Chronic Cough

Chronic Cough

Chronic cough refers to a persistent cough lasting more than 8 weeks in adults or more than 4 weeks in children. A chronic cough is more than just an annoyance — it can severely impact quality of life by disturbing sleep, causing fatigue upon waking, and even leading to complications such as dizziness, nausea, or fractured ribs from intense coughing.

In some cases, identifying the exact causes of chronic cough can be challenging. However, common triggers include smoking, allergies, acid reflux (GERD), and postnasal drip. Once the underlying cause is properly diagnosed and treated, chronic cough symptoms often improve significantly or resolve completely.

If you are experiencing a chronic cough, early consultation with a healthcare professional is key to finding effective relief.

What Are the Symptoms of Chronic Cough? Signs You Shouldn’t Ignore

Chronic cough is a persistent condition that may signal underlying health problems. If you experience chronic coughing lasting more than 8 weeks, it’s important to watch for the following symptoms:

• Persistent runny nose, nasal congestion, or mucus production
• Itchy throat or frequent sore throat
• Hoarseness or voice changes
• Wheezing or shortness of breath
• Sour taste in the mouth or a burning sensation in the chest (often related to acid reflux)
• Coughing up blood (rare but serious)

Proper evaluation of chronic cough symptoms is crucial for accurate diagnosis and effective treatment. If you notice any of these warning signs, consult a healthcare professional promptly.

When Should You See a Doctor for a Chronic Cough?

• When you have been coughing for several consecutive weeks, particularly with mucus and phlegm or blood, or when the symptoms worsen your sleep quality and school or work performance.

Causes of Chronic Cough: Factors Behind Persistent Coughing

Chronic cough can be caused by various underlying conditions, including:

• Nasal and Sinus Conditions: Excess mucus production can drip down the throat, triggering a persistent cough.
• Asthma: Coughing related to asthma often occurs intermittently and may be worsened by weather changes, pollution, irritants, or cold air.
• Allergies: Environmental allergens, such as cold air or pollutants, can aggravate coughing in individuals with allergies.
• Gastroesophageal Reflux Disease (GERD): Acid reflux from the stomach into the esophagus can irritate the throat and cause chronic coughing.
• Infections: Following a cold or respiratory infection, coughing may persist even after the primary illness has resolved.
• Whooping Cough (Pertussis): Often overlooked in adults, whooping cough can be a common cause of chronic cough.
• Lung Infections: Conditions like tuberculosis or fungal infections in the lungs can lead to chronic cough, particularly in cases associated with Long COVID.
• Chronic Obstructive Pulmonary Disease (COPD): Diseases like chronic bronchitis and emphysema are marked by persistent coughing, mucus production, and difficulty breathing.
• Blood Pressure Medications: Use of ACE inhibitors, commonly prescribed for hypertension, may cause chronic cough as a side effect.

Understanding the underlying cause of a chronic cough is essential for effective diagnosis and treatment. If you experience persistent coughing, consult a healthcare professional for a thorough evaluation.

Other less common causes of chronic cough include:

• Food aspiration in adults or foreign bodies in children
• Bronchiectasis 
• Bronchiolitis 
• Cystic fibrosis
• Idiopathic pulmonary fibrosis 
• Laryngopharyngeal gastric reflux 
• Lung cancer
• Nonasthmatic eosinophilic bronchitis 
• Sarcoidosis

Risk Factors for Chronic Cough: The Impact of Smoking and Secondhand Smoke

One of the primary risk factors for chronic cough is smoking. Prolonged exposure to secondhand smoke also significantly increases the risk of developing a chronic cough. Both smoking and secondhand smoke can irritate the airways, damage lung tissue, and trigger persistent coughing. Understanding these risk factors for chronic cough is essential for prevention and early treatment. Avoiding smoking and minimizing exposure to secondhand smoke are key steps in reducing the chances of developing a chronic cough.

Complications from Chronic Cough

Chronic cough can lead to several complications and other associated symptoms, including:

• Headaches
  Persistent coughing can result in tension headaches or migraines.
• Dizziness or Vomiting
  Intense coughing can trigger dizziness or even nausea and vomiting.
• Sleep Disturbances
  Chronic cough may interfere with sleep, leading to insomnia or poor sleep quality.
• Fainting or Lightheadedness
  Coughing fits can cause dizziness or fainting, especially if they strain the body excessively.
• Rib Fractures
  Severe coughing episodes may cause cracked or fractured ribs due to the intense force exerted during coughing.
• Urinary Incontinence
  Persistent coughing can lead to stress incontinence, causing difficulty controlling urination.
• Excessive Sweating
  Chronic cough may also cause abnormal sweating, especially during coughing spells.

Persistent coughing can significantly impact daily life and overall well-being, and it is important to seek medical treatment as soon as possible to prevent complications.

How to Diagnose Chronic Cough

Diagnosing chronic cough begins with a detailed medical history and physical examination to identify the underlying cause. If the initial treatment does not improve symptoms, further diagnostic tests may be required to determine the exact cause.

1. Diagnostic Tests for Chronic Cough:
   • Chest X-ray: A chest X-ray is used to diagnose conditions like lung infections, lung cancer, or other pulmonary diseases. However, it cannot diagnose conditions like asthma, gastroesophageal reflux disease (GERD), or mucus production.
   • Sinus X-ray: This is used to diagnose sinusitis or sinus infections.
2. CT Scan (Computed Tomography):
   A CT scan helps in diagnosing chronic cough and sinusitis, providing detailed images of the lungs and sinuses for better assessment.
3. Pulmonary Function Test:
   • Pulmonary function tests, such as spirometry, assess lung function and can help diagnose asthma or chronic obstructive pulmonary disease (COPD).
   • A methacholine challenge test is often used to diagnose asthma by measuring lung function before and after administering methacholine.
4. Laboratory Tests:
   If the mucus is yellow or green, the doctor may order a bacterial culture test to identify any bacterial infection.
5. Endoscopy:
   • Bronchoscopy: This procedure involves using a bronchoscope to examine the lungs and airways. It may include a biopsy to diagnose lung conditions or infections.
   • Nasal Endoscopy: This is used to examine the nasal passages, sinuses, and upper airways using a fiber-optic camera.
6. Diagnostic Approach for Children:
   For pediatric patients, doctors typically use chest X-rays and spirometry to diagnose chronic cough and assess lung function in children.

