Coughing - Dr. Gerard W. Frank | UCLA Health Community Lecture

my name is dr. Frank and with UCLA and by offices across three from UCLA Santa Monica Hospital and I've been seeing patients there well about 18 years I've been a long time I have a few things to say but the most interesting part of this experience is all is always the question and answer period so I'm going to leave plenty of room for that plenty of time for that well what are we gonna talk about Koff right incredibly common symptom you know I probably probably see 500 patients a year who come to me for cough they're very very common you think I'd be an expert and would cure everyone unfortunately that's not the case well couple of things that we want to talk about today first of all what causes cough what why do people get caught what are the serious things that can cause cough and what are the not so serious but maybe not so easy to treat things that that cause cough okay then we want to talk about how your doctor goes about trying to figure out why you have the cough and what to do about it whether it's something that can be cured or maybe something that can only be kind of minimized in terms of its effect on your lifestyle and then maybe I'll spend most of the time on this huge variety of medicines that are around that that we have for dealing dealing with cough now I have a different call XAR that I give to residents and other doctors where I go into a lot of the physiology of coughing I'm not gonna bore you with all that except to say that our coughed reflex is a very complicated procedure okay and you know you're taking a breath and we press down we close off our glottis and then we release it okay and then the COFF comes up and the cop comes up with very rapid speed you know rapid speed with a very actually quite a high pressure a lot higher than most of your blood pressures believe it or not but it's a very complicated mechanism and it's and it's a reflex and the things that trigger the COFF we call receptors and you have receptors in the nose in the throat in the lung you have them in various places and so any one of those could be a trigger for cough in fact we'll come back to later there are copper acceptors at the bottom of the esophagus and that has implications in terms of heartburn and acid reflux and we'll come back to come back to that point well what causes cough well many things what are the serious things that cause cause well of course number one would be lung cancer although I have to tell you you know and I don't know how many hundreds of patients I've seen over the years who ended up having lung cancer very few of them had caught because of the lung cancer interesting no nevertheless someone who has a cough that doesn't go away the doctor has to worry about that we always have to worry about what could be the worst thing here okay so lung cancer next thing would be some sort of serious infection and probably the most common or the most worrisome thing would be tuberculosis okay not very common in Santa Monica but still present still still a possibility so tuberculosis and then and another thing that will come back to a little bit later is and I'm gonna spell it out when I come to it it's what we call bronchiectasis and some of you may have may have heard that term so those are those are serious things so how does the doctor go about figuring out whether you have something serious or not okay well like it every part of Medicine we start with the history what is the COFF light most important question how long have you had it if you've a knock off for a week it's different from when you've had it all year or if you've had it 10 years I see patients who have had it for a week or a month a year all their lives okay it makes a big difference okay short-term cough is more likely due to some kind of an infection and most commonly it's a viral infection all right as the cough stretches out stretches out farther and farther we begin to think of things like allergies or some other underlying condition in the coughs so the timing or the excuse me the length of time the patients had with the cough is probably the first question the doctor has to ask next thing it would be next important question would be do cough anything up is it a quote dry cough toss seka is it a cough that produces phlegm or sputum or mucus however you want to want to call it if it's producing mucus that's going to be different in its causes from the so called dry cough which might just be what we call a tick you know a tea I see kind of a nervous habit a long time ago I used to have a colleague another pulmonologist and you talk to him in every 10 minutes ago well you know that's a tick that's not not not something serious okay so but if you're coughing up something well then we want to know what's it like is it thin it's a thick is it white as a yellow is it green has there ever been blood in it okay you know blood red flag you know that that makes you think of more serious things cancer perhaps or something like like like tuberculosis so the nature of what you might be bringing up is important then you want to know well as you mentioned does the dependent position you know when you lie down in bed at night you start coughing okay that's a telltale sign maybe