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Reviewed by

Dr. Debraj Jash

Head of the Department - Pulmonology (Respiratory and Sleep Medicine)

Manipal Hospitals, Salt Lake

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Understanding and Managing Chronic Cough

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A cough can be pesky, making you feel like your lungs are working overtime to expel foreign particles from your airways. A cough is a vital protective reflex that prevents the entry of foreign bodies (aspiration) into the lungs. More recent guidelines have adopted 8 weeks in adults and 4 weeks in children to define chronic cough. Continuous coughing can significantly affect your life, keeping you awake at night and hindering your social and work life. The global prevalence of chronic cough in the general adult population is approximately 10%.

Causes of Chronic Cough

Viruses, allergies, or bacteria typically cause coughs. However, these culprits sometimes overstay their welcome, potentially causing damage that leads to a cough and itchy throats that last a long time. Other factors like smoking and long-term acidity can also contribute to chronic cough development. Common chronic cough causes include:

Postnasal drip: Excess mucus dripping down your throat from the back of your nose can lead to chronic cough (upper airway cough syndrome).
Asthma: This chronic lung disease can cause long-term coughing fits and wheezing when triggered.
Chronic Obstructive Pulmonary Disease (COPD): Third leading cause of death worldwide, prevalence increases with age, common for age >40 years, more common for people >60 years of age
Smoking: Tobacco smoke irritates the airways and increases the risk of chronic cough and more serious lung conditions
Tuberculosis: Very common in our country compared to the Western world, frequently remains undiagnosed if not consulted with doctors or not properly investigated
Tumour inside airways: Elderly patients, less frequently younger patients may present with cough with blood-stained sputum, the possibility of an intra-airway tumour should be remembered
Non-resolving pneumonia due to Foreign body: Elderly patients with non-resolving cough and persistent pneumonia can not give proper history many times, and aspiration of food material, betel nuts, peas, and meat bones many times causes such a scenario.
Medications: Some drugs, like ACE inhibitors for high blood pressure, can cause a persistent cough as a side effect.
GERD: Gastroesophageal reflux disease involves stomach acid backing up into your oesophagus, irritating your airways and causing a cough.
Neurological conditions: Patients with a weak cough reflex, often due to neurological conditions, frequently experience repeated aspiration (inhaling food or liquids into the lungs). This causes chronic cough and is mistaken for chest infections

Some lesser-known causes of chronic cough include:

Sarcoidosis
Pertussis (whooping cough) infection
Cystic fibrosis

Accompanying Symptoms

While the most apparent symptom of a chronic cough is continuous coughing, sometimes there may be other accompanying signs, based on the cause. These include:

Shortness of breath
Heartburn
Hoarse voice
Wheezing and breathing
Blood-tinged sputum or coughing up blood
Runny or stuffy nose
Sore throat
Night sweats
High fever
Dizziness or fainting
Persistent chest pain
Unexplained weight loss
If a chronic cough is not addressed, it could lead to complications such as:
Headaches
Fainting
Anxiety
Sleep loss
Vomiting
Muscle pain and soreness
Broken ribs

Diagnosis of Chronic Cough

When you visit a doctor, they will perform a physical examination and ask about your cough and related symptoms.

Based on the symptoms they may request tests such as:

Spirometry: A lung function test that measures airflow in and out of the lungs.
Bronchoscopy: A flexible instrument with a camera at the end is inserted to help look inside the airways. This is especially necessary for elderly patients with non-resolving pneumonia.
Acid reflux tests: Measure the acid content in the fluid in the food pipe.
Sputum cultures: These tests check the mucus you cough up for bacteria.
Imaging tests (X-rays, CT scans): These scans can help the doctor analyse your chest and airways.
Allergy tests: These tests can identify the environmental allergens that trigger the allergic reaction leading to chronic cough.
Endoscopy: A flexible instrument with a light fitted at the end is inserted to help look into the gastrointestinal tract.
Blood tests: Look for possible infections or allergens in the blood.

Treatment Options for Chronic Cough

The doctor will formulate treatments depending on what is causing the chronic cough. Some common treatment strategies for chronic cough include:

For acid reflux: The doctor may suggest lifestyle and diet changes. They may also prescribe medications like antacids or proton pump inhibitors
For asthma: Usually inhaled steroids or bronchodilators are prescribed.
For bacterial infections: Antibiotics can help reduce the intensity of pneumonia and whooping cough.
For postnasal drip: Decongestants, antihistamines and steroid nasal sprays reduce the mucus buildup due to allergies in the nasal cavity and open up the airways.

Home Remedies

You can also incorporate some home remedies to reduce chronic cough along with the prescribed therapies. Some of these include:

Drinking plenty of water and warm liquids
Using cough lozenges
Avoiding overeating and late-night meals to prevent acid reflux
Keep your head propped up at 30 degrees to be comfortable also to prevent acid reflux
Take antacids if heartburn occurs
Using a humidifier or taking steamy showers
Trying saline nasal sprays or nasal irrigation
Quitting smoking

Conclusion

Don't ignore a chronic cough. While a cough is just a symptom, a persistent cough can sometimes indicate a serious underlying condition. Consult a chest physician/pulmonologist as soon as possible for proper diagnosis and treatment if your cough persists for more than a few weeks. The experts at the Department of Pulmonology at Manipal Hospitals, Salt Lake, Kolkata, can help determine the cause of your cough and develop an effective management plan.