I want to stop coughing, damnit!

December 19, 2009 3:16 PM

A few years back I was diagnosed with pneumonia after being sick on and off for about three weeks. When I was finally diagnosed I seem to recall that they gave me antibiotics and a codeine based cough syrup. This combo worked like a wonder. The codeine knocked out my cough and let me sleep, and the antibiotics killed the pneumonia. At least that's how I remember it.

Fast forward to today. After being sick all week I visited the local acute care facility (man, if I had only made my regular doctor's sick call yesterday!) and was diagnosed with pneumonia. OK, no big shock, I'm just glad to know what it is and how we're going to attack it, EXCEPT: the doctor refused to prescribe me any codeine (he did prescribe Levaquin, and Albuterol with an inhaler, which I'm somewhat dubious about). He claimed that I had to cough up the stuff in my lungs, and that suppressing my cough would be a bad idea.

I'm shocked at this, given my past experience. Am I remembering this wrong? Or is this guy full of baloney and I should contact my regular doc asap.

posted by Reverend John to Health & Fitness (14 answers total)

Best answer: It depends on if your cough is productive or not. If you are coughing, but not bringing up anything, and its preventing sleep, then a cough suppressor such as codeine is used. If you are coughing up fluid, then you have a productive cough, and need to continue to bring up whatever you can.

At least, that is how I've always had it explained to me.
posted by strixus at 3:22 PM on December 19, 2009 [1 favorite]

I have to say that, in my experience and in my daughter's experience, the albuterol inhaler works really well. I've only ever had an expectorant (as opposed to a suppressant) when I've had pneumonia.

It's certainly worth a call to your regular doc, if for no other reason than to keep him/her apprised of your situation.
posted by cooker girl at 3:32 PM on December 19, 2009

As strixus says, it depends on whether or not your cough is productive.

If it is productive, then suppressing it leaves all that fluid still in your lungs. This is bad. The fluid in your lungs can actually result in portions of your lungs permanently shutting down as they essentially "drown". What you want in this situation is not a cough suppressant, but an expectorant.
posted by Netzapper at 3:35 PM on December 19, 2009

Best answer: The idea here is to reduce the severity of your symptoms without extending the length of your illness, or adding extensive side effects.

Do you currently have a productive cough? If so, suppressing it is a bad idea. (Well, unless you want your pneumonia to hang on even longer -- pneumonia is, by definition, fluid in the lungs.) You want to get the fluid out of your lungs. A productive cough is the most efficient way of doing that.

If you are coughing only because of lung inflammation, the Albuterol inhaler will deal with the inflammation without the system depressing effects of codeine. If the coughing is keeping you awake even after the Albuterol, then a codiene cough syrup might be a good idea. As a bonus to a healing system, the inhaler will not interfere with a productive cough.
posted by jlkr at 3:45 PM on December 19, 2009

As a data point, when I had pneumonia I was encouraged numerous times to hack up everything in my lungs. I was never given codeine or anything like it.
posted by iconomy at 3:49 PM on December 19, 2009

Best answer: I've had pneumonia 13 times (and Legionnaire's Disease once). My most serious and memorable bout with pneumonia was my very first. I constantly coughed and coughed and coughed until my ribs were so sore I was sure I was having a heart attack. I still lived at home at the time and I well remember having to try to sleep sitting up in a chair in the living room, because laying down in a prone position just activated more coughing fits. I remember my Dad telling me "you don't have pneumonia, I've had pneumonia and it was like this..." and he'd describe in gross detail the yech he'd coughed up. One week after my initial diagnosis (and having taken the antibiotics as prescribed) I wasn't getting any better and went to the ER in the middle of the night. The doctor on duty confirmed my pneumonia diagnosis, but also gave me an Rx for coedine cough syrup. The stuff tasted worse than butt, but I got my first few hours' sleep after taking a spoonful. I think getting some actual sleep must have assisted the healing process, because over the next few days I got progressively better.

Oddly enough, my subsequent bouts of pneumonia have been very different from that first. Every time since then, I've had a very moist, raspy cough and was sort of bringing up mucous/phlegm if I coughed hard enough. It still made my chest ache from the constant coughing, but I had a definite "wet" cough/voice (sounded like a smoker's cough, but I wasn't a smoker). The seond time I was dx'd with pneumonia the doctor prescribed Triaminic expectorant pills (which was not yet an over-the-counter med) along with the antibiotic, and no cough syrup. When I had Legionnaire's Disease I had very serious chest congestion and could actually hear myself wheeze when I inhaled, but still I was not given my much longed-for coedine cough syrup, but rather a strong expectorant instead.
posted by Oriole Adams at 4:00 PM on December 19, 2009

Best answer: Seconding other people's discussion of productive v nonproductive coughs. I am just a medical student, but briefly looking at prescribing guidelines indicates that codeine should not be used in a situation where retention of fluid is possible, eg a productive pneumonia cough. So if you're not bringing anything up (as maybe was the case in your previous diagnosis), then the syrup should be okay - otherwise, it's not the best idea to use any antitussive.
posted by shokod at 4:44 PM on December 19, 2009

I think that in any given case, the doc has to weigh the risks (not coughing up stuff) vs. the benefits (sleep) of a cough suppressant. I don't know that I'd feel comfortable making that call for myself--the last time you had pneumonia you had a different case of pneumonia as well as a different doc.