that's indicating acid reflux okay and and I always ask patients well does it keep you awake or does it wake you up that's a very important does it depend on the weather does depend on whether it's dry or or rainy is it worse in the summer or worse in the winter all these things kind of help you understand maybe there's an allergic phenomenon going on here you know and lately an awful lot of my patients are telling me that their cough came or got worse after guess what the fires all right the fires and all that dust I don't know about about you your houses and homes but we had you know we were just our pool look awful I was just full of this dust you know which we were all breathing okay and I think that caused an increase in the frequency of cough so those are various things if it's kind of short-term cough you know I would I would ask the patient well if you've been around someone else who's been sick you know and I hate to blame little grandchildren but they carry a lot of germs you know and we grandparents have to keep our hands washed or you know we might we might pick up pick up those those germs so you have to start with a history okay and sometimes that that's enough you know and for me I coffees really I'm a specialist but cop is really a primary care problem you know the primary care doctors should know something about it and at least get started on the workup by the time the patient gets to me someone else should also already have been trying to do something you know with with with with the cough okay but if if routine measures don't tell you anything don't help the cough then you lead to a higher level of testing and of course the the first of those would be a chest x-ray okay need a chest x-ray and certainly any patient who gets referred to me as a specialist I would not feel my evaluation was complete without a chest x-ray you know sometimes I'm disappointed when the referring doctor hasn't already gotten one because then I gotta send the patient off off to get it but a chest x-ray will tell us anything obvious like whether there's actually a pneumonia okay pneumonia is like a white patch on on the chest x-ray and might tell us whether the patient potentially has lung cancer which reminds me I forgot one of the most important questions which is do you smoke or have you smoked okay if the patient's a current smoker that's extremely difficult to find any other cause for the cough okay if the patient's been a smoker then they're at higher risk for lung cancer so you know raises my my suspicions for that chest x-ray would show us some large lung cancer the thing is there can be very small cancers that wouldn't be seen on a chest x-ray although those seldom would be a reason for cough wheeze a reason for coffee so chest x-ray would be would be that would be the first thing and if that doesn't seem it looks completely normal and you know we're still struggling with with dealing with this cough we think of other things and one thing we think of is what used to be called cough variant asthma okay because I don't know 30 years ago someone published a series of patients who came in with cough and they all had wheezing and it turned out it was something related to asthma what we call reactive Airways disease and the cop was helped by inhalers most of the patients who come to see me with cough have already been put on an inhaler 'he's the thing is i almost never see a cougher who also is squeezing and so I'm not sure that that's really a very common explanation nevertheless we try everything in in these these patients but if I really suspect something like that then I would order breathing test pulmonary function tests and I might do that enough to say 25% of the COFF patients that I see okay and generally it would be the younger patients all right where I suspect allergy not so much in in in in in you know older older patients and then you know if we see suspicious things on a chest x-ray then we might advance to a CT scan of the chest you know which gives us much better definition particularly in terms of lung cancer or or this entity with a very long name bronchiectasis and some of you may have heard the term but before I get into that I think it's important to really give you a good concept or idea of what we mean by bronchitis okay because it's it's a term that's used very loosely by people bronchitis is not really a disease bronchitis is the symptom bronchitis means you've got to cough in either you're bringing up flam or sputum mucus or you feel it's down there and you can't get it out okay that's what bronchitis is as distinguished from in from pneumonia where we see something on the chest x-ray as well if it's just bronchitis the chest x-ray should look normal okay and then we speak of chronic bronchitis acute bronchitis you know acute bronchitis usually infection chronic bronchitis could be related to smoking it could be related to allergies or other things that's what bronchitis is yes ma'am of cough and either you're coughing up something some mucus or you feel it's down there and you can't get it out and it's primarily the COFF it's the symptom it's it's a symptom it's not really a disease okay it's caused by disease it could be caused by infection it could be caused by a allergy but just the