Introduction. Causes. What causes coughs. Did you know?

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1 Module 1 The Cough

MODULE 1 INTRODUCTION Introduction A cough is your body s way of keeping your throat and lungs clear of foreign particles, microbes, irritants, fluids and mucus 1.

2 MODULE 1 INTRODUCTION Introduction A cough is your body s way of keeping your throat and lungs clear of foreign particles, microbes, irritants, fluids and mucus 1. Causes What causes coughs Some of the more common causes include: Tracheobronchial sputum has an antimicrobial effect kills or inhibits bacteria, because it contains 3 : SUBSTANCE FUNCTION Enzyme that damages or breaks down Lysozyme bacterial cell walls 2 Glycoprotein that binds iron, Transferrin which inhibits bacterial growth and survival 2 Antibodies that bind to specific antigens Immunoglobulins such as bacteria and viruses 4 MODULE 1 CAUSES Viruses and bacteria leading to respiratory tract infections such as a cold or flu Smoking Asthma Some medication Protease inhibitors Fibronectins Antiviral inhibitors that prevent viral replication 5 Glycoprotein that promotes cell adhesion and growth, wound healing and clearance of bacteria 2 Dust and bacteria are inhaled and trapped by mucus and the fine hairs of the nasal membranes Bacteria that get past these hairs stick to the mucous membranes of the trachea or windpipe, or are swept upward by the cilia or hairs of the lower respiratory tract Nose 2. Trachea 3. Bronchial tubes 4. Bronchi 5. Bronchiole 6. Alveoli 7. Mucus 8. Cilia The lungs are well protected by mucus and keep giving off tracheobronchial sputum 2 that has natural bactericidal action 2 (kills bacteria). However, when the lungs are compromised or not working to full capacity, the body will develop a sneeze or cough to help rid itself of bacteria 3. Did you know? Post-nasal drip where mucus drips down the back of the patient s throat because of sinus complications causes about 7% of coughs 6. Thin mucus naturally drips down the back of the throat unnoticed on a daily basis, but when the mucous lining of the throat becomes irritated it could lead to inflammation of the respiratory tract, which in turn leads to dry, tickly coughs

3 MODULE 1 CAUSES The different kinds of cough: Dry vs. Wet 6 Patients may develop one of the following coughs when he/she has a cold or flu: Symptoms How symptoms for a cold or flu develop MODULE 1 SYMPTOMS Dry/Tickly/ Nonproductive Cough Wet/Chesty/ Productive Patients may experience different stages as their flu or cold symptoms emerge 8. Persistent/Constant tickle Sensitive throat Coughs up mucus Wheezing Stage 1: Something is different Stage 2: Something is wrong Stage 3: Full-blown cold or flu Stage 4: Extended throat or chest problems Hacking No mucus expelled Chest tightness Difficulty breathing Severity Sore throat Dry/tickly cough Chesty cough vs. Dry hacking cough The different kinds of cough: Acute vs. Chronic 7 Coughs are also classified according to the length of time a patient has it, and its persistence. Time Cough Stage 1 & 2 Stage 3 & 4 Symptoms Begins suddenly Acute Causes Colds, flu & acute bronchitis Symptoms Lasts longer than 2-3 weeks Chronic Causes Chronic bronchitis, asthma, smoking, allergies & medicines Patient may experience lack of energy, body aches, dry/tickly coughs, symptoms that affect breathing, and a sore throat 9. Patient complains of an itchy/sore throat, or tickly cough. RECOMMEND a cough solution that treats the back of the throat. Patients may experience either wet, chesty coughs or dry, hacking coughs 9. RECOMMEND a cough solution that targets multiple symptoms and various cough conditions. Lasts 2-3 weeks Comes and goes 8 9

