Understanding Cough

Cough (Latin: tussis) is a body reflex to eliminate foreign matters, sputum or irritants from your airway passage in the body. Hence, it is for the body a protective mechanism, however annoying it sometime may be.

An interesting reflection upon surah Al-Baqarah verse 216:

“…But it is possible that you dislike a thing which is good for you, and that you love a thing which is bad for you. But Allah knows, and you know not.”

Cough can either be acute or chronic cough. Acute cough is the type of cough that last less than 3 weeks. Any longer than that, it is referred as chronic cough.

There are several underlying reasons for cough. Some of the reasons and the clinical symptoms are summarized in the table below:

Cough could also be induced by the overdose or toxicity of some medicines, such as

• Amiodarone (indicated for arrythmia)
• Intranasal corticosteroids such as Beconase (to threat the allergic rhinitis)
• Macrolide antibiotics such as erythromycin and roxithromycin (indicated for upper and lower respiratory tract infection)
• ACE inhibitors such as lisinopril (indicated for cardiovascular diseases such as high blood pressure).

The cough resulting from these medicines is usually the dry cough (without sputum or phlegm). If you experience these symptoms while on aforementioned medications, make sure you consult your doctor for the betterment of disease management.

Nonetheless, if you have the following symptoms, you are recommended to see your doctor straight away for the correct diagnosis and the appropriate treatment.

• Dyspnea (shortness of breath)
• Hemoptysis (blood in your sputum or phlegm)
• Unexplained weight loss
• Risk factors for TB (tuberculosis) or HIV infection

Over-the counter Cough Medicines

This article is not intended to promote any brand, so only the name of the medicines are mentioned as a guideline for you to choose the brand, of course after consulting your doctor or pharmacist.

Common cold and acute bronchitis are the two diseases that are caused by viral infection. They will resolve by themselves after a week or so, depending on the severity. As they are caused by viral infection, there is no need for antibiotic. The treatment for these two diseases focuses more on relieving the symptoms mentioned in the table above. However, this article will only talk about the symptomatic treatment for the cough.

If your cough is non-productive (NOTE: NO PHLEGM), then the cough suppressant is for you e.g. products that contain medicines such as codeine, pholcodeine and dextromethorphan. Generally, dextromethorphan is more preferred as it causes less adverse effects and also less addictive.

However, these cough suppressants are contraindicated if you

• are a smoker (usually will have build up of mucus in the breathing passage);
• experience a productive cough.

In both cases, suppressing the cough will cause the mucus or phlegm to be trapped and accumulated in your breathing passage, creating a nice environment for the bacteria to grow and worsen your respiratory tract infection. Opt for mucolytics and/or expectorants instead. The products above are also not suitable for children. Consult your pharmacist regarding the medicines suitable for your child’s cough.

Mucolytics: Look for the products that contain bromhexine or acetylcysteine. They aid in removing the mucus or phlegm by decreasing the viscosity of the phlegm.

Expectorants: Guaifenesin, senega or sodium citrate might promote expectoration of the bronchial secretions in productive cough.

REMINDER:

1)    Make doa to Allah as indeed He is the One who will alleviate your disease. The medicine is just a wasilah/ way following sunnatullah to treat the disease that Allah has Given to you.

“And when I am ill, it is He Who cures me” (As-Syu’ara 26:80)

2)   Do not, I repeat DO NOT choose any product that combine both cough suppressant and expectorant if it is labeled for productive cough.

3)   Do consult your doctor or pharmacist before you self-treat your disease. This article is aimed to provide a basic idea of cough and the treatments available so you that appropriate action can be taken.

Resources:

1)     .AMH 2008: Australian medicines handbook. Adelaide, S. Aust.: Australian Medicines Handbook c2008

2)     Audrey S. Hughes, Jennifer P. Kowalak Handbook of Signs and Symptoms, Third Edition, Springhouse, Lippincott Williams & Wilkins, 2006, Philadelphia, USA

Oleh:

Aisya Nabilah Abd Rahman
B.Pharmacy
Monash University (Parkville)