Understanding and Managing Chronic Cough

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:
 

1. Postnasal drip: Excess mucus dripping down your throat from the back of your nose can lead to chronic cough (upper airway cough syndrome).

2. Asthma: This chronic lung disease can cause long-term coughing fits and wheezing when triggered.

3. 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

4. Smoking: Tobacco smoke irritates the airways and increases the risk of chronic cough and more serious lung conditions

5. Tuberculosis: Very common in our country compared to the Western world, frequently remains undiagnosed if not consulted with doctors or not properly investigated

6. 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

7. 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.

8. Medications: Some drugs, like ACE inhibitors for high blood pressure, can cause a persistent cough as a side effect.

9. GERD: Gastroesophageal reflux disease involves stomach acid backing up into your oesophagus, irritating your airways and causing a cough.

10. 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: 

1. Spirometry: a lung function test that measures airflow in and out of the lungs.

2. 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. 

3. Acid reflux tests: measure the acid content in the fluid in the food pipe.

4. Sputum cultures: these tests check the mucus you cough up for bacteria. 

5. Imaging tests (X-rays, CT scans): these scans can help the doctor analyse your chest and airways.

6. Allergy tests: can identify the environmental allergens that trigger the allergic reaction leading to chronic cough.

7. Endoscopy: a flexible instrument with a light fitted at the end is inserted to help look into the gastrointestinal tract.

8. 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 include:

1. For acid reflux: The doctor may suggest lifestyle and diet changes. They may also prescribe medications like antacids or proton pump inhibitors

2. For asthma: Usually inhaled steroids or bronchodilators are prescribed. 

3. For bacterial infections: Antibiotics can help reduce the intensity of pneumonia and whooping cough. 

4. 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

1. Using cough lozenges

2. Avoiding overeating and late-night meals to prevent acid reflux, 

3. Keep your head propped up at 30 degrees to be comfortable also to prevent acid reflux

4. Take antacids if heartburn occurs

5. Using a humidifier or taking steamy showers

6. Trying saline nasal sprays or nasal irrigation

7. 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.