Cough management, while on group winter adventures
This is about ticklish cough management where coughs inevitably abound when we go on winter adventures with a group of like-minded companions, particularly in dry subzero air.
A background of asthmatic ticklish cough management
At my birth more than 75 years ago I turned up, along with my sister, as an unexpected twin. We were very premature babies and my life was probably saved by being held for some weeks in a newly invented humidicrib. I was the tiny runt of the litter and was told I looked more like a skinned rabbit rather than a baby Sapiens. “Other, less complimentary, rodent names are still used to this day.” However, I don’t mind as I have survived this initial disadvantage and even thrived because of it.
Having asthma from an early birth (triggered by excitement, anxiety, aerobic activity and dust), makes me empathetic toward others with persistent coughs during our winter adventures. Such coughs spread so easily among a close-knit group of winter adventure travellers despite our best efforts to prevent the spread in this post-Covid era.
My asthma made me the least likely person to be selected as a team member for a competitive sport. My forward-thinking parents along with other friends and neighbours sent us off to community-based parties where, under the guidance of a physiotherapist, young asthmatics would meet together in private homes to play breathing games that inevitably resulted in nice additional rewards.
As an example, the child that could lay stretched out on their back, and hiss like a snake, for the longest time on one lung full of air would be given extra jellybeans for their effort. I made very good progress with this incentive, but all of us were rewarded anyway for being the best or the most improved etc. And we all enjoyed the afternoon tea with drinks and treats.
Very much later in life, I learned that we were being taught Buteyko breathing. The method was developed by a Ukrainian doctor Konstantin Buteyko. “It is a strange twist of history that it is now referred to as a Russian technique and Russia is now illegally attempting to invade Ukraine after granting them independence.”
The next step that my parents took, on the advice of the physiotherapist, was to send me off to a weekly boys’ gymnasium class in an old church hall. We did tumbling, vaulting, rings, bars and other aerobic activities and exhibitions on crappy old capoc-filled mats that were a constant source of dust.
Throughout this activity, I could manage my asthma attacks, by good breathing without any medication. This skinny little kid thrived like never before and for the first time in my life felt that I was actually quite good at something. The medals and trophies gave me another sense of pride, but more deeply, I knew then that inside my body and my mind were the tools that I could use to cope with asthma and cough management in any situation. Asthma would not stop me from doing anything that I wanted to do. It also placed me within a great network of friends and companions with similar values and interests.
In some way, I think I benefited from my affliction as I did free diving, bushwalking, skiing surfing, sailing and windsurfing to mention a few. These were an alternative to competitive team sports and they also made me part of the communities that love to do these activities together over a whole lifetime. My timtinker website is also part of this sharing journey.
Lastly, for what it is worth, my experience of the Buteyko breathing method is somewhat different to the description in the above article. I find that the deliberate act of breathing deeply and holding that breath as long as possible, while slowly releasing it, improves my oxygen absorption rate. I think this increased oxygen absorption rate is mediated by developing higher carbon dioxide levels over the oxygen-absorbing alveoli that line my lungs. This is the opposite of what happens when we hyperventilate.
Regardless of the theory, for me, this Buteyko breathing can stop an asthma attack that has started or prevent one that I feel is on the way. Performing the Buteyko breathing importantly causes a euphoric feeling in my brain. This feeling may come from elevated endorphin levels in the brain in response to the Buteyko breathing. “Who knows, but it makes me feel calm.” Some people suggest that the Buteyko breathing just works psychosomatically. Regardless, for me, it works well and it may do so for others.
“It is wonderful to be at a bus stop or nervously preparing to give a presentation or just lying in bed in shared accommodation and invisibly use the Buteyko breathing method to divert an asthma attack or a non-asthma cough. Like a pelvic floor exercise, no one need know that you’re doing it.”
Even better, as an asthmatic, it is fun to be climbing a steep slope on skis and use Buteyko breathing with a closed mouth, as a preparation for, the apparently, effortless passing of fellow climbers with a smile while they are hyperventilating through their open mouths. Even more pleasure comes from skiing down, past them, to the tail-enders and climbing back up for another half run down before the tour party moves on. “Being referred to as ‘that bastard’, a Duracell Snow Bunny or another little rodent is an expected response and is taken as a great compliment.”