4 MODULE 1 DIAGNOSIS Diagnosis How to diagnose a cough effectively 10 A careful scrutiny of the patient s cough since patients can be unaware will help determine a diagnosis or even of the qualities of their cough or a cause. Question the patient, as well as may underestimate its frequency Treatment In most cases, the best way to treat a cough is to allow it to run its course and clear up on its own. However, when a cough lasts several weeks or impairs breathing or rest, it is best to begin treating it 11. MODULE 1 TREATMENT any accompanying family members, and duration. Ask the following questions to paint a better picture: Herbal Cough Remedies Herbal remedies are used worldwide for whole 13. In Western medicine your doctor a variety of diseases and conditions 11. asks about your symptoms, and checks 1 Was the start of the cough sudden and was there a cause? Ayurvedic medicine, one of the world's oldest holistic ( whole-body ) healing your temperature and blood pressure before writing a prescription. 2 How long has the cough been present? Is it persistent or does it come and go? systems, was developed more than 3,000 years ago in India and uses combinations of herbs and minerals to Ayurveda, in comparison, finds the root cause of the problem and, instead of treating symptoms, takes care of 3 How often does a single coughing spell happen and how long does it last? treat and heal conditions 12. any ailments or health issues that are responsible for the symptoms, 4 Can the patient locate the site of origin of the cough or the sputum, such as from the throat or deeper in the chest? (Is it dry or wet?) Ayurvedic vs. Traditional remedies 13 Modern medicine treats symptoms, while Ayurveda treats the body as a giving the body the right tools to defend itself, boost the immune system and heal faster Is phlegm being easily expelled when the patient coughs? Is the cough an isolated only symptom, or is it associated with other respiratory or non-respiratory symptoms? Was the patient exposed to any irritants, such as smoke, that may inflame his/her respiratory tract? In South Africa traditional medicine plays an important role in many regions 1,11 To assess the importance of herbal remedies in the community, patients were interviewed at a tertiary hospital in Ga-Rankuwa, 37 km outside Pretoria. 8 9 What time of the day or night is the cough or sputum production worse? Has the pattern of the cough or nature of the sputum changed recently? 74% of patients interviewed indicated that they had used herbal medication in the past 10 Has the patient had a similar problem with coughing in the past? 34% of those who used herbal treatments in the past, claimed to have used them for respiratory tract infections Once the type and severity of the cough has been established it is possible to make a recommendation. This makes respiratory conditions one of the most common ailments for which herbal remedies are employed

MODULE 1 TREATMENT Wet and dry cough alleviation calls for specific requirements Wet/Productive Dry Cough Cough Alleviation Alleviation Over the counter (OTC) treatment MODULE 1 OTC TREATMENT

used to help relieve respiratory difficulties 15 Expectorant Aid in clearance of mucus/phlegm from the passages of the lungs 17 Agent that helps to soothe and reduce an irritating cough 17

5 MODULE 1 TREATMENT Wet and dry cough alleviation calls for specific requirements Wet/Productive Dry Cough Cough Alleviation Alleviation Over the counter (OTC) treatment MODULE 1 OTC TREATMENT Broncholytic Mucolytic Cough calming Agent that dilates/ opens the bronchial tubes/passages 14 Substance or treatment that reduces inflammation Agent that liquefies thick mucus/ phlegm and is usually used to help relieve respiratory difficulties 15 Expectorant Aid in clearance of mucus/phlegm from the passages of the lungs 17 Agent that helps to soothe and reduce an irritating cough 17 Antiinflammatory Antiinflammatory Substance or treatment that reduces inflammation Broncholytic Mucolytic Expectorant Cough calming Anti-inflammatory Demulcent A combination of herbal extracts that works. Naturally. Effective for wet and dry coughs Helps the body naturally defend against infections to relieve cough For coughs associated with colds and flu Available in syrup and lozenges For day or night use Alcohol free or swelling 16 Demulcent or swelling 16 DOKTOR MOM helps the body naturally defend against infections to relieve cough by assisting the secretion of tracheobronchial substances, discussed above, in addition to soothing the throat. As a result it provides 16,17,18 : Substance which provides a soothing protective coating on mucous membranes of mouth and throat Support of anti-inflammatory effects, which assists with wound healing One, or a combination of the solutions above, can be used to treat a variety of different coughs. Expectorants are ideal to treat wet coughs, while antitussives (cough suppressants) are used to soothe or calm dry coughs Support of immunoregulatory effects, which helps the immune system fight off infections Support of iron-chelating activities, which make it difficult for bacteria to survive This over-the-counter (OTC) treatment, in the tradition of Ayurveda, is a holistic solution that addresses the South African patient s need for a herbal cough remedy and offers pharmacies the opportunity to grow in the home remedy sector

