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Chapter 1: What is the main topic discussed in this episode?
ABC Listen, podcasts, radio, news, music and more. Yuck. I wish she'd muted your mic before you did that. Are you feeling a little under the weather, Norman?
No, I just, you know, it's a bit like the yawning episode. Why do when you start yawning do other people yawn? Why do when you start coughing do other people cough? But that's actually not what we're going to be talking about today.
The reason you start coughing when other people cough is because they've coughed their germs on you and you catch the virus they have. And I'm really glad that I'm a thousand kilometres away from you as we have this chat.
I'm still coughing. Am I infectious? Is the topic of this week's What's That Rash?
It's the show where we answer the health questions everyone is asking. And today's question comes from Jive. Jive says, "'Coughs lasting weeks after a respiratory virus have always been annoying, but since COVID, going to work with a residual cough feels inappropriate, but also unreasonable to expect people to stay home for a month plus.'"
Jive's asking, "'How can we know for sure whether our residual cough is not infectious to others, and when is it okay to go to work?' So let's talk about coughing. What is coughing?
So a cough is... I'm going to explain the bleeding obvious here. It's a forcible expulsion of air. And the main purpose is thought to be to enhance the body's own mechanisms for getting rid of irritants and mucus out of your airways. So you have...
In your respiratory tract, you have little cilia and mucus production, which then waft upwards to your throat and brings all the crap that you're breathing in and slowly brings it to your throat and then you swallow it. In other words, you get rid of the stuff in your lungs. It's a cleaning mechanism.
Sorry, it wafts it up out of your airways and then you yuck. Yuck. Human bodies are disgusting.
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Chapter 2: What does a cough mean in terms of infectiousness?
You can have acid reflux, where the acid goes into the lungs and irritates the lungs. You can have a post-nasal drip from the back of your throat. And you can also be drug-induced. So a common anti-blood pressure drug or family of drugs are called ACE inhibitors.
And about 40% of people on ACE inhibitors develop a cough, which is presumably a central effect on your brain, producing a cough in your respiratory tract.
Yeah, it makes sense that you're trying to cough something up and we can wallow in the disgustingness of that as much as we like.
Wallow is the word because sometimes you wallow because it's really fruity and sometimes it's dry.
But this is it.
We should have put a health warning on this.
We really should have.
Content warning. Stop eating, yeah.
It's so disgusting. But again, bodies, man. But I'm thinking about Jive's question and how long a cough sometimes hangs around for me after I've been sick or if I'm a bit run down and my throat's a bit scratchy because I've been, I don't know, yelling too much or something because I've been out having too much fun. I often find that I have a cough that isn't bringing anything up.
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Chapter 3: How does coughing help the body?
And you're trying to figure out when it's the disgusting spluttering cough that is spraying viruses all over your co-workers in your office, or when it's that irritation of your throat that you just can't seem to get over. But Otherwise, you kind of feel fine.
Yeah. And I think different viruses have or different bacteria have different durations of cough. So, for example, if you have had a bit of pertussis or an episode of the whooping cough, that can go on for a long time.
They call it a hundred days cough, don't they? That's one of the names for it.
If you've got asthma already and you have a viral infection, you can get post-viral bronchitis, which lasts for quite some time. So different viruses cause a different level of irritation, and it also depends on your propensity to getting bronchitis as well. And it doesn't necessarily mean that you're infectious.
It's interesting that you mentioned bronchitis, so inflammation of the bronchia. Is that what you're talking about? And I know sometimes when a cough has hung around for a long time and when you are coughing, especially at night and it keeps you up and you can't sleep, even if you've only been coughing for a week or so, it feels like a lifetime and you'll do almost anything to make it stop.
There was a study that looked at patients' expectations around how long their cough should last and people basically seeking out antibiotics for a cough, which we know if the reason for your cough is viral and you don't have a bacterial infection, then antibiotics are at best useless and at worst potentially contributing to antimicrobial resistance.
So a cough after a viral infection is normal and it's normal to last a week or so and not unusual to last three weeks or so. The question really comes down to whether or not you're infectious.
Well, the irony of this is that you can be infectious before you start coughing. In fact, we know with a lot of respiratory diseases, you're most infectious right before or right at the very beginning of having symptoms.
COVID being a classic example.
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Chapter 4: What are the common causes of coughing?
For people with chronic cough or cough at night, sometimes the GP will wonder whether or not you've actually got asthma. And treating you for asthma might help you, particularly if that's the only time you're getting a cough, is at night or first thing in the morning. So anti-asthma medications might help you, but cough and cold medications, leave them on the shelf.
Well, I did actually go back and find some old-timey cough and cold remedies. Can I share a few of them with you? Absolutely. I'm going to lead with my ace here. One that I really loved is the medication delivery system is a cigarette.
Oh, because it clears your... It gets it right into your lungs.
And so basically, literally, these cigarettes that... It contained a herb called cubebs. I've never heard of it. It was meant to help loosen mucus. But yeah, the way that you got it into your lungs was by smoking it, which I can only...
Well, my dear old grandfather, who was a 40-cigarette-a-day smoker and had chronic bronchitis as a result, when he got up in the morning, he had to have a cigarette so he could cough up the phlegm. Oh, God. First thing in the morning.
Yuck. Oh, charming. There's also ones that contained belladonna, which was what women used to kill their husbands with, if my history is not mistaken. And something called stramonium.
So belladonna is not mad stuff because it can dry up secretions.
Yeah, like secretions of your blood flowing through your body.
Yeah. So the mild versions of that are contained in cold tablets, not belladonna itself. But that's the idea is it dries up secretions. But, you know, these secretions and the cough mechanism is part of the healing process from your virus and you don't want to inhibit it.
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Chapter 5: How long can a cough last after a respiratory infection?
So if you find yourself having to clean your computer screen more often, it's probably a sign that you should close the lid and go to your bed.
Yeah.
Go have a nap. So what's our bottom line for Jive, who's obviously looking for a bit of guidance on when to go back to the office, maybe when to advise their colleagues to come back if they're still coughing?
For most common colds, you're not infectious after, say, let's say three days. If it's COVID, it's longer than that. And it's hard to generalise. But if you're still feeling sick, stay at home.
Well, Jive, I hope that has provided you some guidance. Feel free to distribute this far and wide in your office and beyond. And if you have a question you want to ask us, our email address is thatrash at abc.net.au.
And what's a no-meal bank?
So a couple of people emailing us about Hantavirus, our Hantacast episode that we did as a bonus drop a little while ago. Richard said, your Hantavirus episode made me think about what exactly is meant by common probability words. You said that the chance of a Hantavirus pandemic was low, but what does this mean?
I would have said that low normally means one in 10, but in this case, I suspect it's closer to one in a million. Richard continues, similarly, if a health outcome is possible, probable, likely, I suspect that different people hear different percentages. I'd welcome your thoughts on the definition of low when it comes to the chances of lots of people catching hantavirus.
So that's a different question from pandemic. So pandemic is an infection that's spreading on every continent on earth. So it's got a global context. And in fact, there was an influenza pandemic in 2009, which was a pandemic because it was in every continent. And lots of people did get infected, many, many thousands, but it wasn't a massive disastrous pandemic that people were predicting. Yeah.
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