Effective Treatment for Chronic Cough

Treating chronic cough begins with identifying the underlying cause, as it may result from various factors, such as underlying health conditions or lifestyle habits like smoking.

Treatment Based on the Cause of Chronic Cough:

• Quit Smoking: If smoking is a factor, your doctor may recommend a smoking cessation program to help reduce coughing and improve lung health.
• Adjust Medications: For patients on ACE inhibitors (ACEI) that may cause chronic cough, your doctor may recommend switching to alternative medications.
• Medications for Chronic Cough:
  • Antihistamines and Decongestants: These can help relieve symptoms of allergies and clear mucus.
  • Asthma Medications: For those with asthma-induced cough, medications like corticosteroids and bronchodilators may help reduce inflammation and open airways.
  • Antibiotics: If the cough is caused by bacterial infections, fungal infections, or tuberculosis, antibiotics may be prescribed.
• Treating Acid Reflux (GERD): For a cough caused by acid reflux, medications to suppress stomach acid production may be prescribed. In some cases, surgery may be necessary.
• Specialized Treatment: If the chronic cough is related to a specific respiratory condition, it is important to consult a pulmonologist or respiratory specialist for targeted treatment.

Cough Suppressants:

In some cases, doctors may prescribe cough suppressants to provide temporary relief while diagnosing and beginning treatment.

• Over-the-Counter Medications: OTC medications can help alleviate cough and cold symptoms but do not treat underlying conditions. Research has shown that cough medications are often no more effective than placebos and may have significant side effects, especially in children under 2 years old.

Advice for Children:

• Cough and Cold Medications: It is not recommended to give children under 6 years old any medication other than fever reducers and pain relievers. Parents should also exercise caution when giving medications to children under 12.

Self-Care Tips for Chronic Cough with Mucus and Sore Throat

Self-care at home can help relieve symptoms of chronic cough with mucus and a sore throat. It’s important to follow your doctor's recommendations to reduce discomfort and aid in recovery.

How to Care for Yourself at Home:

• Drink Warm Liquids:
  • Drink warm beverages like tea, fruit juice, or clear broth to soothe a sore throat and help clear mucus.
• Take Lozenges for Sore Throat:
  • Sucking on lozenges can help relieve a sore throat and dry cough.
• Consume Honey:
  • Honey can soothe a cough, but should not be given to children under 1 year of age due to the risk of harmful bacteria.
• Use a Humidifier:
  • Use a humidifier in your room or take a warm shower and inhale steam to keep your airways moist.
• Avoid Smoking:
  • Refrain from smoking or inhaling secondhand smoke, as it can irritate your lungs and worsen coughing. If you smoke, consult your doctor about quitting strategies.

Additional Recommendations:

Self-care measures can alleviate chronic cough symptoms, but if your symptoms worsen or don’t improve, it’s important to consult a doctor for a proper diagnosis and treatment.

How to Prepare for a Doctor's Visit for Chronic Cough

Proper preparation before seeing a doctor is crucial for effective diagnosis and treatment. If you’re experiencing chronic cough, it’s important to gather key information ahead of your appointment. Here’s what you should prepare:

Things to Record Before Seeing Your Doctor:

• Detailed Symptoms:
  Include the duration and severity of your cough.
• Your Medical History:
  Note any chronic conditions that might be related to your chronic cough, such as asthma or GERD.
• Family Medical History:
  Mention any family history of conditions like asthma, lung disease, or allergies.
• Medications and Supplements:
  List all medications and supplements you’re currently taking.
• Smoking Habits:
  Note if you currently smoke or have smoked in the past.
• Questions for Your Doctor:
  Prepare any additional questions or concerns you have about treatment options or lifestyle changes.

Questions Your Doctor May Ask You:

• What are your symptoms, and when did they start?
• Have you had a cold, fever, or COVID-19 in the past week?
• Do you smoke or have you ever smoked?
• Do you inhale secondhand smoke at home or work?
• Is there dust or chemical exposure at your home or workplace?
• Do you experience chest burning or heartburn?
• Do you cough up blood or mucus? What color is the mucus?
• Are you currently on any medication for high blood pressure?
• When did you first start coughing?
• What makes the coughing better or worse?
• Do you experience shortness of breath or wheezing in cold weather?
• Have you traveled recently?

Why Preparation is Important:

Having detailed information ready will help your doctor diagnose and treat your chronic cough more efficiently and accurately.

FAQ

• What is chronic cough?
  A chronic cough is a cough that lasts for more than 2 months in adults and more than 1 month in children.
• What causes chronic cough?
  Common causes include smoking, allergies, acid reflux, asthma, and respiratory infections such as the common cold or pneumonia.
• How is chronic cough treated?
  Treatment depends on the cause. For acid reflux, acid-suppressing medications may be used. For allergies, antihistamines or corticosteroids may be prescribed.
• When should I see a doctor for a chronic cough?
  If the cough lasts longer than 2 weeks, produces phlegm, or includes blood, you should see a doctor to identify the cause and receive proper treatment.
• How can I manage chronic cough at home?
  Drink warm liquids, use a humidifier, avoid smoking, and use throat lozenges to help relieve coughing.