We may still have some warm days left, but not only is a little chill felt and some darkness creeping back, but colds and coughs are once again rampant across the country, cold season is back in full force. And of all the problems colds cause, including fever, runny nose, sore throat, no sleep, no appetite, cough may be the worst of all. Cough is a terrible experience for our children, but also for those who get to listen to the cough go on, sometimes all day, all night, not just for days, but for weeks.
After 5, 10, or 20 days of a cough, we often get a call at the office, especially if the cough really bothers the child and family.
There must be something that can be done? That question makes a lot of sense, after all modern medicine is doing miraculous things every day, surely the cutting edges of science must hold a solution to something as common and mundane as a cough.
And, the drug store shelves are lined with 100’s of remedies for cough, pharmaceutical, herbal, naturopathic, at least one of these items must work, right?
To answer this question, it will be helpful to think about why a cold makes you cough.
Why does a cold make you cough?
A cough happens when the nerves that activate the circuits to make a cough happen sends a signal to those circuits. No signal, no circuit, no cough. It turns out the signal to activate a cough is fired when the tissues lining the airways is bothered. That lining can be in the throat, the neck, or the airways of the lungs.
What can bother those nerves and set off coughing? Many things, but they group into 3 main causes:
- Allergies and asthma
- Infections- viral and bacterial
- Physical irritants like smoke
- Rare diseases of the lung
It’s in the category of viral infections where colds belong. Colds cause cough by literally stripping off the outer lining of the nose, eyes, throat, larynx, and lungs, because that’s what cold viruses do, they kill the cells that make the lining of these airways.
If the lining of the nose is stripped off by the virus, you get a runny nose.
If the lining of the whites of the eyes is stripped off, you get a viral pink eye.
If the lining of the throat is stripped off, you get a sore throat.
If the lining of the larnyx is stripped off, you get croup, or laryngitis.
And, if the lining of the lower throat, larynx (voice box), and/or lung is stripped off, you get a cough.
How long does a cold make you cough?
If you are like me, you dearly want every cold to last no more than a day or two. And, sometimes, our wishes come true.
But most of the time, this wish does not happen.
There are two ways to talk about how long colds and coughs last, but there is no way to know how this cold of your child’s will last. That is, every cold is different, so today’s cold could last longer or shorter than expected or hoped for, but if you look at a million colds, certain patterns do emerge.
The first pattern is the median length of a cold. Take a million colds, how many days mark the time that half of those million colds will last a shorter time, and half will last a longer time than that duration? The answer to that is well known and turns out to be– eight days. So, half of all people with a cold will be sick for less than 8 days, and half for more than 8 days.
The other pattern is the 95th percentile (95%tile) length of cold symptom. We all know about percentiles since we track height, weight by percentile, as well as SAT and ACT scores. But a short reminder may help. If you take a million people and measure their height, the 95% percentile is the height that 95% of people are shorter than.
With colds, you can look at how long a fever lasts, a runny nose, a sore throat, and of course, a cough. The 95%tile for each goes as follows:
- Fever- 5 days
- Sore throat- 8 days
- Runny nose- 10 days
- Cough- 25 days!
Again, what this means is that you have to wait 5 days for 95% of kids with a cold to no longer have a fever. Many may stop having a fever in 1 or 3 days, but you have to wait 5 days for 95% to not have a fever from a cold.
The real shocker here is the 95%tile for cough, you have to wait 25 days (!) for 95% of a million kids with a cold to be free of a cough. Again, a cough may go away in 1 day, or 5 days, but 95% aren’t done with a cough until 25 days are past, nearly a month!
How do you know the cough is from a cold?
In the winter time, if you have a mild fever, runny nose, feel achy, and a cough, and you have no trouble breathing when you are not coughing, chances are very solid that the cause of a cough is a cold, a viral infection.
But how do you know it’s not something else? Let’s take a look at those 4 causes noted above and note how you know it’s not one of them.
1. Allergies and asthma.
This is actually a common cause of cough.
When it comes to allergies, we look for patterns, such as coughing every spring, or every time you visit Aunt Janice who has a cat. Other clues it is an allergy are associated problems, like itchy eyes and itchy nose. But the best way to know is to do either eliminate exposure, like to that cat; or, try an antihistamine like claritin. If taking claritin stops the cough, it’s an allergy.
When it comes to asthma, it can be hard to now. Having a cold is perhaps the most common trigger for asthma, so how do you know if your child who has been coughing for 3 weeks has just a cold, or if she has a cold and has asthma active? The best way to know is to treat for asthma, if the cough is bothersome, with inhaled albuterol (by inhaler or nebulizer), if the cough ceases, there is an element of asthma, if not, it’s more likely all cold and no asthma.