term bronchitis doesn't really in turn itself tell us you know what what's what's wrong but just to return to this funny term bronchiectasis okay kind of a fascinating term it comes from Greek words meaning the bronchi are open bronchi are open and what that means is if you look at the Airways in the lung you have the trachea and it divides like this and then it divides again and then it divides again and and and the bronchi get you know smaller and smaller and they taper nice and smoothly people who have bronchiectasis instead of tapering nicely and smoothly their bronchi kind of look like like that they're sort of expanded and when I was in medical Anaya's in training is a pulmonologist the teaching was that patients with bronchiectasis and by the way the only way we can discover it is by doing a CT scan on the patient that's the only way to really show it the the teaching was oh these are patients who were born before we had antibiotics so they grew up with these infections as kids and didn't get treated and that led to bronchiectasis well that was the teaching but that's gone by the boards because nowadays our CT scans are so good that we see this in people who weren't that old you know who did get antibiotics as children and and we don't have a good explanation why some people develop bronchiectasis and most people don't and the reason why it's kind of interesting from a pulmonologist standpoint is we see it primarily in women usually in their 50s or 60s and it tends to be associated with a certain kind of chronic infection that can explain cough and that and I'm only gonna do this briefly I'm gonna give you the whole name we call an EM avium because it's a germ that sometimes is seen in in birds it's in the same family as tuberculosis but it's not like tuberculosis it's not contagious or anything like that and it can be extremely very mild just cause chronic cough okay so I might worry about that in a middle-aged woman who's had this cough on and off for many years now when it's severe these patients caught up a lot of mucus but they might not cough up any they might not have it ready so that's what we mean by bronchiectasis okay so so we've talked about some of the causes and what doctors need to do you know to try and figure out what might be causing the cough okay having said that if we're sure it's not lung cancer it's not an acute infection it's not bronchiectasis it's not an allergy you know what is it well there are a lot of studies and particularly the group of pulmonologists in Chicago oh boy must be almost 40 years ago sort of wrote the definitive paper on coffin what they found and it's everyone's experience that there are three important causes of what we call persistent cough persistent meaning going more than a month okay the most important one is post nasal drip okay second most important one is acid reflux the third most important one and is kind of way down the list is what I refer to a few minutes ago as coughed Varian asthma where the patients have some inflammation of their Airways that sort of mimics asthma okay that's like what happens in asthmatic s-- those are the three most most most common things and unfortunately we don't have a good test for post nasal drip and for acid reflux sure we can do endoscopy but you know there's no point in that and again the the coffee Aryan asthma is not that common and we have pulmonary function tests that can tell us whether that whether that's the case or not so we end up just giving patients medicines that we think will address that issue all right give them something for post nasal drip give them something for acid reflux so let me talk about you know some of these some of these medicines okay let's let's talk about post nasal drip now people will say well gee I don't have stuffy nose I'm not blowing my nose how can I have post nasal drip well you still can because it's all in the back all right and and and in the fluid that those cells put out has histamine in it and the histamine drips down and that's what causes the cop receptors to reflux and cause the cough okay so what can we do what can we do for that well you can try and histamines you know sir tech claritin you know all of those medicines what I like to try and I'm not going to say it works a hundred percent of the time is a nasal spray that has an antihistamine in it it's called ASA lasting or estulin you know a tester pro but what yeah the generic is a ze l a s TI and TI any okay however most of the patients that come to see me are already on something else for the nose and that's usually flonase you know flonase yeah flonase is an anti-inflammatory steroid okay and the theory there is these cells are putting out the fluid because they're inflamed so an anti-inflammatory steroid will calm down the inflammation and will stop them the unfortunate thing is I've seen countless patients that have been on flonase for years and they still have their coffee okay so I would always add this one and said well you can continue this you know use use both of them okay there is yet another spray for for post nasal drip and the brand name there is at prevent now after vent is also an inhaler but they do make a nasal preparation - that has the that's a fancy anti muscarinic agent and that also