Most coughs last less than two weeks, a cold for ex­am­ple.

Cough­ing for more than two weeks is usu­al­ly due to si­nus and asth­ma.

Of these two, si­nus is by far the more com­mon. It’s be­cause of the chang­ing cli­mate. The air is be­com­ing more and more pol­lut­ed This ir­ri­tates and in­flames the lin­ing of the res­pi­ra­to­ry sys­tem which re­sponds by over­pro­duc­ing mu­cus and oth­er chem­i­cals that cause dis­ease.

In ad­di­tion there are sub­stances, called al­ler­gens, that of their own cause in­flam­ma­tion. An al­ler­gen is any sub­stance such as pollen, food, or dan­der, that is harm­less to most peo­ple but trig­gers an over­re­ac­tion in a sen­si­tive per­son’s im­mune sys­tem. In chil­dren they are of­ten part of the al­ler­gy syn­drome, al­ler­gic der­mati­tis or eczema; al­ler­gic rhini­tis known lo­cal­ly as “si­nus”, and al­ler­gic bron­chi­tis or asth­ma.

The ma­jor func­tion of the res­pi­ra­to­ry tract is to move oxy­gen in­to the lungs and move car­bon diox­ide in the op­po­site di­rec­tion. The free move­ment of O2 and CO2 is de­pen­dent on the ab­sence of ob­struc­tion to the free flow of air. Any ob­struc­tion to the flow of air caus­es sounds. The sec­ondary func­tion of the res­pi­ra­to­ry sys­tem is to make sounds, some which are nor­mal, as in speech, and some of which are ab­nor­mal, e.g a cough. But there are many oth­er ab­nor­mal sounds com­ing out of the res­pi­ra­to­ry tract.

The res­pi­ra­to­ry tract is long and com­pli­cat­ed but many of these sounds are so char­ac­ter­is­tic of a cer­tain kind of res­pi­ra­to­ry ill­ness that they can be used for di­ag­no­sis.

“Pulling up” or “snort­ing”; “nose pick­ing”; “snor­ing”; “throat clear­ing”; “stri­dor”; “croup”; “wheeze” and “grunt”, are all dif­fer­ent sounds you hear when the res­pi­ra­to­ry sys­tem is sick.

Start­ing from the be­gin­ning of the res­pi­ra­to­ry tract, “pulling up” is the com­mon­est ab­nor­mal sound. At its worst it be­comes a “snort”. Ex­ces­sive mu­cus in the nose is the cause. It’s an at­tempt to suck nasal mu­cus in­to the throat from where it can be spat out, or swal­lowed and de­stroyed by stom­ach acid. Swal­low­ing is the more hy­giene op­tion.

Pulling up is of­ten as­so­ci­at­ed with “nose pick­ing”, called the “al­ler­gic salute” in West­ern so­ci­ety.

The al­ler­gic salute is the repet­i­tive up­ward wip­ing or rub­bing or “nose pick­ing”, caused by itch­ing, of­ten seen in peo­ple with al­ler­gic rhini­tis. This move­ment re­peat­ed­ly folds and wrin­kles the skin in the same spot. Af­ter years of “nose pick­ing”, it caus­es a per­ma­nent dark, hor­i­zon­tal line run­ning from side to side across the mid­dle of the nose in adults. In any room in T&T with around 30 peo­ple you will find half a dozen noses with that crease.

Snor­ing is so com­mon in T&T that it is con­sid­ered nor­mal. It is not. It’s caused by an ob­struc­tion to the free flow of air in­to and out of the up­per res­pi­ra­to­ry tract. Any­one who snores should see a doc­tor.

Throat clear­ing is an­oth­er com­mon fea­ture. It’s ei­ther an at­tempt to clear the throat of mu­cus pro­duced by in­flam­ma­tion of the up­per air­way or it’s a mech­a­nism to re­lieve itch­ing of the throat sim­i­lar to rub­bing an itchy part of the skin or nose.

In­flam­ma­tion and swelling of the lar­ynx and vo­cal cords caus­es two dis­tinc­tive sounds.

The first is a high pitched whis­tle called “stri­dor” as the child forces air in­to the lungs through the nar­rowed res­pi­ra­to­ry tubes.

The sec­ond is the deep, hoarse cough need­ed to force air out through the tight pas­sages. It’s known lo­cal­ly as a “dog cough.” Up north it’s called “croup”. (Di­a­gram 1) It does sounds ex­act­ly like a hoarse dog’s bark. In fact “croup” has some­thing in com­mon with dogs. Since the elim­i­na­tion of bac­te­r­i­al croup by vac­ci­na­tions, mod­ern croup is usu­al­ly al­ler­gic or vi­ral and its “bark” is worse than its bite.

A “wheeze” is a high pitched, whistling kind of sound. It’s caused when the sick child tries to breathe out through bronchial tubes that are nar­rowed from in­flam­ma­tion. It’s typ­i­cal of asth­ma. Treat­ment is with drugs that di­late the bronchial tubes and re­move the in­flam­ma­tion. Asth­ma tends to re­cur and a prob­lem aris­es when par­ents are not ap­pro­pri­ate­ly in­formed of this.

There is an­oth­er type of “wheeze” that scares par­ents. It’s a low­er pitched sound that comes from the nar­rowed nose or throat pas­sage when the child breathes in. This is not a prob­lem.

Fi­nal­ly, “grunt­ing” is per­haps the scari­est of the res­pi­ra­to­ry sounds. It hap­pens when the alve­oli or air sacs of the lung sub­stance it­self are be­gin­ning to col­lapse and the body tries to raise the pres­sure in­side the air sacs by nar­row­ing down the air­way when breath­ing out. This is usu­al­ly due to pneu­mo­nia (Di­a­gram 2) and it is se­ri­ous. It re­quires an­tibi­otics and im­me­di­ate hos­pi­tal­i­sa­tion.