I've had codeine cough syrup prescribed for bronchitis, but never for pneumonia. (I've had each a few times in my 45 years.)
posted by Sidhedevil at 5:36 PM on December 19, 2009

Something must be going around....I just went into the Dr. on Wed. and found out that I have bronchitis. Prescribed were: Antibiotic, Codeine/Phenegran cough syrup. So maybe the Dr. is concerned more with the pneumonia sticking around in your lungs. Hope you feel better soon!
posted by snoelle at 6:21 PM on December 19, 2009

You should also know that calling around asking for a codeine cough suppressant is probably not a great idea as you could wind up on a list of drug seekers. It's liquid codeine. Lots of people would love to get their hands on some of that.
posted by Justinian at 9:23 PM on December 19, 2009

Codeine is a specific depressant of the cough reflex, which is why a productive cough precludes a codeine remedy.
posted by anadem at 10:24 PM on December 19, 2009

Best answer: Agree with the above. With the caveat- even if the cough is productive, too much coughing can irritate the lungs and make "production" more difficult.

Now, I am an asthma sufferer, so it probably makes a much larger difference to me than for others. But when I have these sorts of infections, there is a huge difference in my recovery and comfort between 5 minutes of coughing to hock up one decent loogie, and a couple coughs to get the same loogie. If I cough to much, it fires up my asthma symptoms and closes down my airways, making the coughs even more difficult. But even for a normal lunged person, too much coughing can cause some constriction. (And fatigue, making it harder to cough when it is really necessary.)

(And, the albuterol inhaler is used to open up constricted airways. But, depending on the form it is in and your particular lungs, it might cause just as much constriction as it prevents, if it irritates your lungs.)

Also, it isn't like cough suppressents are an on off switch for coughing. The right dosage just knocks it down a few notches. Too much, obviously, shuts it down too much and makes drowning in your sleep a possibility. So my suggestion would be that you do two things:

1- Ascertain whether your coughing is too much or not. I think the threshold is can you sleep or not. If you can't sleep, you can't heal.

2- Armed with that, head to your regular doctor and explain what happened. I'm sick, I went to the hospital, here's what they said, I feel like I'm coughing too much or not, last time this worked for me, what do you suggest?
posted by gjc at 10:42 AM on December 20, 2009

Doctors tend to be hesitant (for obvious reasons!) about prescribing opiates like codeine, so it's not terribly surprising.
Before you run back and beg for drugs, I'd see if the stuff that he did prescribe work. If not, go back, tell him it didn't work, and see what he'd suggest. I'm also going to second Justinian's suggestion about NOT asking lots of doctors to give you codeine - probably a bad idea.
posted by vanitas at 12:25 AM on December 21, 2009

Response by poster: Hey all, Thanks for the info.

I'm finally on the mend. I saw my regular Doc the day after I posted, and they prescribed me some Tussinex without hesitation. I didn't have a productive cough, and I *know* I told the Doc at the Acute Care Clinic that I was coughing up "very little". I guess he took that to be "something", but in reality what I was coughing up was almost entirely saliva, with *occasional* small amounts of mucus after I had been laying down for a long time.

I only used the Tussinex at night for sleeping, and the rest did me a world of good. During the day it was Mucinex, but even on that I hardly ever coughed up anything significant, except again, first thing in the morning, and even then not much.

It does sort of bug me, though, even despite all of the cautions, which I am in agreement with, that I had to go begging for even a small dose of codeine for rest. After the antibiotics, rest has been by far what has done me the most good in recovering from this.

I am, for sure, no drug seeker. If anything I'm adverse to taking any kind of medication unnecessarily, and potentially habit forming, mind altering substances even more so. But in the last few years codeine has worked such wonders for me in times that I was either in severe pain for one reason or another, or had a very bad cough, that I've come to resent the difficulty in obtaining it when I have had a legitimate need. And when I think back on times before I was exposed to its helpfulness, when I miserably suffered through bad illnesses or painful injuries with nothing more than ineffective over the counter remedies it makes me a little angry. I'm all for making it necessary to get a prescription for the stuff so a Doc can keep his eye on your illnesses, but I think it should be just a given when the need is there, not something that people have to beg for.

Sorry to vent, but even as I am almost better, as my small supply of blessed sleep enabling cough syrup dwindles and I worry that I might have to go begging again or endure some more nights of interrupted sleep, both for myself and my wife, and my girls who hear me coughing in the next room. Fortunately the end is in sight one way or another, and I won't want another drop of codeine after that, but I hope I can get there as gently as possible.
posted by Reverend John at 8:22 AM on January 4, 2010