has the effect of decreasing the fluid and counteracting the the histamine so that's you know that's that's nasal sprays now and I'm thinking of a young lady that I that I saw that this morning though sometimes if none of these work but you think that's really the problem you can suggest a decongestant okay sudafed for example or any of the combinations claritin-d D is the decongestant Allegra D and now the only problem with decongestants is if you have high blood pressure they can they can elevate your pressure so someone who's being treated for a high blood pressure I wouldn't I wouldn't recommend them but sometimes you know it helps particularly someone who does feel plugged up plugged up here okay so that's post nasal drip when you talk about acid reflux I'm sure you're all familiar with prevacid prilosec protonix you know all these different all these different types though those are about what we call the P P is the proton pump inhibitors and they're the more modern ways to treat s3s with acid in the stomach and and acid reflux and even if you're not feeling heartburn you can still have acid reflux because causing cop because this receptors for copper way at the bottom of the esophagus alright so you may not not notice the symptom sometimes if I really think that's the problem and the patient's been on something like prilosec or prevacid i might add ranitidine we're zantac well it's usually like 150 twice a day you know something like that Ranade tea is not a proton pump inhibitor it's it's it's it's it's what we call a histamine to blocker and so maybe the you know that okay histamine is a chemical okay we all have it in our bodies okay and it causes a variety of symptoms that's what causes us to itch when we have a sore it it's it's involved in in in COFF as i've said it's it's kind of an irritant it just you know makes us react to things histamine so I mean it evolutionarily it must have something good for us you know why we evolved to have it but we normally think of it only in the negative side that it causes unpleasant symptoms itchiness sneezing coughing all of those things so like when you get those like a fever runny nose death system right histamine is one of the things that allergies cause allergies cause other chemicals to be released too which may also be involved in cough I'm not going to go into all I'm not going to bore you with immunology but but histamine is usually usually the main problem in in various things that irritate us you know well I mean it stimulates an inflammatory reaction would which may in some senses be related to healing be related to healing but you know there's so many antihistamines on the market it's it's generally we think of it as a bad actor you know okay so that's acid reflux okay then if we think well maybe maybe this isn't really caught very in asthma but maybe there's some inflammation down in the airways that's kind of lowering the threshold for triggering calm that's why so many of these patients get put on inhalers okay same things that we use in asthma same things we use in COPD chronic obstructive pulmonary disease and the idea is both to open up the airways and to decrease inflammation in the air and I don't know whether any of you have been on them we have albuterol is a very common bronchodilator if I wanted to use therapy like that though I would generally give patients one of the long-acting agents there's advair symbicort do Lera Brio I don't know if you're familiar with it with any of those their combos where they have both what we call a bronchodilator that opens up the airways and an anti-inflammatory steroid which decreases you know in inflammation in the lungs okay so those are you know various things that we use to try and address the potential causes of cough post nasal drip acid reflux reactive Airways in the lung but if none of these things work and if we're sure that we're not dealing with lung cancer or serious infection although I let me say parenthetically obviously someone who comes in to me and they've only had the COFF for a couple of days or a week and I'm suspecting an infection I have to decide what is this a virus or is it a bacterium do they need antibiotics or not and I assure you I'm sure you read in the press we doctors are accused of using antibiotics too often all right if I know someone has some kind of underlying lung disease though then I would have a lower threshold for using you know an antibiotic okay and most of the patients that I see with cough have already gotten antibiotics from their primary Doc's so it's not even a decision that I make bacteria you're just for that well I mean you can do throat cultures you can do throw cultures for that okay I mean if if there's no fever though you know I would generally think no it's more like after all viruses are far more common than bacterial infections okay so the odds are it is virus okay particularly if it's the flu season although I'm sure you've had this experience this particular flu season has been extremely severe and a lot of people get secondary pneumonias after getting the bad flu and one friend of ours an elderly lady died of pneumonia that she got after after the flu so it's potentially that but if we've tried all these different things and they don't seem