6 DOKTOR MOM is made of a blend of herbal extracts, ready mixed for the patient s convenience. DOKTOR MOM Herbal Cough Lozenges DOKTOR MOM Herbal Cough Syrup Glycyrrhiza glabra (Liquorice Root) 19 Glycyrrhiza glabra helps to loosen and thin mucus in airways. Adhatoda vasica (Malabar Nut) 34,35 The leaf of the Malabar Nut plant is used to make medicine. Zingiber officinale (Ginger) 5,20 Used as an expectorant and suppressant to accelerate tracheal mucus secretion, a demulcent to treat sore throats, and an anti-inflammatory agent. Employed in the treatment of colds and flu. Used as an anti-inflammatory agent to treat headaches and upper respiratory tract infections, coughs and bronchitis. Solanum indicum (Indian Nightshade) 23,36,37 Used as an expectorant to loosen chest congestion and as a bronchodilatory agent to open the breathing tubes (bronchi). Both the root and berries of Indian Nightshade are used for medicinal purposes. Used as an expectorant and treatment against bronchitis, and to treat dry and spasmodic coughs. Emblica officinalis (Indian Gooseberry) 8,21,22,23 Found in India, the Middle East and some southeast Asian countries, all parts of the plant have been employed in Ayurvedic medicine for thousands of years. Inula racemosa (Indian Elecampane) 38,39 Indian Elecampane, inula or pushkarmool, is a powerful Ayurveda herb known for its antiseptic, antibacterial and anti-inflammatory properties. Levomenthol (Mint) 24,25,26,27 Ocimum sanctum (Holy Basil) 28,29,30,31 Used as an antiviral and antibacterial substance, an expectorant and an antioxidant. Mint is used to treat the common cold, coughs, inflammation of the mouth and throat, sinus infections and respiratory infections. Levomenthol is used as a decongestant and expectorant agent to thin mucus, and for its soothing and cooling properties. Holy Basil or tulsi is valued for its medicinal properties. Used as an expectorant, anti-asthmatic and anti-catarrhal. Piper cubeba (Cubeb Pepper) 40 Terminalia bellerica (Bahera Fruit) 41,42 Used to treat respiratory diseases such as coughs, bronchial asthma and bronchitis. Cubeb Pepper or tailed pepper is native to India. Used for its expectorant qualities and stimulating effect on the mucous membranes of the respiratory tract and to ease the symptoms of chronic bronchitis. Terminalia bellerica is grown throughout India. Used as an expectorant and treatment for respiratory conditions, including respiratory tract infections, coughs and sore throats. Curcuma longa (Turmeric) 32,33 Also used in the treatment of bronchitis, the common cold, fever, influenza and catarrh. Turmeric is derived from the dried rhizome of Curcuma longa. Used for the treatment of headaches, bronchitis, the common cold and respiratory infections. Aloe barbadensis (Aloe Vera) 43,44 Aloe Vera is the juice extracted from the leaves of the succulent Aloe plant. It has been used medicinally since 2200 BC in Mesopotamia for its anti-inflammatory properties and to help treat asthma and colds

MODULE 1 DOKTOR MOM DOKTOR MOM Herbal Cough Syrup and Herbal Cough Lozenges alleviate coughs and boost the effectiveness of the lungs: Wet Cough Alleviates wet or productive coughs DOKTOR MOM HERBAL

naturally defend itself against infections to relieve coughs Liquorice Root Ginger Indian Gooseberry Mint Relieves coughs Soothes the throat Ideal for use day or night Top tip for pharmacy staff

Alcohol and tartrazine free Effective partner in assisting in cough relief associated with colds and flu Available in a pack of 20 lozenges.

