CHRONIC COUGH
 

A chronic cough is usually defined as a cough that lasts more than eight weeks in adults and four weeks in children. Chronic coughing is the second most common reason to seek a doctors care.

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Causes

There are several medical conditions that are linked to a chronic cough. These include:

  • Asthma:  Asthma causes your airways to become inflamed and constricted.  This can result in coughing due to the airways hyperreactivity.  

  • Bronchiectasis:  This condition causes inflammation and thickening of the airways in addition to the production of copious amounts of mucus.  Coughing can result from trying to clear the mucus from your airways.

  • Bronchitis:  This condition causes swelling in the bronchial tubes and increased mucus production.  Both the swelling and mucus production can cause coughing.  Bronchitis can be both an acute and a chronic condition.

  • Chronic obstructive pulmonary disease (COPD):  COPD is actually a term that refers to a group of respiratory issues that includes chronic bronchitis and emphysema.  

  • Upper respiratory infections:  These infections are generally caused by viruses. Coughing is one symptom that tends to last even after the infection has cleared.

  • Allergies:  Allergies can cause coughing from airway sensitivity and a post nasal drip.

  • ACE inhibitors:  This class of drugs is used to treat hypertension.  A well known side effect of these drugs is the development of a chronic, dry cough.

  • Acid reflux:  Acid from the stomach makes it's way up the esophagus and into the throat.  This can cause chronic coughing and a hoarse voice. 

If you have a chronic cough and you take one of these medications, you shouldn’t just stop taking the medication on your own. Talk with your healthcare provider about what’s going on. They'll probably be able to recommend a different medication.

Symptoms

Symptoms may include:

  • Nasal congestion

  • Post nasal drip

  • Shortness of breath or wheezing

  • Heartburn

  • Sore throat or frequent throat clearing

  • Fever (higher than 101°F)

Serious symptoms include:

  • Weight loss without any effort

  • Coughing up blood

  • A hoarse voice that does not go away

  • A drenching overnight sweat

 

COMPLICATIONS

The most obvious complication is that you can become extremely tired because you can't sleep.  

You might also have:

  • Headache

  • Dizziness

  • Loss of bladder control

  • Minor bleeding in the eye

  • Hernia

  • Fainting or passing out (syncope)

DIAGNOSIS

Diagnosis starts with a thorough history and physical exam.  Your provider will ask questions like when the coughing started, what seems to trigger the cough, and questions about the nature of the cough (like is it a dry cough or does it produce mucus). The answers will suggest what kind of testing is needed.

  • Lab tests:  Different lab tests may be able to provide clues to different causes of the coughing.  They may be able to indicate an infection or high inflammatory markers.

  • Pulmonary function study:  This test evaluates the function of the lungs.  The results will clue the provider in to issues that may be present such as airway obstruction or restrictive lung disorders.

  • X-ray:  An X-ray takes a picture of the lungs and heart and could show things like congestion, inflammation, hyperinflation, or increased tissue density.

  • CT scan:  This provides more detailed imaging that can help to evaluate tissues in greater detail.

  • Bronchoscopy:  A physician will use a camera to go into the lungs and evaluate the lungs under direct observation.  This allows for the investigation of any areas of suspicion in addition to the ability to biopsy tissue to evaluate those suspicious areas.

TREATMENT

Treatment will depend on the cause of the cough.  

  • Asthma / COPD / Bronchiectasis / Bronchitis:  These will all be treated using a combination of bronchodilators, steroids, and airway clearance techniques.  

  • Allergies:  Allergies will be treated by trying to reduce symptoms through the use of antihistamines, steroids, and possibly bronchodilators.  Avoidance of triggers will also be recommended.

  • Upper respiratory infections:  If the cause is bacterial, antibiotics may be used.  In the case of viral infection, symptoms will be treated while the infection is resolving.

  • ACE inhibitors:  If it is determined that the most likely cause of your cough are ace inhibitors, your physician may look to change to a different class of medication to address hypertension.

  • Acid reflux:  In the case of acid reflux, your physician will prescribe a medication to reduce the acidity in your stomach.  In addition, losing weight (if over-weight) and eating a clean diet will be recommended.

Cough suppressants are always a consideration in managing a cough.  Ideally, the underlying cause of the cough should be addressed as opposed to relying on cough suppressants long term.

 

PREVENTION

 

To prevent chronic cough:

  • Quit smoking, as it is the most common reason for chronic cough.

  • Practice good hand hygiene and minimize contact with people you know to be sick.

  • A proper diet can help to prevent many causes of chronic coughing.  More specifically, a diet high in fruits and vegetables.

WHEN TO SEEK MEDICAL ATTENTION

 

Call your doctor if you are:

  • Coughing up blood

  • Wheezing and short of breath

  • Running a fever (temperature greater than 101°F)

  • Losing weight without trying

  • Having a drenching sweat overnight

CHRONIC COUGH EDUCATION VIDEO