Other types of coughing
People, with and without asthma, often have ‘ticklish’ coughs that are not asthma-related. Dry subzero air temperatures while skiing seem to make the coughing worse. These coughs are often dealt with by sucking on sugar-based throat lozenges etc. These work well, but the benefit often does not last very long and they usually leave a sweet sticky finish in the mouth that almost demands to be washed away to prevent it from feeding mouth bacteria and acidity that follows.
Sleeping position for cough management
I find that while sleeping and horizontal resting, laying on one side or partially on the stomach can ease the urge to cough. Holding this position while doing Buteyko breathing is another great cough management option. If this strategy still does not suppress the coughing urge, my next option is a very mild pharmaceutical one.
Paracetamol micro oral absorption- another cough management tool
Some persistent recurring coughs do not respond to the above strategies. Consequently, I prefer to use a microdose of paracetamol to quickly stop a cough or to prevent a cough that is ‘in-the-making’.
I do this by breaking a plain 500mg paracetamol tablet into about six parts and storing these crumbs in a suitable small container or pill bottle. This means that it can be easily carried and reached everywhere I go, particularly in the dark of night. At bedtime when others may be sleeping (and coughing) nearby I place the pill bottle close at hand so that I can silently use a crumb to prevent a coughing event. One paracetamol crumb can be placed in the mouth, not to swallow into the stomach. Rather, I allowed it to disperse in the rear of the mouth with the aid of my tongue.
I resisted the use of the word dissolved, as the dispersed crumb of the tablet seemed to be quite insoluble and ‘sticks around’ on the skin of my mouth (start my throat) for some time after rapidly falling apart in saliva. I assume that the paracetamol is slowly absorbed through the dermal lining of the mouth as the cough management benefit is almost instantaneous. If salivation and swallowing are minimised, the slightly acrid taste of the paracetamol persists in the mouth for 30-60 minutes. This provides cough relief for that period and usually more time after that.
While the taste of the paracetamol is not particularly pleasant, it is not so bad and I easily put up with it when it prevents coughing. I find that it is far less unpleasant than the lingering sweet taste of sugar-based lozenges and their ability to foul the mouth subsequently.
A 500mg tablet (at about 4 cents/tablet) can provide many hours of cough relief. If its use is largely restricted to nighttime cough management there should be no concerns about overdosing on paracetamol which has a maximum safe usage rate of 4,000mg of paracetamol/24h. “I seldom need to use more than six crumbs per night (~500mg) for effective cough relief if body position and Buteyko breathing are used in conjunction and as the first remedial action.”
While paracetamol is widely used as an analgesic (pain-reducing) and antipyretic (fever-lowering) drug, it is not an anti-inflammatory drug (swelling-reducing). However, it is also reported to be a bronchodilator (causes widening of the bronchi) by relaxing the smooth muscle, by inhibiting the generation of prostaglandin and histamine, which play roles in asthma. In other words, they say that “….paracetamol might be a new bronchodilator.”
Consequently, the cough-soothing effect of micro oral absorption of paracetamol, which I report from my simple experience, may have some real pharmacological basis after all. It would also be interesting to see if an even smaller crumb of paracetamol would be just as effective, given that the absorption site is so close to the affected bronchial smooth muscle. At this stage, I find that 1/12th of a tablet works quickly and persistently with a less acrid taste. The grain in the pressed tablet allows six ‘pizza wedge’ shapes to be easily split into two portions with half the thickness, with the use of a blade.”
Conclusion
Some of my skiing companions have suggested that the Buteyko breathing, paracetamol crumbs and sideways sleeping cough management only work psychosomatically for me because I simply expect them to be beneficial. I agree that it is indeed very calming to have a comprehensive cough management tool kit up my sleeve. This is particularly the case on crowded long aircraft flights and at bedtime in tiny tents or crowded sleeping quarters. Nevertheless, I think that more physical elements to this cough management may be worth consideration by others, with or without an underlying asthmatic condition.
Tim
