Chronic Cough

What is Chronic Cough?

Coughing that persists for more than 8 weeks in adults and more than 4 weeks in children is termed chronic cough. Chronic cough can disrupt sleep and make patients feel fatigued. In severe cases, it can lead to vomiting, dizziness, and rib fractures.

Identifying the cause of chronic cough is not always easy. Common causes include postnasal drip, tobacco use, and conditions like acid reflux. Typically, treating the underlying issue resolves chronic cough.

Diagnostic Methods for Chronic Cough

To diagnose chronic cough, a medical history should first be taken and a physical examination conducted. A comprehensive medical history and physical exam provide crucial clues about chronic cough. Subsequently, various tests may be requested to investigate the cause of the chronic cough.

However, many doctors prefer to start treatment for one of the common causes of chronic cough rather than requesting expensive tests. If this treatment does not work, tests for less common causes are requested. These tests include:

• X-ray
• CT scans
• Lung function tests
• Laboratory tests examining mucus samples
• Bronchoscopy
• Rhinoscopy

Causes of Chronic Cough

Occasional coughing in humans is normal, as it helps clear irritants and secretions from the lungs and prevents infection as part of the immune system. However, coughing that lasts for weeks is usually the result of a medical issue.

In many cases, multiple factors can cause chronic cough. The reasons listed below can individually cause chronic cough or in combination be responsible for a significant portion of chronic cough cases.

Postnasal Drip

Excess mucus from the nose or sinuses can drip down the back of the throat and trigger the cough reflex. It is also referred to as upper airway cough syndrome.

Asthma

Asthma-related cough can vary seasonally. It can emerge following upper respiratory infections or worsen with exposure to cold air, certain chemicals, or odors. Chronic cough is considered a primary symptom of asthma.

Gastroesophageal Reflux Disease (GERD)

In GERD, stomach acid escapes into the throat, causing irritation and subsequently coughing.

Infection

Respiratory infections can cause coughing. In adults, chronic cough is a common but underrecognized result of pertussis. Moreover, chronic cough can emerge in fungal infections of the lungs, tuberculosis, and other lung infections caused by different organisms.

COPD

Chronic obstructive pulmonary disease (COPD), a chronic and inflammatory disease, results from blocked air flow in the lungs. Chronic bronchitis, a part of COPD, causes a productive cough with colored phlegm.

Blood Pressure Medications

Medications prescribed for high blood pressure can cause coughing in some people.

Other Causes

Other less common factors that can cause chronic cough include:

• Aspiration
• Bronchiectasis
• Bronchiolitis
• Cystic fibrosis
• Backflow of stomach acid into the throat
• Lung cancer
• Non-asthmatic airway inflammation
• Accumulation of inflammatory cells in the lungs
• Chronic scarring in the lungs due to unknown causes

Symptoms of Chronic Cough

Chronic cough can manifest with the following symptoms:

• Coughing up phlegm and blood
• Runny nose
• Nasal congestion
• Heartburn
• Postnasal drip
• Wheezing
• Sore throat
• Shortness of breath
• Frequent throat clearing
• Sore throat

Complications of Chronic Cough

Persistent coughing can be extremely tiring for patients. Chronic cough can lead to various issues including:

• Sleep disturbances
• Headaches
• Dizziness
• Vomiting
• Excessive sweating
• Urinary incontinence
• Rib fractures
• Fainting

Treatment Methods for Chronic Cough

Identifying the cause of chronic cough is crucial for the success of treatment. In many cases, multiple factors cause chronic cough. Smokers need to quit smoking.

People using ACE inhibitors should be switched to another medication without cough as a side effect. Some of the medications used to treat chronic cough include:

• Antihistamines, corticosteroids, and decongestants, which are standard treatments for allergies and postnasal drip
  
  
• The most effective treatments for asthma-related cough are inhaled asthma medications. These medications, which reduce inflammation and open the airways, include corticosteroids and bronchodilators.
  
  
• If chronic cough stems from bacterial, fungal, or mycobacterial infections, antibiotic medications are prescribed.
  
  
• If lifestyle changes do not cure acid reflux, medications to inhibit acid production are prescribed. In some cases, surgery is necessary to resolve the issues.
  
  

Cough Suppressants

In some patients, while identifying the cause of the cough and starting treatment, cough suppressant medications may be prescribed to hasten the improvement of symptoms. Over-the-counter cough medicines do not treat the cause but can help alleviate symptoms.

Moreover, studies on this subject have not proven that cough medicines work better than placebo medications. The use of this group of drugs in children under 2 years of age can lead to serious side effects, including death. In children under 6 years of age, medications other than fever reducers and pain relievers should not be used to treat cough or common cold.

Children aged 2 to 6 should not use over-the-counter medicines for cough and common cold. Furthermore, the use of these medicines is not recommended for children under 12 years of age.