“Against persistent cough, it is better… to do nothing”
A study published in the Canadian Medical Association Journal indicates that a chronic cough can continue in almost a quarter of people after a respiratory infection, for 3 to 8 weeks. However, in the usual absence of alarm signals for another pathology, investigations show that attempts at treatment with inhaled corticosteroids, bronchodilators and oral cough suppressants are ineffective. Additionally, pressurized aerosols emit powerful greenhouse gases! Treating your cough is not eco-friendly. Bottom line: Don’t do anything. It heals on its own.
Not very charitable
Immersed in study figures, we easily forget our role as caregiver. Chronic cough is an extremely distressing symptom. Has the author of the article already experienced it before launching his peremptory conclusion? It is not very charitable to let others wear it out. But this is not the most crucial flaw of this study. Like most of them, it is not transdisciplinary. In neurology we know today that there is a process of sensitization of frequently stimulated nerves. They make new sensors at their terminations. Consequence: if you are not particularly hypersensitive in one area, you become so after a few days of irritation. Increasing function develops the organ. The nerve enriched with sensors becomes a real celebrity in the nervous system. Now it reacts feverishly to any stimulus.
This is why some children and adults are more prone to prolonged irritant cough than others. Following a viral infection that is particularly damaging to the pharynx and trachea, local nerves become hyper-reactive. Any future infection, even mild, begins to trigger an endless and exhausting cough.
How to get rid of the problem?
All excitation of the incriminated endings must be stopped early, long enough for the nerve to lose its richness of sensors and become normally sensitive again. Any nerve can be affected. In rheumatology, for example, we use mesotherapy against chronic neuralgia (sciatica, cruralgia, cervico-brachial neuralgia). It consists of subcutaneous injection of anesthetics over the entire sensitive area. A single session is sometimes enough to make sciatica that has been stubborn and frustrating for months disappear. The initial cause of sciatica has faded and the pain is a sequela of prolonged irritation of the nerve, reflecting its enrichment of sensors. The injection of its territory, possibly repeated once or twice, triggers a sort of “reset” in the nervous system. The nerve loses its fame and no longer gets excited without good reason.
Here’s how to follow the same principle for a chronic cough. This method is very effective, has no side effects, and is very environmentally friendly! Ask for a prescription for Paracetamol-Codeine in effervescent tablet form. At the start of a coughing fit, dissolve one tablet in a little water. Half a tablet may be enough. Take a small sip but do not swallow. Lie down so that it bathes the back of your throat. You should try to hold as long as possible in this position, before swallowing or spitting out the liquid. This is the most difficult. It doesn’t matter if a straight drink quickly interrupts your effort, you will try to last longer with the next sip. The first will have already made the back of your throat less sensitive.
It is allowed to swallow the sip to increase the effect with a passage of the ingested codeine into the general circulation. But it’s not mandatory, especially for those who tend to get a bit of a headache from codeine. The side effects remain mild. The only precautions: do not use on a productive cough, which is much more useful than an irritant cough and which does not last long. Also be careful if you have insufficient breathing, avoid using codeine in the evening and swallowing it, so as not to reduce your nighttime breathing rate.
To put in the first aid pharmacy
Codeine acts by direct contact. It anesthetizes the endings of your hyper-reactive nerves. Take it again at the start of a new straight. You won’t need to continue for long. The sensor richness of your pharyngeal nerves will decrease. No abnormal sensitivity to cough in the future. Paracetamol-Codeine 500mg/30mg can be used at a maximum dose of 2 tablets every 6 hours, but this limit is only necessary if you swallow them.
It’s also a good painkiller and I always put a tube in my travel medicine cabinet. It is not only yourself that you can exhaust with a cough, but also your companions…
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Postinfectious cough in adults, Kevin Liang, Philip Hui and Samantha Green, CMAJ February 12, 2024 196 (5) E157; DOI: https://doi.org/10.1503/cmaj.231523