to be working and describing the patient nuts and it's keeping them awake at night we begin to talk about cough suppressants okay oh I almost forgot well yeah I'll come back to that in a minute what I forgot okay so cough suppressants how do we suppress cough okay well you're going to see a lot of a lot of products on the shelf which purport to be caught suppressants okay mucinex robitussin [Music] Delsin a lot of them have in them what's called guaifenesin - Essen is a chemical which is actually an expectorant it's an expectorant robitussin is an expectorant okay mucinex is an expectorant well some people want that because they're having trouble getting the mucus out but it's not an effective suppressant for the cough that's why the companies combined combined it with a coughs present so you have robitussin dm who have mucinex DM ok DM is dextromethorphan which is a cough suppressant it's not a narcotic but it works like a narcotic in fact I think you can even get it just ISIL I'm not sure with what the trademark is well not that per se but but but I'll address that question in in in in the next minute or so you know you would wonder well gee why combine an expectorant with a suppressant that they seemed but it works for some people you know but at any rate my favorite particularly especially for patients who are kept awake at night is phenergan with Cody now phenergan is as an antihistamine okay and nana histamines yes make you sleepy okay but that's what you want at night okay so phenergan with with codeine of course codeine is a narcotic okay and a lot of people say they're allergic to codeine when what they probably meant was it caused severe constipation you know that's that's not really an allergy what I would prefer to give these people is the combination of phenergan and dextromethorphan because that's not a narcotic the only problem is the pharmacies can't get it anymore you know yeah so I don't know I that the company isn't making it or they're just not supplying it to the pharmacist pharmacies I have been able to get it for patients in a long quiet long while phenergan with dextromethorphan well yeah I mean potentially maybe in Europe you can get it you know I I don't know the exact reason why why it doesn't seem to be available and sometimes the phenergan with codeine they will have to order it for you they don't they don't always stock it they probably do the only other problem actually with phenergan with codeine is it's a street drug that's a street drug and and so you know with with my patients you know I have to worry make sure they're not diverting some of the medicine to someone else particularly when they're asking it again and again and again and again because it has become a street drug that kind of kind of covers covers the base you know I the disclaimer is most coughs are not caused by serious problem you know like lung cancer or serious an infection but the things that cause them seem to be very difficult to treat you know the sound that happens before you get it [Music] okay okay rails you know it's from the French and French a means rattle means rattle okay it means rattle and we used to use the term a lot it it's not medically speaking not not a approved term because what it really refers to when we listen to the lungs are what are better described as crackles crackles yeah now what you're talking about is maybe better described as a wheeze okay you know that's more a wheeze yeah I mean it's certainly not a crackle okay and what wheezes me well they're obviously very characteristic in asthma because of the tightening of the of the air tubes in the rushing of the air it causes a noise but just a lot of mucus in the lung can also result in a sound of wheezing okay what you're describing you know and someone on their deathbed I can't address that what you're describing though might represent mucus high up in the airways like in the throat yes ma'am it's not a narcotic and then it's suppresses thing suppresses cough in fact when it's been rigorously studied it's it's said to be just as good as codeine okay and the point is you don't need a prescription for not really no no I mean you might get habituated to it not never but not strictly addicted to it Oh glad you mention it what's your question right okay thank you very much for reminding me about that yes you know any of us who who choked if you choke on something as you're eating you know we immediately start to cough okay but unfortunately as we get older and up into our 80s and and and and 90s our swallowing mechanisms aren't quite as well coordinated as they were in younger years and so we might be aspirating small amounts of fluid particularly when we're asleep at night okay which might cause us to cough in in the morning and I certainly ask patients whether they have any difficulty swallowing whether they ever ever choke on food if I suspect that as you say I would order a swallow study and I probably do that and maybe 5% of the cop patients that I that I would see and that's that's done by a speech pathologist you know you swallow barium that they can see with fluoroscopy and they can see whether any any of it spills into your into your lungs instead of going down in your stomach did you have another question about that yes