2. Infections- viral and bacterial
Colds are viral infections, so how do you know if the infection may be bacterial. The key bacterial infections that cause cough are pneumonia and bronchitis. Typically, bacterial infections of the lungs are far more serious than colds. That is why we ask if your child is having trouble breathing when not coughing. Children with pneumonia or bacterial bronchitis typically are breathing quite rapidly, coughing or not, struggle to breathe.
So, a good way to know if your child’s cough is from a viral (a cold) or bacterial (serious pneumonia) is to see if they are breathing comfortably when not coughing.
A useless guide to making this distinction is the color of the mucus. All colds start with clear mucus and end with yellow and green mucus, all of them. So seeing yellow or green mucus cannot help one know if the infection is a mild virus or a more serious bacterial infection.
3. Physical irritants like smoke
This one can be easy. Coughs from physical irritants only happen if physical irritants are present. Major irritants like smoke are easy to know if they are present. Sometimes the irritant may not irritate everyone, like perfume, though.
4. Rare diseases of the lung
As the category suggests, this is a very rare cause of cough and is only to be considered if more serious disease is suggested by many other symptoms such as unexplained fever for more than 4-6 weeks, unexplained weight loss, and other very unusual events.
How does one treat a cough from a cold?
Before answering this question, a quick look at those 4 categories and how therapies work for all but a cold:
- Allergies and asthma- For allergies the treatments are avoidance of the source of allergy (if it’s a food or animal) or treatment with allergy medications is you cannot avoid the source (if it’s pollen, for example)
- Infections- viral and bacterial- For bacterial infections, antibiotics will end the cough
- Physical irritants like smoke- Ending the exposure to the irritant will end the cough
- Rare diseases of the lung- Treatment of the disease present may ease and even at times end the cough
But, the troubling fact about the cough from a cold, is that the destruction of the lining of the airway that the virus causes (see above) means no real therapy exists to get rid of the cough.
Allergy treatments, asthma medications, antibiotics, and even steroids do nothing to heal the burned off lining of the airway the virus has destroyed.
It’s very much like having a burn on your hand, what treatment would get rid of the burn in a day? The answer is of course that we have no such treatment. No pill can make your burn heal suddenly in a few hours.
Think of a cold like a viral burn, leaving us no choice but to keep our children comfortable while we wait for there burned airways to heal. The good news is that the burn from a virus always heals. As long as the cold does not lead to complications, everyone recovers from a cold and heals splendidly.
One note on what does not work. Nearly everyone’s parents, or grandparents used to ask about using codeine medications to calm down a cough. When I first trained we were taught in medical school that codeine actually stops the centers in the brain that make a cough happen, the centers we talked about above. Codeine was for many years thought to stop someone from coughing.
It turns out this is so untrue that in the October issue of the leading journal, Pediatrics, the American Academy of Pediatrics has issued a policy alert: stop using codeine, it doesn’t do anything about cough, and it’s dangerous.
As far as cough syrups go, the story is not much better. The FDA a couple of years ago launched investigations of 500 cold and cough remedies for fraud. In fact, no substance has yet to be proven to reduce the number of coughs per hour, or numbers of days of cough, a child with a cold will have.
And the same is so for homeopathic, herbal, and naturopathic remedies, no substance, natural or otherwise, has yet been found to heal a cough in a cold. Once that substance if found, we will all know about it, since coughs will stop happening.
One ray of hope- when you swallow, you cannot breathe, or cough. So if you can swallow many times a minute, you will not be able to cough many times a minute. That’s why sipping liquids or sucking on candies cuts down on how much you cough while you sip and suck.
BOTTOM LINES
- Colds cause coughs, and in the winter are by far the most likely cause of a cough.
- Coughs result from the lining of the airway in the throat, larynx, and/or lung being irritated. Several causes can be treated, like allergies, asthma and bacterial infections.
- But if your cough is from a cold and nothing else, no drug, So natural or otherwise is known to stop the cough.
- Sipping on a liquid or sucking on a candy, increases the number of minutes your lungs are closed, and the time you cannot cough.
- Coughs from a cold normally last a lot longer than one would think. It takes 25 days for 95% of a group of kids to stop coughing from a cold!
So, stay warm this winter, know that no matter what you try colds will cross your paths, and if they do, keep your child comfy, but don’t think any medication will get rid of their cough. And know that their cough, and cold, will go away, even it takes many weeks. Of course, we hope all your colds will be the 1-3 day type!
To your health,
Dr. Arthur Lavin
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