7 MODULE 1 DOKTOR MOM DOKTOR MOM Herbal Cough Syrup and Herbal Cough Lozenges alleviate coughs and boost the effectiveness of the lungs: Wet Cough Alleviates wet or productive coughs DOKTOR MOM HERBAL COUGH LOZENGES For cough relief on the go The lozenges are made from a blend of 4 herbal extracts: MODULE 1 DOKTOR MOM Dry Cough Alleviates dry or tickly coughs Natural Defence Helps the body naturally defend itself against infections to relieve coughs Liquorice Root Ginger Indian Gooseberry Mint Relieves coughs Soothes the throat Ideal for use day or night Top tip for pharmacy staff Since DOKTOR MOM is a herbal cough remedy, it can also be recommended to patients by front shop assistants. Alcohol and tartrazine free Effective partner in assisting in cough relief associated with colds and flu Available in a pack of 20 lozenges. DOKTOR MOM HERBAL COUGH SYRUP Comes in 4 soothing flavours: Lemon Pineapple Berries Mixed Fruit For the relief of coughs The syrup contains 11 herbal extracts already mixed for the patient s convenience: Aloe Indian Elecampane Turmeric Mint Cubeb Pepper Ginger Holy Basil Indian Nightshade Liquorice Root Bahera Fruits Malabar Nut Effective partner in assisting in cough relief associated with colds and flu Relieves wet and dry coughs Soothes the throat Loosens mucus Opens airways Ideal for use day or night Helps the body naturally defend against infections to relieve cough Top tip for pharmacy patients Quick Question Top tip for patients DOKTOR MOM Herbal Cough Lozenges can be used whenever a cough or throat irritation develops. Encourage patients to stock up on these convenient packets that are great for on-the-go use. In addition to soothing the throat, mention three ways in which DOKTOR MOM provides support. DOKTOR MOM Herbal Cough Syrup 2. Alcohol and tartrazine free can be used during any stage of illness when you experience a cough or throat 3. irritation. Advise patients to keep a Available in a 100 ml bottle. bottle at home, so they can soothe their "DISCLAIMER: As stipulated in Section 22A subsection 4 and 5 of the Medicines and Related Substances Act 101 throats when they start feeling sick. of 1965, product recommendations can only be made by Pharmacists and Pharmacist Assistants acting under the 16 personal supervision of a pharmacist (S1-S2). Any customer seeking medical advice from a Front Shop Assistant should be referred to the Pharmacist on duty." 17 1.

