What About That Cough?
By Ralph K. Campbell, MD
Coughing has a wide range of significance and severity. Starting with the attention getting, brief cough associated with clearing the throat before speaking, progressing through what an advertisement described as “great expectorations,” we can appreciate the need to look at the causes.
Another way of categorization of coughs is to consider where they originate—a superficial “tickle” from the nasopharynx or from deep down in the bronchial tree.
The cough reaction is designed to clear the airway and can be initiated by just a “tickle” to the need to get copious amounts of material out of the airway.
It is accomplished by a sudden, hard contraction of the diaphragm—the flat sheet of muscle that separates the chest cavity from the abdominal cavity. This increases the pressure in this closed space that, like squeezing a toothpaste tube, forces air to exit the lungs and releases the material in the airway.
It will be repeated in spasms of coughing if the secretions are too sticky or viscous.
If someone is choking on a particle of food that is blocking the airway, the same action of increasing pressure in the lungs can be accomplished by the Heimlich maneuver, in which a sudden and forceful thrust in and upwards is applied just below the rib cage.
Post-nasal drip is an apt term. Infection, irritants in the air, or nasal allergy from airborne agents such as pollens, or food allergens, can cause excessive amounts of mucus. The resulting “tickly” cough is an attempt to get this irritating stuff out of the airway. If there is inflammation from a virus infection, the drip and the resultant cough can be almost unrelenting. Treatment consists of getting the airway as open as possible and keeping the secretions from reaching the cough trigger point in the throat. In infants and small children this is done with a nose syringe that draws the (what doctors and everyone else call) “gunk”, out of the nose and nasopharynx. Another aid, particularly for infants, is to be propped up (45 to 60 degree angle) in a car seat during sleep time. When propped up, the secretions are swallowed rather than having them pool, as they would if the infant is flat down.
Moving down, we have coughs developing from the larynx. People who are hoarse complain of a “frog in their throat”. The reference to frog might indicate the beholder would wish it would simply hop out of there. The larynx is another amazingly well-designed part of the human body. The two vocal cords are set over a box-like structure. Their length and proximity to each other are controlled by muscles innervated by the laryngeal nerve. Just consider the possibilities of what can result from this arrangement. The varieties of sound from a growl to a sopranos “high C” are infinite. With an inflammation of the larynx we call “croup,” breathing in produces strange, crowing sounds, and the resulting cough may sound like a seal bark. Inflammation and swelling narrows the gap between the vocal cords, and if carried to extreme, can shut off the airway, necessitating a tracheotomy (creating an opening in the trachea to bypass the larynx). A severe allergic reaction, called angioneurotic edema, can also produce this life-threatening condition. Treatment with injectable adrenaline is lifesaving, but along with this, it’s critical to begin an immediate search for the cause. At the same time the patient is prescribed an adrenalin preparation to always be carried (by the patient or parent) in case of a recurrence or until detective work reveals an allergen that can be avoided. Most laryngitis is due to a virus infection which is annoying but rarely serious. Unfortunately, pediatricians must always keep in mind that along with viral influenza, little ones can get an infection of H. Influenza b (Hib, a gram negative bacterium) that may have serious consequences. These children are sick before the severe respiratory signs are noted: On inspiration there is a marked crowing sound. As the airway obstruction increases, one can notice a sinking in of the chest and the obvious difficulty of drawing a breath. Emergency treatment is needed, immediately.
H. Influenza b (bacterial) infections seem to come in waves; so during those periods, doctors have to be on the lookout for an equally severe, emergency situation–epiglottitis. The epiglottis is the flap of tissue on top of the larynx that can act like a flap valve—open when breathing; closed when swallowing, to prevent food stuffs from going down the wrong pipe, so to speak. The esophagus, where the food should go, lies directly behind the larynx. The infected, inflamed epiglottis can swell to the point of complete obstruction of the airway, necessitating the emergency measure of a tracheotomy. The Hib infection, since it is bacterial, usually does respond to antibiotic treatment, but there is no time to wait. A cortico-steroid, like prednisone, is given in the hopes that it will relieve the swelling enough to avoid the surgical procedure. Without immediate, dramatic relief, a tracheotomy is indicated. The respiratory noises at the onset are the noises of uncomplicated croup; but the signs of worse sickness, including a rapidly rising fever, change rapidly.
