Chronic Cough

Overview

A chronic cough is a cough that lasts for eight weeks or longer in adults or four weeks or longer in children. It can be a symptom of various underlying medical conditions, such as tobacco use, postnasal drip, asthma, acid reflux, chronic obstructive pulmonary disease (COPD), blood pressure drugs (ACE inhibitors), and infections like pneumonia, flu, or tuberculosis. Chronic coughing can lead to several complications, including sleep disruption, headache, dizziness, vomiting, excessive sweating, loss of bladder control, fractured ribs, and passing out. If you have a persistent cough that lasts for weeks, it is essential to consult a doctor for an accurate diagnosis and appropriate treatment.

Understanding the disease

Symptoms

The symptoms of chronic cough are:

1. A cough that lasts eight weeks or longer in adults, or four weeks in children
2. A runny or stuffy nose
3. A feeling of liquid running down the back of your throat (postnasal drip)
4. Frequent throat clearing and sore throat
5. Hoarseness
6. Wheezing and shortness of breath
7. Heartburn or a sour taste in your mouth
8. In rare cases, coughing up blood If you have any of these symptoms, it is recommended to see a doctor.

Risk Factors

Risk factors for developing chronic cough include being a current or former smoker and frequent exposure to secondhand smoke. Other potential causes of chronic cough may include aspiration, bronchiectasis, bronchiolitis, cystic fibrosis, laryngopharyngeal reflux, lung cancer, nonasthmatic eosinophilic bronchitis, sarcoidosis, and idiopathic pulmonary fibrosis.

Development

The various causes of chronic cough develop in different ways:

1. Tobacco use: The inhalation of tobacco smoke irritates the airways, leading to chronic cough.
2. Postnasal drip: The overproduction of mucus from the nose or sinuses can drip down the back of the throat, triggering coughing.
3. Asthma: In people with asthma, the airways become inflamed and narrow, causing coughing and shortness of breath. Coughing can be triggered by various factors such as allergies, exercise, or cold air.
4. Acid reflux: Gastroesophageal reflux disease (GERD) causes stomach acid to flow back into the esophagus, irritating the airways and leading to chronic cough.
5. Chronic obstructive pulmonary disease (COPD): This condition, which includes chronic bronchitis and emphysema, causes inflammation and obstruction of the airways, resulting in chronic cough.
6. Blood pressure drugs: Angiotensin-converting enzyme (ACE) inhibitors, commonly prescribed for high blood pressure and heart failure, can cause chronic cough in some people.
7. Infections: Pertussis (whooping cough), fungal infections of the lung, TB infection, or infections with nontuberculous mycobacterial organisms can cause persistent coughing. It's important to note that in some cases, a chronic cough may be the result of a combination of these causes. If you have a persistent cough that lasts for weeks, it's advisable to consult a doctor to determine the underlying cause and receive appropriate treatment.

Assessment and Diagnosis

Triage

You should see a doctor if you or your child experience a chronic cough that lasts for weeks, especially if it brings up sputum or blood, disturbs sleep, or affects daily activities such as school or work. Additionally, consult a healthcare provider if you notice any of the following symptoms accompanying the cough: wheezing, shortness of breath, chest tightness, or frequent throat clearing. Early treatment can help manage symptoms and prevent complications associated with a persistent cough.

Diagnosis

Diagnosing a chronic cough involves a thorough medical history and physical exam by a doctor. In many cases, the doctor may start treatment for common causes of chronic cough rather than ordering expensive tests. However, if the treatment doesn't work, the doctor may order imaging tests like chest X-rays or CT scans. In some cases, special scope tests like bronchoscopy or rhinoscopy may be considered if the cause of the cough remains unclear. In children, a chest X-ray and spirometry are typically ordered to find the cause of a chronic cough. The underlying cause of the cough is crucial for effective treatment, which may involve medications like antihistamines, inhaled asthma drugs, antibiotics, or acid blockers, as well as lifestyle changes or smoking cessation assistance.

Management and Treatment

Complications

Potential complications of chronic cough include sleep disruption, headache, dizziness, vomiting, excessive sweating, loss of bladder control, fractured ribs, and passing out (syncope). A chronic cough can also lead to social isolation, anxiety, and depression. Additionally, chronic cough can be a sign of an underlying medical condition that requires proper diagnosis and treatment.

Home Remedies

It is worth trying some simple measures to alleviate the symptoms. Some general home remedies for a chronic cough include:

1. Honey: Mix a teaspoon of honey with warm water or tea to soothe your throat and suppress coughing.
2. Ginger: Ginger has natural anti-inflammatory properties. Drink ginger tea or suck on ginger candies to help relieve cough symptoms.
3. Steam Inhalation: Inhale steam from a hot shower or a bowl of hot water to help loosen mucus and soothe your throat.
4. Saline Nasal Spray: Use a saline nasal spray to help reduce postnasal drip and alleviate coughing.
5. Humidifiers: Keeping the air moist with a humidifier can help reduce throat irritation and coughing.
6. Fluid Intake: Staying hydrated can help keep mucus thin and easier to clear.
7. No Smoking: If you are a smoker, quitting smoking can help reduce chronic cough caused by smoking or secondhand smoke exposure.
8. Warm Compress: Applying a warm compress to your chest or back may help ease coughing spells. Remember that if your chronic cough persists or worsens, it's essential to consult a doctor for proper diagnosis and treatment.

Treatment

Treatments for chronic cough depend on the underlying cause. Some common treatments include:

1. Quitting smoking and avoiding exposure to secondhand smoke.
2. Managing allergies or asthma through medication or other treatments.
3. Addressing acid reflux through lifestyle changes or medication.
4. Treating infections with antibiotics or antifungal medications.
5. Managing COPD through bronchodilators, corticosteroids, and other medications as prescribed by a healthcare provider.
6. Avoiding triggers for conditions like laryngopharyngeal reflux or cystic fibrosis.
7. In some cases, changing or discontinuing the use of ACE inhibitors or other medications causing chronic cough. It's important to consult a healthcare professional for an accurate diagnosis and appropriate treatment recommendations tailored to the individual's specific condition.

Preparing for medical consultation

To prepare for an appointment for chronic cough, you should:

1. Be aware of any pre-appointment restrictions: Ask your healthcare provider if there are any specific preparations you need to make, such as avoiding certain foods or medications before the appointment.
2. Gather information about your symptoms: Take note of the duration, frequency, and any triggers of your chronic cough. Also, jot down any associated symptoms like wheezing, chest tightness, or shortness of breath.
3. Prepare a list of your medical history: Include any previous illnesses, surgeries, or hospitalizations. Additionally, note any medical conditions your family members have.
4. List your medications: Make a comprehensive list of all prescription, over-the-counter medications, vitamins, and herbal supplements you are taking or have taken recently.
5. Note your smoking history: Include any smoking or exposure to secondhand smoke.
6. Compile a list of questions for your doctor: Prepare a list of questions you want to ask your doctor during the appointment, such as treatment options, potential causes of your chronic cough, or recommended lifestyle changes.
7. Be ready to discuss your family and social history: Prepare to share information about your family's medical history, your work environment, and any recent travels or exposure to animals. By gathering this information and being prepared with your health history, you can make the most out of your appointment and facilitate a productive discussion with your healthcare provider.