Hack, hack: What's with that awful cough?

I have never seen the opera La Boheme, but I hear the diva dies of tuberculosis. Does Mimi sing her final aria with coughing between high C's: "La, la... cough, cough, laaaaaa-phlegm, laaaaaa, hack"?

I don't think Puccini would have written his opera that way. It would sound more like the Guys & Dolls song "Adelaide's Lament." I often get the question, "Should I be coughing up the infection or suppressing it?"

People cough for different reasons. If you suck in a foreign object, like a piece of lint from grandma's wool sweater, you need to cough up the lint, like Speed Racer's Ejection Seat.

If you choke on your own saliva, food, or drink, you naturally will cough it up. Unfortunately, in people with neurological deficits who can't gag or cough well– such as after a stroke– an aspiration pneumonia can develop. An aspiration pneumonia is not a lung disease that you aspire to achieve, like the Nobel Prize or MTV Video Award. It means you cannot cough up bacteria in the saliva that causes a bad pneumonia.

If you have pneumonia, your lungs will mobilize sputum and pus up your airways and into your mouth. It's the way your lungs vomit, so to speak. When you have pneumonia, you want to clear out the junk to make room for oxygen and carbon dioxide to exchange freely.

However, if you start coughing like Bette Davis after her 100th cigarette for the day, then problems can arise like shortness of breath, pain in the chest and throat, bloodshot eyes, vomiting, incontinence, and... more coughing. Coughing can cause more coughing because the lungs and respiratory muscles spasm worse than Vanilla Ice dancing.

For those with COPD (chronic obstructive pulmonary disease: emphysema and chronic bronchitis) and asthma, coughing can be as much fun as scuba diving without the oxygen tank. Though it's important to clear the lungs of the crud, constant coughing doesn't allow a person to breathe well. Albuterol, ipratroprium, mucolytics, cough suppressants, and sometimes steroids in addition to antibiotics are usually very helpful in these cases.

In the hospital, respiratory therapists actually do pulmonary toilet maneuvers, not with Tidy Bowl, but with percussion, positioning, and other modalities to get the junk out of the lungs. Sometimes a huge mucus plug will come flying out like a cannonball, and oxygen levels rise dramatically in the ailing patient. (Cirque du Soleil should consider doing an act like this– okay, not.)

Coughing up blood is usually due to bronchitis, but if accompanied by fever, weight loss, and night sweats, it could be TB (tuberculosis). TB is no laughing matter because it's on the rise, and some TB strains are resistant to practically every antibiotic. It can be deadly, and it's contagious. The old name for it was "consumption," and it killed lots of famous people, like John Keats and James Monroe of Ash Lawn-Highland fame.

Anyone can end up coughing weeks to a month after recovering from a chest cold or pneumonia. This type of coughing isn't helpful. The coughing is from irritation of the airways from the infection, so the airways kind of feels like Norma Rae covered in textile dust. And the more you cough, the more you cough. This is when you act like Susan Powter and say, "Stop the insanity er, coughing!" Plus, if you're sitting at the symphony or at a play and coughing like a hyena, people are going to start throwing inhalers at you.

Most people take over-the-counter Robitussin and cough drops to stop coughing. I'm considering opening a Cough-ee shop with non-fat choka as the medicine/drink of the day.