To cough or not to cough?

It appears during the fall or winter when the circulation of respiratory viruses increases. It appears during the late afternoon and at night in people with asthma. It also appears after a fit of laughter or when something we are eating or drinking goes “astray”. We are referring, of course, to coughing.

Coughing is a reflex that acts as a defense mechanism of the respiratory system. It not only intervenes to expel excess mucus, but also to protect our bronchi and lungs from inhaling harmful substances (smoke, irritating chemical substances…), from a piece of food that we choke on or from excessively cold or hot air. .

What happens when we cough?

Before we hear the characteristic sound of a coughing fit, several phases take place.

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

2. As a consequence we inhale air. Specifically, before a cough we take in approximately half of all the air that fits into our lungs.

3. That air that has reached the lungs is compressed, until it reaches a pressure of around 300 mmHg. To do this, the glottis is closed and the vocal cords are brought closer, while the abdominal muscles are forcefully contracted.

4. In the last phase, or expulsion phase, the glottis suddenly opens and allows air to escape at high speed (in healthy adults, between 360 and 1,200 litres/min), dragging away whatever was irritating or obstructing the airways.

Are there several types of cough?

Those who have ever attended a cough-related medical consultation know that one of the first questions doctors ask us is whether or not we cough. That question serves to classify cough into two types: productive and dry.

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

On the contrary, a dry cough is one that is not accompanied by the expulsion of secretions or foreign bodies. It is also called irritative cough because this type of cough causes great irritation in the airways, especially in the throat.

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

Sometimes what is generating continuous dry cough attacks is the insistent activation of cough receptors that are located in areas such as the ear, the pleura, the pericardium, the esophagus, etc.

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

What complications can cough have?

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

Some of the adverse effects that a cough can have are:

• Poor sleep quality.

• Excessive tiredness throughout the day.

• Urine losses.

• Headache.

• excessive sweating

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

• Nausea and vomiting.

• Fatigue and/or sensation of stiffness in the abdominal muscles and in the diaphragm.

• Appearance or aggravation of umbilical, inguinal or abdominal hernias.

• Syncope.

• A decrease in the quality of life and social and work relationships.

In some rare cases, more serious complications such as rib fractures, ruptured spleen, eye bleeds, tearing of muscle fibers (both in the abdominals and diaphragm), or splitting of the edges of a scar have occurred in people with a recent operation. .

What is better: to cough or not to cough?

Depends. In case of a productive cough, the answer is always to cough.

For a dry cough in which there are secretions or foreign bodies to be eliminated but they do not emerge because the subject has weak abdominal muscles, little lung capacity, or the secretions are very adherent to the bronchial tree, the answer would be to solve these conditions to transform this false dry cough into a productive cough.

Finally, for cases of pure and hard dry or irritative cough, it is best not to cough. Do not cough to avoid cough complications. This can be achieved:

• With drugs to inhibit coughing, always under medical prescription.

• With changes in posture and breathing: sit down, bend your head, close your mouth, swallow saliva several times, take a breath slowly through your nose until it fills your lungs and let it out very slowly.

• With natural remedies. Taking honey is effective in reducing attacks of irritative nocturnal cough in children. So is drinking water in small sips, chewing gum, or sucking on candies.

Of course, be very careful with the mint candies. It has been shown that there are times when the intensity and duration of coughing can worsen.

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.