if you if one was able to swallow like a vitamin pill okay in the past but now he has to chew it up okay well that doesn't mean your aspirating your - yeah but you are having difficulty swallowing place yeah well you you could do the test but like in any test in medicine you have to asked what are we going to do with the result let's say your aspirating a little bit do you want to have a feeding tool put in well if it's severe in the back sir when she's eating make sure she's sitting up all right right sometimes as people get older they can't chew you know chunks of meat can't chew chunks of beef but she didn't like the soupy food she got well I know pureed Diane yeah yes in the back relax [Music] [Music] so you having trouble breathing or you talking about cough and your inhalers used to work but they don't work now well that's like flonase yeah Nasonex right yeah well that helps now I'm not sure the quote it sounds like post nasal drip and how that would be related to an industrial accident I'm not sure but [Music] ma'am you had a question I just well sure any of us if we inhale a lot of dust is gonna make us coffee sir and and some people some of us are more sensitive to that than others okay I mean you know I I I notice it when I'm you know trimming bushes or something you know and the bushes collect dust and you know if I don't wear a mask or something like that yeah makes me cough so do you think that if you do develop a pump it might have something to do with you system rarely I mean rarely I would say that that's not usually although well let me enjoy talking analogy but there we have various antibodies in our body and one of them is called IgA we have IgA in our throat and IgA in our throat combats viruses in other pathogens that get into our throat I don't know what percent probably less less certainly that's in five percent of the population have a deficiency of IgA so those people will more frequently have more frequent colds more frequent cough but I can tell you in the few times in my career that I measured that in a patient they've always been normal I've never seen I think I saw one patient who really had an IgA deficiency that's the to answer your question I think that's the only immune system problem that would relate to cough and that would be a lifetime thing you know you would be born with that with that deficiency ma'am did you have and voluntary gasping huh hate to say anxiety that can be I think you know certainly inhaling some irritant yeah you're going to you know gas them well kind of you know in in between I mean I'll call me you can say all coughing part is voluntary because you know if you go like this you can keep from coughing you know you don't feel very good you don't feel very good well anxiety is always at the bottom of my diagnostic list I want to make sure it's nothing else ma'am okay COPD chronic obstructive pulmonary disease and you can eat medicine it can be a lump or a splitter you can say well someone with asthma who needs medicine every day it's chronic its obstructive and it's pulmonary isn't that COPD but if you're a splitter you say no COPD should be reserved to the people whose disease is because they smoked okay all right most asthmatics are not able to smoke they can't it's to irritate and that they can't pick up the thing so I think of COPD primarily in the patients who have smoked for a long period of time and there are kind of two divisions in COPD although they overlap a lot they're the patients that the British like to call the pink puffers those are patients with a lot of emphysema and know you know and they're there huffing and puffing all the time the others are what the British called blue bloaters there are the ones with chronic bronchitis who are coughing up a lot of mucus all the time now most people with smoking related disease may have some of both they may have some of both to kind of try to address your question emphysema in and of itself causes shortness of breath but it doesn't cause cough okay chronic bronchitis where your your lungs have kind of hyperactive mucus glands because they've been irritated because of the smoking and produce a lot of mucus yeah that's going to cause a productive cough but not necessarily low oxygen or difficulty breathing waiter who hasn't had a chance yet regarding distance do they have any reason to cut and if they do are there foods that raise the level you're going to get blood tests say they showed a higher low well you can't really do a blood level because we're what we're talking about is the histamine that's out in the cells not not with what's in the blood offhand you know I I'm wondering I the only hat I can't give a definitive answer the only thing I can say is the way we all react to onions makes me think maybe they're causing the release of some histamine if you have and you can't bring up what there is but you want to be should happen which of these things is it better to take an expectorant that brings it up or suppressing an expectorant I would say it explains one expected to three to bring it up correct and right and you also had to make sure you're well hydrated that you get plenty of fluids to get plenty of fluids yeah now you know again people with bronchiectasis who have the severe form and