The trachea (wind pipe) lies between the larynx and the bronchial tree. It shares any inflammation that its neighbors might have. The cough could be described as a hacking, dry cough. Secretions from it are usually not as copious and they don’t usually diminish the flow of air greatly. However, the “gunk” is harder to remove since this relatively short tube is because of its small, straight surface, so it doesn’t provide as much area for fast-moving air to to catch. Nevertheless, the trachea’s nerves transmit an irrepressible urge to cough and to keep coughing until there is some clearing of the airway. Dry air, produced in the winter by indoor heating of already dry air, is its worst enemy. A winter-long tracheitis can ensue, made worse by irritants or allergens indoors that an individual might be exposed to (house dust sensitivity, animal dander, molds, etc.). Irritation in the upper airways that induces a chronic cough can also be caused by gastroesophageal reflux (frequent heartburn).
Now for the most well-known cough–the one produced by an irritated bronchial tree. Thanks to advertising of symptom-relieving drugs, we all have heard of COPD (chronic obstructive pulmonary disease). Inflammation or irritation of the lining of the bronchial tree, if not managed, can become chronic. Inhaled irritants, such as tobacco smoke, particulate matter, sulfur dioxide (smog) or allergens can cause inflammation that can become chronic or can even lead to lung cancer. Secretions can be copious to the point that one can actually drown in them. The cough, by its sound, reveals this. It makes one cringe to hear great gobs of gunk being coughed up with the person in no position to spit it out, just having to swallow the foul stuff. Years ago, tobacco companies played on the fact that their clients didn’t want to cough. The maker of “Old Golds” claimed, “There isn’t a cough in a carload.” Older patients can be so encumbered by these secretions that they have to undergo anesthesia and bronchial lavage in which, bit by bit, the bronchi are washed out. Whenever the cough is “tight,” taking grapefruit or grapefruit juice helps as an expectorant to loosen the cough and allows the cough to better clear the bronchi. If not effective, about the only over-the-counter drug I have prescribed for children is “Mucinex” (guaifenesin), an effective expectorant. It comes in either liquid or tablet form with clearly recommended doses. For the liquid preparation, look for the generic, guaifenesin, as the main ingredient without any other active ingredients, such as “sleep aids.”
Treatment with nutrition
Infections and inflammation caused by irritants can be effectively treated with excellent nutrition. Children with repeated bouts of bronchitis during winter time usually fare much better when they are given adequate doses of vitamins. A daily multivitamin and bowel tolerance vitamin C will greatly help all through the “cold” season.[1-6] Liposomal vitamin C is available that avoids the laxative effect with huge oral doses. Vitamin C helps to prevent inflammation and has been shown to lower the incidence of inflammation in the lung and COPD . Vitamin C helps the immune system to rid the body of viruses and bacteria, and is essential in maintaining and regenerating collagen, the protein that holds together the airways and blood vessels. Recovery and repair of airways from a severe cough goes faster with adequate vitamin C and other vitamins and essential nutrients.[5-9] Problems with digestion such as heartburn, that can irritate the airways, can often be cured with an excellent diet that minimizes carbohydrate consumption and contains a good amount of fiber and raw vegetables and fruits. Consider juicing raw vegetables for a greater dose of nutrients. Avoid taking antacids as they slow the digestive process — which will then proceed more completely, allowing the body to absorb a larger amount of essential nutrients.
