Q: My mom, who is 86, has started to worry me. Over the last week or so, she is coughing so much she appears to be ready to throw up. Initially, we all thought that this was just a cold-like illness. One of her caregivers had a cold -- or possibly the flu -- and we think mom might have caught it from her. My mom has memory loss, so it is not that easy to figure out if she has any other problems. She always says she is fine no matter what. The question my sister and I have is how dangerous is that cough and how would we know whether she is getting sicker? Getting her to her doctor now is a production, as she really hates to leave her home and gets very anxious when she does. Any advice on how to help her?
A: How is it that the most common symptoms bother us the most?
A cough is a reflexive response of our airways to an irritant. Although extremely difficult to control at times, it rarely signifies a serious problem. However, the list of different maladies responsible for cough is very long, so, not surprisingly, many people struggle with a cough for weeks, and sometimes years.
The most common reason for acute bouts of cough is the common cold. As I have discussed before, the common cold is caused by a virus. Stuffy nose, mild fever and sore throat also go with a common cold. It does sound from the story that Stella's mom got her cold from one of the helpers at home. This is yet another reminder not to come close to elderly and frail individuals when we struggle with a cold.
Cold spreads through the air and through touch. Although wearing a mask may help a little and washing hands is a must, it is just not possible most of the time not to infect a person we get in close contact with.
The best way to help a cough is to drink plenty of fluids. One may consider such sports drinks as Gatorade to supplement salt and water at the same time (yes, too much water without salt is no good). Humidifying the air, either by using a humidifier or just hanging wet towels around the room, is another necessary step.
Some people have an exaggerated reaction to cough and their airways just do not know when to stop. For these hypersensitive people, it may be wise to see a doctor to discuss a prescription medication to help with this problem. As a rule, antibiotics have a very limited role, if any, in the treatment of a cold.
Seasonal allergies -- particularly one known as allergic rhinitis -- also carry cough as a symptom. Allergic rhinitis is when the lining of our nose overproduces fluid in response to irritation from pollen. With this disease often come itchy eyes and congestion. Antihistamines and prescription nasal sprays are very effective here. When the pollen count is high, many people may have a very miserable spring and early summer.
I do need to mention that a cough also may be a side effect of certain blood pressure medications. In anyone with a chronic cough, medications may need to be reviewed by the primary doctor.
Paradoxically, stomach problems may cause cough. Gastric acid reflux may keep irritating airways with acid content of the stomach traveling back up to the air pipes especially at night. This may require a completely different approach, as the treatment of acid reflux doesn't have much in common with the treatment of allergies or the common cold.
There is yet another condition elderly patients and their families may need to be very aware of, especially in people with progressive memory loss. Sometimes the memory loss can get so bad that the person may start forgetting how to swallow. This will result in food going from the mouth to the airways and lungs instead of going to the stomach. This is called aspiration and it may get worse over time, with cough being the only symptom. That cough, however, will have at least some connection to eating. Coughing spells will typically happen 20 to 30 seconds after a bite of food or a sip of liquid. The way to help this condition is to try to thicken fluids by adding a readily available powder and to chop or puree solid food. Eating slowly will also help here.
We do need to discuss that, in some rare cases, cough may be a sign of a serious illness. Even a simple cold may progress to pneumonia. There may be a permanent irritation from cigarette smoking or from a more deadly problem. Some people get a permanent widening of the air ducts called bronchiectasis. Unfortunately, with this condition, airways are no longer able to clear any particles and the cough may actually lessen, indicating a more serious stage of this disease.
Although all of these conditions are scary, they are also very rare. Most people with a cough will get better quickly as long as they avoid cigarette smoke and stay hydrated.
Stella did ask when to start being concerned that the cough is more than just a cold or an allergy bout? When a person gets sick, other symptoms happen as well. Fever is not a good sign, especially if it persists for more than a few days. Coughing up thick green or yellow phlegm may be a warning sign. A person whose has cough is getting weaker, or who is confused or just being all of sudden different also warrants more attention. The inablity to eat or drink fluids might be a sign of a serious problem as well. Any relation of the cough to the swallowing process needs to be carefully evaluated by a professional.
But let reassure Stella and all of our coughing and sneezing readers that we will survive the colds and the allergies. I promise.