cause greater concern.
Pneumonia is one serious condition that may be signaled by a cough, said Mannan, noting that it is often localized to one side or the other. A patient who coughs up blood — not just blood-tinged mucus but “blood that would fill a shot glass” — should consult their doctor, he said, noting that coughs can also be a sign of congestive heart failure, particularly if they occur while lying flat.
And for patients with lung diseases or at high risk, acough should be taken seriously. “If you are a smoker, have COPD, chronic lung disease, or rare conditions like cystic fibrosis, everything is out the window,” said Abad. “Always talk to yourdoctor.”