are bringing up all this up you know they need you know they need a sort of therapy where you pound on their chests and to help them you know get it out but that that relates only to very severe to very severe cases if I start laughing I can't I can't so hard it's like go into as well that's not rare oh I've heard that a lot are there yeah well I think I had I'd be I'd be concerned and not worries I think you know I'd want to know more about your Airways and in your breathing to know whether there might be an appropriate inhaler that would help that would help that well it's interesting most of the lung cancers we end up seeing are in patients who really have no symptoms but someone did it for whatever reason did a chest x-ray and saw something suspicious now we screen long we're trying to screen longtime smokers with CT scans that's been shown to improve treatment and and longevity by screening people who are at high risk for lung cancer with with CT scans but it's interesting generally unless the cancer is very large and is blocking some part of the lung it doesn't cause a lot of symptoms okay and we see a lot of lung cancers that are just like spots in the lung and they don't cause any symptoms any symptoms at all I mean I've seen in the last month at least three patients with it with with those kind of cancers who really don't have any symptoms relating to it okay so we have to think who's at risk and unfortunately even non-smokers can get lung cancer okay right right do you for those well then we work them up if if the cancer is just limited to where we see it then they go to surgery if it's already spread to other parts of their body they have to be seen about chemotherapy sometimes radiation it has to be it has to be staged we have to know how extensive the spread of the of the cancer is right you mean if you've already had one yeah well it's hard to think how anyone would go through all their life and never need a chest x-ray right okay but it it could happen you know I think any relative of mine I would think by the time they were 70 I would like to have seen at least one chest x-ray done during their life because you know even non-smokers can get can get lung cancer but if you haven't been a smoker you're probably probably right it's not necessary however if you came to me and you you had a cough that wasn't going away I would certainly get another chest x-ray so are you saying like for a routine chest x-ray yeah routine well they say I rented some places if they find cancer you'll probably die and they still get ya that's funny cuz that came up with an elderly lady that I saw today 86 year old lady who smoked until last year and and and she thought she no longer was at risk for lung cancer there were already two people in her family who died of lung cancer well we when I was in training the teaching was that after 10 years your risk for lung cancer is back to the general risk but we know now that that's not true that for the rest of your life you will have elevated risk my own dad was the heavy smoker until mid 50s he died of lung cancer at 88 Oh [Music] we're actually only about six months and the way it turned up he was shorter breath and his cancer caused a large amount of fluid in the lung and that's why he was symptomatic I mean then and he was 88 the docs you know you didn't want to expose him to any harsh treatment you could but if it's it's malignant and if you don't put the patient on chemotherapy it's just gonna come right back yeah and in the hospital they make us do mask fitting they got to make sure that we use a mask that fits right on our face you know the last my thing is like the so you then you're short of breath with it correct and so I have noticed that last time I had it which is a couple of Mexico Turkey messed up the copying it's wearing me out like I feel like I'm ready to do it so that's just age no I that kind of coffee would be tiring for anyone you know I you know I would if you have you been given any kind of a cough suppressant nice the next DM didn't help you the last time she recommended major shakeups oh okay yeah thanks for reminding you that that was one one medicine that I should have mentioned the tehsil on pearls so called Ben's own to take their little gelatin capsules that's why they call them pearls you don't chew them you swallow them and they don't make you sleepy but they don't work very well you know and and if I'm going to prescribe it I always prescribe the higher dose see that there's the 100's and the 200 I don't waste my time with the 100's they work for some people okay so you know if you're coughing at work you don't want something that's going to sedate you at work alright so that's something you can try that that won't sedate you and hopefully use them three times a day yeah I know that you're right it's not it's not available genera yes thank you [Applause] [Music] you

Channel: UCLA Health

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Keywords: WISE & Healthy Aging Center, Santa Monica, coughing, gerard w frank, how can I treat my cough, what's the best treatment for coughing, coughing tantrum, ucla health, pulmonology

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Length: 57min 13sec (3433 seconds)

Published: Mon Jun 11 2018