Cough medicines are not the same

WELLNEWS

Victor Dumaguing

It seems that typhoons Maimai, Neneng, Karding and lately terrible Paeng have not only spawned gusty howling winds and the series of landslides as well as flooding in Baguio and nearby Cordilleras with lonely days and scary nights without electricity but also a lot of respiratory tract ailments, ranging from sore throat to bronchitis to even the more serious pneumonia. Of course, many asthmatics were brought to the ER because of worsening of breathing. No wonder, many texted and even called, what to do with all those coughing.
    Cough, believe it or not, bothersome as it is, is a protective and defensive mechanism of the body to get rid of anything- toxic gas, dust, microbes, particulate matters to gain access to the alveoli- the innermost recesses of the lungs where the exchange of oxygen and carbon dioxide takes place. Just like sneeze, vomiting, coughing has its Center in the medulla oblongata of our brain- these centers are called Vital centers- vita from the Italian or Latin word which means life.
    Cough medicines may be in the form of mucolytic expectorants- medicines which have the ability to liquefy or soften hardened phlegm inside the tracheobronchial tree, so that the person may be able to expectorate or expel it out. Hardened phlegm provides a fertile culture medium for microbes, so the sooner they are removed, the better is for the person. The tenacity or hardness of phlegm is, from a biochemical point of view, is made of strong disulfide bonds, therefore do not be surprised if one of the most common expectorants contain the substance “acetyl cysteine or carbocisteine" because these have the ability to break the bonds connecting the cysteine amino acids in the phlegm. Other members of mucolytic expectorants include guaiafenesin, glyceryl guaiacolate, bromhexine, cough syrups sourced from lagundi and oregano.
    Mucolytic expectorants are prescribed by the physician, if based on the history as well as physical examination of the patients, there is a need to evacuate the bronchi or the lungs of phlegm, so that there would be what doctors call “productive cough" meaning that every effort brings about copious amount of sputum. These medicines indeed, increase coughing. Which reminds me of a nervous mother, frantically calling a pediatrician in the afternoon complaining that her kid is coughing more than she was early morning. The pediatrician calmly assured the mother, “talaga pong pinapaubo ko ang anak nyo ", and for obvious good reason- to remove and get rid of that phlegm.
    Now, it's sad if for some reasons, the doctor may have just told the patient to take these medicines three times a day, after meals, without warning them, not to take it too late at night. by virtue of its mechanism of action, since the medicines would have lysed or liquefied the phlegm, when the person lies down to sleep, the phlegm starts flowing , irritating the throat and therefore, the patient coughs the whole night, losing precious restful sleep.
Good as they are, mucolytic expectorants therefore are best given daytime, when the person is awake and upright, so that even if he/she coughs, then sleep is not disturbed plus the greater ability to expectorate when awake. So when you have a cough, it would be wise to ask your doctor how and when is it best to take them.
Your columnist gives his patients detailed schedule or time to take the mucolytic-expectorant;  so that if it is TID or three times a day, the patient takes it after breakfast, after lunch and the last dose in late afternoon probably 4-5 pm . By the way, H2O or HOH or our dear old water is a reliable helpful partner in liquefying those tenacious thick phlegm.
Next Week: Cough Suppressants