Chronic Cough
We understand that dealing with a chronic cough can be an annoying and frustrating experience. Fortunately, we have different treatments that may help alleviate your cough. Listed below are some information that can help you better understand your chronic cough.
We define cough to be either:
- An “Acute” cough lasting less than 2-3 weeks (most likely due to a common cold); or
- A “Chronic” cough lasting for 3 weeks or more
In patients with a normal chest x-ray, 95% of chronic cough is caused by one or more of the following three problems: postnasal drip, asthma and gastroesophageal reflux disease.
Postnasal Drip (PND)
PND is the most common cause of cough. It may be caused by a recent cold, within the past 6 weeks. Other symptoms associated with PND may include:
- a feeling of mucous dripping into the throat
- frequent throat clearing
- nasal congestion or discharge
- hoarseness
PND is usually treated with an oral antihistamine and a nasal spray to decrease mucous production in the back of the nose. It is important to understand that newer, nonsedating antihistamines (such as fexofenadine or Allegra and loratadine or Claritin) seldom relieve cough in patients with PND since they do not dry secretions. These newer antihistamines may be useful for patients with true allergic PND, but that is a less common cause of chronic cough.
Nasal steroid sprays rarely are effective by themselves in treating chronic cough from PND. The sinuses need to be pretreated with Kaiser Permanente’s saline flush kit (flushing mucus out of the sinuses before applying nasal steroids) or else the nasal steroid sprays merely coat the mucus and do not work.
Asthma
Asthma is the second most common cause of chronic cough. In some patients, cough is the only symptom of asthma (“cough variant asthma”). Other patients may have wheezing, shortness of breath, and a feeling of tightness in the chest. Adult onset asthma is fairly common and can come and go with colds, changes in the weather, or high pollen seasons.
Cough due to asthma usually goes away when the asthma is effectively treated. Asthma is usually treated with one or more inhaled medicines.
Gastroesophageal Reflux Disease (GERD)
Stomach contents can travel back up the swallowing tube and irritate the airway opening or even get into the bronchial tubes, causing cough, chronic bronchitis and/or asthma
GERD may be difficult to diagnose. Many patients with GERD-related cough do not have typical “indigestion” symptoms such as heartburn, sour taste, or regurgitation.
Treatment of GERD includes dietary restrictions (giving up caffeine, chocolate, alcohol and spicy foods), elevating the head of the bed, and the use of medicines to decrease the production of stomach acid. These therapies may take several weeks to have a full effect on GERD-related cough.
Chronic Bronchitis
Chronic bronchitis is especially common in smokers because tobacco smoke irritates the airways and damages the body’s normal ways of clearing mucus. Quitting smoking is the only effective treatment for chronic bronchitis in a smoker.
Because smokers often “expect to cough,” they may not seek medical attention for a cough that persists. Smokers should contact their physician if they notice a change in their coughing pattern, or any sign of blood in their sputum.
Bronchiectasis is an uncommon disease of the airways in which some of the bronchial passages are widened and bacteria can grow in these areas more easily. This condition is seen in patients with cystic fibrosis and may be seen in a much milder form in patients who have a history of multiple pneumonias or childhood respiratory infections. Bronchiectasis is usually characterized by chronic cough with periods of increased mucus production. It is diagnosed by plain chest x-ray or CT scan.
Lung Cancer
Lung cancer is an uncommon cause of chronic cough in nonsmokers. A new cough in a smoker or ex-smoker should be evaluated within the first month by chest x-ray.
ACE Inhibitor-Induced Cough
Angiotensin-converting enzyme (ACE) inhibitors are blood pressure-lowering drugs that cause chronic cough as a side effect in up to 10% of patients. The cough is typically dry and hacking. Stopping the medication causes the cough to improve or resolve within a month.
Habit Cough
Frequent throat clearing may be done out of habit or in the setting of anxiety or personal stress.. Medical treatment is not necessary.
Interstitial Lung Disease
Inflammation or scarring of the lungs is an uncommon cause of cough that may be seen in the setting of some medications (such as Amiodarone or Macrodantin) or rheumatologic illnesses (such as Rheumatoid Arthritis or Scleroderma). Often the underlying reason for the inflammation is unknown (“idiopathic”.) This condition is diagnosed by chest x-ray and/or CT scan.
