Chronic Cough

A chronic cough refers to the cough that that lasts for the duration of eight weeks or longer in adults, four weeks in children.

It is difficult to exactly determine the exact problem that is triggering a chronic cough.

The most common causes contributing to chronic cough include tobacco use, postnasal drip, asthma and acid reflux (regurgitation of stomach content into the throat causing irritation).

The treatment of underlying causes can resolve chronic cough.

Signs and symptoms of chronic cough are listed below:

• A runny or blocked nose
• A sensation that liquid is running down the back of your throat
• Scratchy throat the requires frequent throat clearing
• Sore throat
• Hoarseness
• Wheezing and panting
• Burning sensation in the chest or you may feel sour taste in your mouth
• Rarely, coughing up blood

When to see a doctor

Visit your doctor if cough persists for more than a week. Be more cautious if you observe blood or sputum in cough and the cough disturbs your sleep or affects your work.

Nearly 90% of chronic cough cases are caused due to one or combination of the following factors:

• Postnasal drip: Excessive mucus produced from nose or sinuses can drip down back to the throat which triggers the cough reflex. This condition is also known as upper airway cough syndrome.
• Asthma: Cough caused by asthma can have seasonal occurrence and exposure to cold air, certain chemicals or fragrances can worsen the cough.
• Gastroesophageal reflux disease (GERD): GERD causes acidic contents from stomach to move upward along the esophagus which can irritate the throat and lead to chronic cough.

Chronic cough can also be caused by:

• Infections: Cough might persist even after other signs of cold, influenza, pneumonia or other upper respiratory tract have subsided. Rarely, whooping cough (pertussis) can cause chronic cough in adults.
• Blood pressure drugs: A class of drugs used for lowering blood pressure, called Angiotensin-converting enzyme (ACE) inhibitors, can cause persistent dry cough.
• Chronic bronchitis: Chronic bronchitis is associated with congestion, breathlessness, wheezing and cough producing discolored sputum. Chronic bronchitis is closely linked to smoking.

The less common causes of chronic cough include:

• Aspiration: breathing in foreign objects
• Bronchiectasis: Permanent damage and enlargement of airway in the lungs
• Bronchiolitis: inflammation of bronchioles
• Chronic bronchitis from an infectious disease
• COPD (Chronic Obstructive Pulmonary Disease)
• Cystic fibrosis: Over-active exocrine glands
• Foreign body aspiration often in children
• Laryngopharyngeal reflux
• Lung cancer
• Non-asthmatic eosinophilic bronchitis
• Sarcoidosis: An inflammatory disease that affects various systems in the body

Several tests are used to diagnose the hidden cause of chronic cough.

You doctor may refer you to a specialist in lung diseases (pulmonologist).

How to prepare yourself for the visit

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

• List out all the symptoms.
• Write down your key medical information.
• Write down the names of all your medications, vitamins or supplements.
• Make a list of the questions to ask your doctor.

Some typical questions can be:

• What could be probable cause of my cough?
• What are the tests that I need?
• What are the treatment options?
• How long will it take for me to recover?

What your doctor wants to know

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did you start experiencing the symptoms?
• Do you smoke or have smoked in the past?
• Are you exposed to second hand smoke during stay at home or at office?
• Do you feel burning sensations in your chest?
• Do you cough up sputum? If yes, mention its color.
• Are you on any pressure lowering medication? If yes, specify the type.
• Is your cough more prominent at any specific period of time such as after meals or at night?
• Do you feel breathing problems during exertion or when exposed to cold air?

Your doctor can recommend one or more of the diagnostic tests to determine the hidden cause of your symptoms.

Imaging tests available are:

• X-rays: An X-ray can reveal the most common reasons of chronic cough such as postnasal drip, acid reflux or asthma. It also helps to exclude other causes like lung cancer, pneumonia and sinus infection.
• Computerized tomography (CT) scans: Evidence of sinus infections may show up in CT Scan results.
• Lung function tests (LFT): LFT is a simple, noninvasive test performed to determine how well your lungs inhale and exhale air. LFT can be used to confirm diagnosis of asthma. In some cases, your doctor can give you a drug to inhale (methacholine) and test you for improvement in breathing.
• Lab tests: Sputum samples can be tested to detect presence of specific bacteria.

Once the cause of chronic cough is established, treatment approach can be selected.

Medications used to treat chronic cough may include:

• Antihistamines and decongestants: These agents treat the symptoms of allergy and help to allow easy flow of air through nose.
• Inhaled asthma drugs: If asthma is the cause of chronic cough, you doctor may recommend inhaled anti-asthmatic medications to inflammation and facilitate air flow.
• Antibiotics: Your doctor can prescribe antibiotics to treat bacterial infections that have caused chronic cough.
• Acid blockers: Acid reflux can be controlled by using medications that block acid production.
• Cough suppressants: A cough suppressant is used to reduce cough reflex. However, it has not been explained if they are useful or not. Use of cough suppressants in children is not recommended.
• Home Remedy: Dissolve a teaspoon (5 grams) of honey in warm water and take it as hot as possible. It may help to loosen up sputum. It is not recommended for the children under one year of age.

Exercise caution while using drugs in children because non-specific cough in most children may not respond to these treatments.

Lifestyle modifications are necessary in order to cope with chronic cough.

Here are some ways that might prevent or minimize your chronic cough:

• Avoid allergens: Avoid any known factor that might cause allergies, for example dust.
• Quit smoking: Give up smoking right now to prevent or slow down the health effects of tobacco use.
• Reduce acid reflux: Life style modifications can prevent the regurgitation of acidic stomach contents. You may try simple changes like not lying down immediately after a meal.

There are several risks and complications associated with chronic cough.

RISKS

• Smoking and history of smoking
• Passive smoking or secondhand smoke
• Gender: Women are at a greater risk of developing chronic cough

COMPLICATIONS

• Headache
• Dizziness
• Excessive sweating
• Urinary incontinence (inability to hold urine)
• Fractured ribs