8 MODULE 1 REFERENCES References 1. Web MD Cold, Flu, & Cough Health Center. Coughs: Age 12 and Older. Available at 2. Immune Defense against Bacterial Pathogens. Online Textbook of Bacteriology. Available at textbookofbacteriology.net/innate_3.html. Accessed on 2 March Zakharova I.N. et al. Doctor Mom herbal cough syrup in combination therapy of acute respiratory infections in children. Paediatrics Appendix to Consilum Medicum. Volume 06/N 2/ ebioscience. Immonuglobulin (Ig). Available at Accessed on 2 March Protides of the Biological Fluids. Available at books.google.co.za/books?id=6ncebqaaqbaj&pg=pa137&lpg=pa137&dq=sputum+pro- tease+inhibitor&source=bl&ots=dhvzumcjfl&sig=xcqctfgrmz62ypithshyeuegoza&hl=en&sa=x&ved=0ceqq6aewbwovchmi2qbzxduwy- QIVilkaCh3JNgel#v=onepage&q=sputum%20protease%20inhibitor&f=false. 6. PreventDisease.com. 8 Different Coughs. Available at preventdisease.com/news/14/021814_8-different-coughs-their-symptoms-what-each- Means-For-Your-Health.shtml. 7. Medline Plus. Cough. Available at 8. Medline Plus. Flu. Available at 9. Healthcommunities.com. Chronic Cough. Available at Accessed on 2 March National Centre for Biotechnology Information. Clinical Methods. Cough and Sputum Production. Available at NBK359/. 11. Marais A, et al. Conditions frequently self-treated with herbal remedies by patients visiting a tertiary hospital in Gauteng, South Africa. South African Family Practice. Available at The Ayurvedic and Naturopathic Medical Clinic. How To Boost your Immune System with Ayurvedic Medicine. articles/how-to-boost-your-immune-system-with-ayurvedic-medicine/. 13. Illuminated Health. The Difference Between Ayurveda and Modern Medicine. Available at illuminatedhealth.com/the-difference-between-ayurveda-and-modern-medicine/. 14. Medical Dictionary Online. What is a Broncholytic Agent? Available at HowMed. Anti Tussives, Mucolytics and Mucokinetics. Available at howmed.net/pharmacology/anti-tussives-mucolytics-and-mucokinetics/. 16. The Free Medical Dictionary. Anti-inflammatory. Available at medical-dictionary.thefreedictionary.com/anti-inflammatory. Accessed on 2 March NPS. Cough and cold medicines. Available at Symonowicz M. et al. Flavonoids and their properties to form chelate complexes. Institute of General Food Chemistry, Lodz University of Technology, Poland, Yang R. et al. The antiviral and antimicrobial activities of licorice, a widely-used Chinese herb. Available at articles/pmc /. 20. Natural Medicines Comprehensive Database. Ginger. Available at naturaldatabase.therapeuticresearch.com/nd/search.aspx-?cs=&s=nd&pt=100&id= WebMD. Vitamins and Supplements. Indian Gooseberry. Available at gooseberry.aspx?activeingredientid=784&activeingredientname=indian%20gooseberry. 22. Himilaya Wellness. Indian Gooseberry. Available at Accessed on 2 March Health Canada. Monograph: Amla - Phyllanthus emblica. Available at webprod.hc-sc.gc.ca/nhpid-bdipsn/monoreq.do?id=841&lang=eng. 24. WebMD. Vitamins and Supplements. Peppermint. Available at Drugs.com. Levomenthal. Available at Livestrong.com. Medicinal Properties of Menthol. Available at Accessed on 2 March US National Library of Medicine. The Cooling Effect of Menthol. Available at Natural Dispensary. Holy Basil An Overview of the Research and Clinical Indications. Available at herbal_monographs. 29. Webmed Central. Ocimum Sanctum (Tulsi): Bio-pharmacological Activities. Available at Accessed on 2 March Mother Herbs. Basil Herbs. Available at WHO Monographs on Selected Medicinal Plants Volume 2. Folium Ocimi Sancti. Available at apps.who.int/medicinedocs/en/d/js4927e/21. html#js4927e WHO Monographs on Selected Medicinal Plants Volume 1. Rhizoma Curcumae Longae. Available at apps.who.int/medicinedocs/en/d/ Js2200e/14.html#Js2200e Natural Medicines Comprehensive Database. Turmeric. Available at naturaldatabase.therapeuticresearch.com/nd/search.aspx?pt=100&id= Natural Medicines Comprehensive Database. Malabar Nut. Available at naturaldatabase.therapeuticresearch.com/nd/search.aspx-?cs=&s=nd&pt=100&sh=1&id= WebMD. Vitamins & Supplements. Malabar Nut. Available at Mother Herbs. Solanum Indicum. Available at HolisticOnline.com. Indian Nightshade. Available at Easy Ayurveda. Pushkarmool Inula Racemosa. Available at easyayurveda.com/2013/09/18/pushkarmool-inula-racemosa-benefits-usage-dose-side-effects/. 39. Mother Herbs. Inula Racemosa. Available at Mother Herbs. Piper Cubeba. Available at Mother Herbs. Terminalia Belerica. Available at WebMD. Vitamins and Supplements. Terminalia. Available at International Agency for Research on Cancer. Monographs: Aloe Vera. Available at monographs.iarc.fr/eng/monographs/vol108/mono pdf. 44. Natural Medicines Comprehensive Database. Aloe. Available at naturaldatabase.therapeuticresearch.com/nd/search.aspx?pt=100&id=607. MODULE 1 REFERENCES S0 DOKTOR MOM HERBAL COUGH SYRUP (ALCOHOL, TARTRAZINE & COLOURANT FREE). Each 10 ml contains: Ocimum sanctum 100 mg, Glycyrrhiza glabra 60 mg, Curcuma longa 50 mg, Zingiber officinale 10 mg, Adhatoda vasica 60 mg, Solanum indicum 20 mg, Inula racemosa 20 mg, Piper cubeba 10 mg, Terminalia belerica 20 mg, Aloe barbadensis 50 mg, Menthol 6 mg; Contains Sugar. S0 DOKTOR MOM HERBAL COUGH LOZENGES (ALCOHOL, TARTRAZINE & COLOURANT FREE). Each lozenge contains: Dry extracts derived from: Liquorice root (Glycyrrhiza glabra) 15 mg, Common ginger rhizome (Zingiber officinale) 10 mg, Indian gooseberry fruits (Emblica officinalis) 10 mg, Levomenthol 7 mg; Contains Sugar

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