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Coughing and Multiple Sclerosis

Does your cough last a long time? It might have something to do with your MS.


Updated February 25, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

As much as I welcome cooler weather, I always get a little anxious when the thermometer starts dropping, as that signals the onset of cold, flu, bronchitis and pneumonia season. Many years ago, I discovered that when I got a respiratory illness, my cough would be the very last symptom to resolve and it would last much, much longer than seemed "normal."

My bouts of coughing also tend to be a lot more prolonged and dramatic than those of others, as it is hard for me to catch my breath, so I turn red and have to lean on something to keep my balance. More than once, during public coughing fits, I have been asked by restaurant managers or salespeople if they should call someone to help me.

It turns out that this tendency to cough is at least partially related to my multiple sclerosis. It is estimated that about 30% of people with MS have decreased respiratory function. However, this number may be even higher, as measures of mouth pressure  in one study were found to be between 60 and 70% of normal even in patients with low disability (EDSS scores of 1.5 to 5.0). These tests are used to assess the functioning and strength of respiratory muscles by testing maximum inspiratory (breathing in) pressures and maximum expiratory (exhaling) pressures.

Lower respiratory strength can result in coughs that are weaker, and therefore, less productive (bring up less mucus). In some people, this may translate into a cough that lasts longer, since the coughs aren't getting the job done. One study found that lower "voluntary cough efficacy" is related to level of disability in people with MS, so that people with a higher EDSS tend to have "weaker" coughs.

I dread coughing so much that I have become very aggressive in my efforts to prevent or shorten such cough-producing illnesses. I have found that it is very important to see the doctor early.

In my younger days, I would let a cough go for a long time before seeking treatment. I remember a time during graduate school where my cough lasted from Christmas to Spring Break (you can imagine that I was a favorite in the lecture hall). Finally, it petered out on its own.

Now, I head to the doc within a day or two of developing a cough. Even if the doctor thinks it is a virus (that will not respond to antibiotics), she can give me instructions such as, "call me back if it is not better in 4 days," which may indicate that a bacterial infection has developed. A doc can also prescribe something to keep your cough under control – the over-the-counter cough remedies do nothing for me, I need the stuff that requires a prescription.

So, my bottom line here is to take all of the precautions to stay healthy during the "cough season" (avoid sick people, wash your hands, get your flu shot, get enough rest), as well as respond quickly to first symptoms of illness by seeing a doctor. 

One tip here: I have recently found that many doctors and clinic staff are more reluctant to prescribe antibiotics for coughs, even in the case of bronchitis. Instead, they recommend drinking plenty of fluids, getting rest and using a humidifier. They will also prescribe narcotic cough syrup and inhalers in many cases. While these measures might be adequate for most people, I find that antibiotics can really shorten the duration of my cough (by months, even). I find that docs are much more willing to give me a prescription for antibiotics once I tell them that I have MS, as they realize that people with MS have impaired lung function and need the extra help getting over bronchitis that antibiotics will provide.

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