'The Cough' -- so violent, it can take your breath away

January 16, 1993|By Frank D. Roylance | Frank D. Roylance,Staff Writer

It has no official designation, like "The Hong Kong Cough." But some of its victims call it "The Cough from Hell."

Whatever you call it, The Cough is harsh and persistent, and rises from a viral or bacterial bronchitis. And it is being heard a lot this winter in schools, offices, theaters and doctors' waiting rooms.

"I don't think I've ever been busier, with exactly what you've described," said Dr. Robert B. Stoltz, an internist on staff at the Greater Baltimore Medical Center.

"In the last two weeks, in my own personal practice, it seems to be greatly increased," he said. "And other internists in the northern part of [Baltimore] county, their experience seems similar to mine. Their waiting rooms are filled with people coughing and with low-grade fever."

Dr. William E. Randall Jr., a GBMC lung specialist who sees the sicker patients referred by primary care physicians, said he has seen patients coughing so violently that they vomit, black out or even break a rib.

"It can be a pretty dramatic thing," Dr. Randall said. "And we really have seen a lot more of it than normal . . . It seems as busy now as I can ever remember it being."

Dr. Glynn Wells, a Bel Air internist, said he and four other physicians who practice at the Plum Tree Center are seeing more bronchitis this winter, too, with the most serious symptoms among older patients.

"These people are losing time from work, and they're having a prolonged convalescence," he said.

Even after the infections are cured, The Cough can persist for weeks.

Some, particularly the elderly or those with underlying cardiac or asthmatic problems, or whose infections have advanced to pneumonia, have been hospitalized.

The Cough is not easy to document. Unlike outbreaks of influenza, it's not an illness that doctors or school health nurses routinely report to public health authorities.

Dr. Diane Dwyer, chief epidemiologist for the state Department of Health and Mental Hygiene, said, "I've heard those same anecdotal reports, but in terms of actually knowing what the cause is, I don't."

It is not the flu. So far, Maryland has seen very little of that, she said.

The Cough hasn't shown up everywhere, at least not above the normal mix of seasonal complaints.

"I couldn't say we're having higher than usual numbers of coughing-like illnesses, bronchitis or persistent cough," said Dr. J. Michael Niehoff, a family practitioner at Franklin Square Hospital.

On the other hand, he said, "there are definitely several individual patients who fit that category . . . so this may be something that is just showing up now."

Accounts of the illness are mostly anecdotal.

"We're seeing maybe 3 to 6 kids a day with it," said Dr. Michael E. Sherlock, a Towson pediatrician. "Some kids have to be put on codeine they're coughing so bad. I saw one just now who was sent home from school because he was disrupting the whole class [with his coughing]."

"I've heard of some kids going on [coughing] for a month," he said.

Bronchitis is an inflammation of the bronchial tubes -- the airways branching from the trachea, or windpipe, into the lungs. It can be caused by bacterial infection, which can be treated with antibiotics, or by a viral infection, which cannot.

"These infections as a rule start with a sore throat and go to head and then chest congestion," said Dr. Stoltz. "If untreated, it will not uncommonly go to pneumonia," an infection of the lungs themselves.

"In my patients, they generally come in with a low-grade fever, and . . . either a dry cough, or a productive cough. They'll say they feel there is something down there and they can't get it up. It's always worse at bedtime."

The infection and cough can be exhausting, and patients report "just feeling like a dishrag," he said.

Mucus generated by the bronchial inflammation can make it more difficult to move air through to the lungs, and patients "feel like they can't get the air they're used to getting," Dr. Stoltz said.

Doctors are treating the bacterial infections with antibiotics such as erythromycin, and the coughs with a strong, prescription cough syrup.

"The over-the-counter [cough medicine], as far as I'm concerned, is almost a waste of your money," Dr. Stoltz said.

Once on antibiotics, "usually within 48 hours they start responding well," he said. "If not, it's likely they have a viral problem, and a virus does not respond to antibiotics."

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