For vitamin A, adequate doses can be found in a multivitamin, either pediatric or adult. It helps to prevent inflammation of the bronchial tubes and lungs to lower the risk of pneumonia. As huge doses of vitamin A can be toxic, eating brightly colored vegetables (carrots, winter squash, greens) will provide a healthy dose of beta-carotene that the body can convert to vitamin A when needed. Doses of vitamin D should be given proportional to body weight (30 IU/pound/day), so adults should take 2,000-5,000 IU/day, and more when stressed by severe illness. Infants should be given 200-800 IU/day — chewable tablets are a good way to give the doses. To make sure the dose is adequate after taking vitamin D for several months, one can get a blood test of the 25-OH vitamin D level — this is quick and easy. Adequate magnesium (taken in the preferred chloride form at dose of 3 mg/pound/day or 50-100 mg/day for toddlers, 300-600 mg/day for adults) is essential to help vitamin D be utilized by the body. Magnesium also helps to prevent asthma and other serious conditions associated with lung inflammation. Taking vitamin D and magnesium should be started before the fall flu season arrives. Liquid magnesium chloride is available online and an appropriate dose for an infant or small child can be prepared by diluting and adding to juice. Although not appropriate when a little one is very sick, a bath with Epsom salts (magnesium sulfate) is an easy and inexpensive way to get magnesium for both children and adults. Zinc (adult dose, 50 mg/day) is known to help prevent viral infections and quicken recovery. Since vitamin D is a fat soluble vitamin, its level in the body rises and falls slowly, so rather than trying to remember to give a very small dose every day, it is easier to give an infant or toddler a larger dose (1,000-2,000 IU) once per week. To give better absorption, vitamin D should be taken with food, for example at breakfast or dinner. Adequate doses of vitamin D and magnesium, taken over several months, especially in the winter and early spring, reduce the risk of severe respiratory tract infections. [9,10]
A cough can be serious if it is associated with a life-threatening blockage of the airways or with a fast-moving infection. A cough associated with a cold or flu that progresses to a secondary bacterial infection and pneumonia can also be life-threatening. These conditions can largely be prevented with adequate nutrition to prevent an infection or inflammation from taking hold. A diet with lots of dark green leafy and colorful vegetables and fruits along with adequate doses of vitamin C and D will help to keep the lungs free of infections. Recovery from an airway infection is usually much quicker when adequate doses of vitamins and other essential nutrients are given at the first signs of illness.
1. Campbell R, Smith RG. Fever: Friend, Foe or Both? http://orthomolecular.org/resources/omns/v14n08.shtml
2. Campbell R. Influenza. And no, I am NOT getting a flu shot. http://orthomolecular.org/resources/omns/v14n02.shtml
3. Jonsson BH. Vitamin C for Pneumonia? http://orthomolecular.org/resources/omns/v12n18.shtml
4. Saul AW. Vitamin C Cures Pneumonia http://orthomolecular.org/resources/omns/v12n17.shtml
5. Case HS. Tips from a Megavitamin Mom: Getting Kids to Take Vitamins and Lots of Them. http://orthomolecular.org/resources/omns/v12n09.shtml
6. Levy TE (2012) Primal Panacea. Medfox Publishing, ISBN-13: 978-0983772804.
7. Park HJ, Byun MK, Kim HJ, et al. Dietary vitamin C intake protects against COPD: the Korea National Health and Nutrition Examination Survey in 2012. Int J Chron Obstruct Pulmon Dis. 2016 Oct 31;11:2721-2728. https://www.dovepress.com/dietary-vitamin-c-intake-protects-against-copd-the-korea-national-heal-peer-reviewed-article-COPD
8. Saul AW, Case HS. (2013) Vegetable Juicing for Everyone: How to Get Your Family Healthier and Happier, Faster! Basic Health Pubs. ISBN-13: 978-1591202950.
9. Dean C. (2007) The Magnesium Miracle. Ballantine Books (2017) ISBN-13: 9780399594441.
10. Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017 Feb 15;356:i6583. http://www.bmj.com/content/356/bmj.i6583.long
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