Good Health Tips: The Chronic Cough
Brought to you by the Medical Staff of Saint Anthony’s Health Center
November, 2011
By Manju Ramchandani, M.D.
Family Practice Physician | Saint Anthony’s Physician Group | 618.462.2222
An occasional cough is the body’s way of clearing foreign substances and secretions from the lungs and airways. When you have an upper respiratory infection such as a cold, coughing is normal and may last several weeks.
A chronic cough, one lasting eight weeks or longer, is another matter. It can disrupt your sleep and that of your bed partner. And eventually, it can affect your work and your relationships.
There are many reasons a cough may linger, some serious and others not so serious. But if a lingering cough is bothering you or your colleagues, it’s a good idea to see your doctor and find out what’s causing it.
FOREIGN OBJECT: One relatively rare reason for a persistent cough, particularly in a child, is a foreign object that has become trapped in the lungs. An x-ray is a simple way to rule out this cause.
A SMOKER’S COUGH: Cigarette smoking is the most common reason for a chronic cough, but most smokers fail to acknowledge the cough or brush if off as “a smoker’s cough.”
Damage to the lungs and air passages starts to occur long before the development of lung cancer or emphysema, and coughing is one of the major signs.
A change in the pattern of a cough is an ominous sign that should not be ignored.
Even persons exposed to second-hand smoke can have a smoker’s cough. But if you’re a non-smoker with normal chest x-rays, these are some of the most common reasons for a chronic cough:
POST-NASAL DRIP: The mucus glands in your nose, sinuses and throat are constantly producing secretions to moisturize your nasal passages. You ordinarily swallow the excess without noticing it.
Allergies, a cold or a sinus infection can cause more than the usual amount of secretions to occur. And when these accumulate in the back of the throat, the result is an urge to cough. As long as the drip continues, so will the need to cough.
For allergic post-nasal drip, combination treatment with antihistamines and decongestants may help, but the antihistamines that are most effective are the older ones that also are likely to make you drowsy.
UPPER RESPIRATORY TRACT INFECTION: When you’re recovering from a cold, the flu or pneumonia, the cough is usually the last symptom to go.
If an infection has occurred in the sinuses as an effect of the illness, it may result in continuing post-nasal drip. Even if the initial infection was viral, this secondary infection may be bacterial, and that’s why doctors may prescribe antibiotics during the lingering tail end of a cold.
In many cases, however, the coughing continues after the infection has cleared. The airways remain inflamed from the infection and become even more inflamed from the constant coughing. Even a slight irritant can prolong the cough, creating a vicious cycle – the more you cough, the more you need to cough. In such cases, a cough suppressant may help.
ASTHMA: You probably associate asthma with wheezing and shortness of breath, sometimes accompanied by coughing. In one type of asthma, known as cough-variant asthma, the only symptom is a dry cough, often occurring at night.
This asthma-related cough is likely to come and go, getting worse during certain seasons of the year. As with other types of asthma, triggers may include exposure to cold air, certain chemicals or perfumes.
The diagnosis of cough-variant asthma is usually made when the patient responds favorably to asthma medications such as bronchodilators and inhaled corticosteroids.
GASTROESOPHAGEAL REFLUX DISEASE (GERD): GERD occurs when stomach acid backs up into the esophagus because of a weak or faulty sphincter muscle. The sensation in the esophagus is known as heartburn, but coughing, wheezing and chest pain may also occur.
In some individuals, cough, rather than heartburn, is the dominant or only symptom of GERD. Again, if the patient’s cough responds to medications commonly used to treat heartburn, then GERD is assumed to be the cause.
PNEUMONIA, WALKING PNEUMONIA: What doctors refer to as a “productive cough” is one that produces a greenish or rust-colored mucus. A productive cough, along with fever, chills, chest pain, weakness, fatigue and nausea may be a sign of pneumonia, a serious illness.
With treatment, pneumonia usually clears within two to three weeks, but the cough may linger for much longer.
“Walking pneumonia” is a relatively mild lung infection, more like a bad cold or the flu, usually caused by mycoplasma bacteria. As the name suggests, symptoms are mild enough that the patient is able to walk around, maybe even work. But the cough may be severe and persistent.
BRONCHIECTASIS is a serious lung condition that often follows even a mild bout of pneumonia. It involves abnormal widening of the bronchial tubes, impairing their ability to clear mucus from the lungs. Symptoms of bronchiectasis include shortness of breath, fatigue and coughing up discolored sputum or blood.
A chronic cough is not a disease but a symptom and should not be ignored. Those who harbor a cough for months or years may not be aware of the toll it is exacting from them in terms of energy. It may be a factor in fatigue, headaches, dizziness and even urinary incontinence. In many cases, the coughing itself causes a chronic irritation that leads to more coughing.
Studies of chronic cough patients have found that, in nearly every case, a specific cause – and a remedy – can be found.
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