By Victor S. Sierpina

Still coughing? A few days ago I was swapping home remedies with a lively Italian grandmother on how coughs were treated in our families. Her favorite was a mix of honey, lemon juice and a splash of bourbon. During a recent hospitalization for a bronchial infection, her cough was unremitting so she asked the nurses for her favorite cough syrup. Our professional and patient-centered nurses agreed to bring the honey and the lemon juice. The rest of the recipe would be fine if someone brought it in and they just didn’t know about it. Wink, wink!

Well, she was in the office a couple weeks later and though a powerful opiate laced cough syrup helped, she still was up at night and fatigued from a persistent cough. I recommended the lemon-honey-whiskey mixture at bedtime along with an expectorant and an inhaler. We got along well, I think, and I expect she and her cough will improve.

Keep in mind that the cause of chronic cough is most commonly one of three things: post nasal drainage, asthma, and gastroesophageal reflux. Treatments for chronic cough from these common conditions are straightforward though not necessarily intuitive: nasal saline washes, prescription sprays and antihistamines for post nasal drainage; steroid and other inhalers for asthma; antacids for reflux induced cough.

A chronic cough may need further evaluation by your physician, especially if accompanied by other signs and symptoms such as weight loss, night sweats, bloody sputum or worsening shortness of breath. Lung infections such as tuberculosis, chronic obstructive lung disease, especially in smokers, cancer, heart failure and other serious conditions can cause a cough that doesn’t go away. If in doubt, check it out.

A chest x-ray, CT scan, skin test, pulmonary function or heart evaluation and some simple blood tests can usually sort out serious sources of cough from more minor but aggravating causes. ACE inhibitors like lisinopril are commonly used heart and blood pressure medicines and should always be considered as a cause of chronic cough, even if you have taken them for some time. Another cause of persistent cough is pertussis, or whooping cough, which is making its rounds lately due to lapses in immunizations. Such a cough can last for weeks after exposure to the initial infection.

Most of the time, a cough is nothing to worry about. You might have a dry, hard, tickly cough or a wet, juicy, rattly cough that brings up phlegm. Especially at this time of year, such coughs are most commonly due to a passing flu or other viral respiratory infection.

If you have a cough that doesn’t go away, here are some common home remedies and integrative approaches to try:

1. Let the shower run for 10-20 minutes and sit in the steamy bathroom.
2. Consider inhaling some aromatic herbs like eucalyptus, peppermint, tea tree or thyme oils in a bath.
3. Use an expectorant to thin mucus and help your body clear it. Examples are commonly available over the counter products such as guaifenesin (Mucinex™), licorice, mullein and wild cherry bark. Other herbal mixtures including pleurisy root, horehound, plantain and marshmallow are available at your health food store and may be useful.
4. Cough drops with menthol, licorice, horehound and other herbs that calm the tickle and reduce the cough reflex. Ricola and Hall’s are reliable brands.
5. Hot soups with chicken, barley and spicy herbs like garlic, onions and ginger can help mend both mind and body.
6. Avoid mucus-producing foods like those with high sugar or fat content and other refined, processed foods.
7. Drink lots of water to thin mucus.
8. Vitamin C, Echinacea, zinc and N-acetyl cysteine can boost immunity and thin phlegm according to some studies.
9. Avoid cough suppressants during the day so you can clear phlegm but save these for nighttime use so you can get some needed rest.
10. Try deep, slow, diaphragmatic “soft belly” breathing to enhance lung expansion and to help quiet annoying reflex coughing.

By the way, if you are a smoker, give it up for your own sake and that of your family. Smoking and secondhand smoke are common causes of chronic cough. Finally, if a cough persists, be sure to be evaluated for allergies. Allergies to mold, dust, ragweed and other inhalants are a very common cause for chronic cough and postnasal drainage.

And don’t forget the grandmother’s recipe of honey and lemon juice, with or without the bourbon.