We all cough. Even animals do it. We cough because we need to clear something out from our breathing passages. Frequent severe coughing that doesn’t clear up in a short time usually indicates the presence of a disease, such as asthma and allergies.
By far the preferred approach to prolonged coughing is to find the cause and eliminate it. In the 21st century medical world, though, the common accepted approach is to do something to merely stop the cough, to mask the underlying cause by hiding the symptoms. The use of a simple soothing agent – a syrup or a piece of hard candy – has long been used to temporarily relieve part of the symptoms until the underlying cause is removed.
The modern approach is to use potent drugs to stop the cough process, drugs that may have serious side effects. Singulair (R) (montelukast sodium) is one such drug. It is very common and perceived to be a safe prescription.
I disagree, especially when the patient is a young child.
How It Started A father called to say that his 6-year-old son has had a dry cough every day, just before bedtime, which started less than 10 days ago. The concerned parents took their child to see their primary care physician to make sure there wasn’t any cause for immediate concern.
A Visit to the Doctor Without digging too deeply into what may be an underlying cause of the coughing, the busy doctor offered a handful of drug samples – intending to only stop the symptoms. There was no laundry list of questions about bedroom humidity, other symptoms or sick friends at school, just a large pocket full of drugs.
The drug is Singulair, a leukotriene (loo-koe-TRY-een) inhibitor. It is used to prevent asthma attacks in adults and children as young as 12 months old. It is also used to relieve symptoms of allergies in adults and children as young as 6 months old.
Allergies are disorders in which the body’s immune system reacts to something outside the body to which the person is sensitive. This is called an allergen. In many cases, asthma is a specialized presentation of the typical allergic reaction. An allergen, the trigger, initiates symptoms that are located primarily in the lungs, such as wheezing.
Is This a Problem? Research suggests that allergic reactions can be inhibited with substances such as Singulair. However, the goal ought to be to discover an actual cause and eliminate it, rather than just covering up the symptoms.
Here’s an allegory. My car doesn’t run when the needle points to E. If I can’t read the letter E, maybe the car will run. If I cover up the letter E, I won’t have to worry about the car not running.
Silly? Yes, but it is eerily similar to the medical situation I am describing here.
Which approach seems best for being healthy; covering the symptoms or removing the cause?
I’d clearly choose to remove the cause, but modern medicine no longer embraces that approach. It is usually easier to quickly prescribe a drug that covers up the symptoms without doing anything about the cause – except hoping that whatever is causing the problem will resolve on its own.
NOTE: A doctor once told me that, with proper medication, the common cold will be cured in about seven days. Without medicine it will take a week.
How Does This Apply in this Situation? In the case I’m presenting, the child had a coughing experience that began about 10 days ago. It wasn’t a long-term situation that demanded some drastic measure – like prescribing a potent drug to a child. Instead, it really demanded some effort to identify a cause and remove it. It is unlikely that the child spontaneously developed an allergy to nothing. The focus should have been on what has changed in the past 10 days; different foods, new detergent or fabric softener; new clothing or bed linens, or maybe a simple virus, or maybe it went from summer to fall rather quickly.
Time is Money Take a moment to think about how much time it would take to investigate the possible causes and to devise a plan to find a cause, test it, and then adjust as needed. Now, compare that to the time it would take to order a drug – whether with samples or by prescription. The busy doctor might need a minute or two to handle the drug transaction, whereas the investigation and clinical approach may take several hours – even days. The easiest course of action is obvious.
Too Many People Take Too Many Drugs I am not a fan of using drugs, especially on children. It is the easy way out and very likely to be the cause of other symptoms, some far worse than the ones that brought a person to the doctor in the first place. Sadly, it has become the standard of care in the 21st century. That means it’s the way help is offered. It doesn’t mean that it’s the manner through which a person has to receive medical help. Individuals can – and should – stand up against the overuse of drugs. Tell the prescriber “no” when the prescription pad comes out or when samples are offered. Demand clinical evaluations and attention. The prescription pad is effectively a “flick of the wrist dismissal” of your concerns and you don’t have to put up with it. Demand better. If your doctor refuses to help, find another doctor. You have a right to be healthy – and your doctor is the person who is charged with the professional responsibility to help you.
Drugging a person to cover symptoms is not medical help.
I looked up the potential side effects for Singulair, and personally wouldn’t want to risk those kinds of problems for myself – and I think it is poor logic to suggest that a parent subject his or her 6-year-old child to them. Giving a child a glass of wine can be called abusive these days. Giving that same child a drug that has all those possible side effects is not a problem. Something is out of balance. Nevertheless, you can do something about it. If you so choose.
What would I suggest to the concerned father who called us? First, I’d ask him to look at the things that may have changed in the past couple of weeks. I’d recommend a simple nasal rinse – to help remove potential allergens from the nasal passages and sinuses. If those failed, I’d suggest elimination diets that can help identify food substances that may be at the root of the problem. Failing that, I’d suggest finding an allergist who is familiar with testing for specific allergens in children. All of this is part of what I refer to as medical care. It is unfashionable these days, but it still seems a wise course of action.
Follow-up: I received the following note the day I published the above article. Something is very wrongwith the way our medical care system is operating. It seems that too many of our “health professionals” are operating from positions of fear and ignorance. It has to change.
“I had the opposite experience last year. My doctor prescribed a new blood pressure med before we moved out of state. By the time we got to our new home in the deep South, I was coughing persistently. I went to a new doc and explained that I thought it was the new meds that were causing my cough. It was a tickling sensation and aggravating, unproductive dry hack. To her credit, the new doc was very thorough. She was sure that I was allergic to my new environment, especially because it was peanut harvest season and a lot of dust was in the air. A lot of folks around here have allergies to the peanut dust. So she suggested a nasal rinse (neti pot), gave me a prescription for Veramist at $140 a month, Allergan, Singulair, a cough suppressant, etc. After three months, the harvest season was past, and I was still coughing. I lived on common cough drops. Finally, in January, the doctor decided to try another blood pressure med (hello!) and the cough cleared up almost immediately.”