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Some insights on the COPD’s cough and “smoker’s cough”: a myth?

Posted Aug 29 2010 6:07am

Cough is a symptom of many lung diseases. However, Cough is also a symptom that can lead to diagnosis of some conditions of the nose and throat as well as esophagus or stomach. There are distant organs that can also be affected and send messages to us in the cough “envelope”.

Cough and COPD

When cough is a symptom of Chronic Obstructive Pulmonary Disease, it lasts longer that if the disease were an acute condition. Often, smokers tend to call it “smoker’s cough” which is true but requires a careful assessment. Cough in the smoker goes beyond a pure irritation of the airway. The smoker’s cough can be symptom of the airway obstruction. The  trapped air  inside the lungs  (due to airway obstruction) is partially released with an extra expiratory effort. That extra expiratory effort can be the regular cough that seems to be a fake reliever. It doesn’t work completely because every cough effort is also accompanied by a full inspiration that might bring more air to be trapped in the lungs.

The forgotten symptom?

The complete functional description of the COPD’s cough has not been established. What is clear is how common cough and COPD are together. What is also clear is how oblivious the symptom is for most patients. It seems more relevant to patients when the symptom becomes exhausting or even associated with pain. At this point it is important because there is no “smoker’s pain” or “smoker’s exhaustion” that patients might consider “normal”.

A cough class

Cough can be dry (without phlegm) or humid (with phlegm). The humid cough can be productive (when the patient can release the phlegm) or not (when the secretions stagnate inside the chest). It is important to cough in most respiratory illnesses because it can become in a defense/protective mechanism.

Exercise coughing

According to a recent non-COPD-related article by Dr. Wen-Lin Su and cols. in CHEST 2010;137(4):777-82; Cough is a defined sequence: “deep inspiration followed by strong expiration against a closed glottis (-where your vocal chords are-), then opens with an expulsive flow of air, followed by a restorative inspiration”.

To cough effectively, it is important to make a slow full exhalation after a normal exhalation. Then, the subject should prepare to inhale completely and slowly and, after doing so, focus in the abdominal muscles. An effort to contract the abdominal muscles should start and then cough to force phlegm (if any out) or to help part of trapped to air to be released. One way to help is to put a pillow on your lap when sitting to cough. Being conscious about the cough really help to cope with this symptom. And don’t feel embarrassed.

Help with respiratory exercises

Patients should be sure to train themselves on respiratory exercises like pursed lip breathing. It is also key to understand the role of exhalation in the breathing process because that is where the limitation becomes important in COPD’s lungs.

Be sure to cough and be sure it is “normal” …

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