Chronic cough

2021-07-24 12:30 PM

Chronic cough is called for an over eight weeks of cough, this can cause a runny or stuffy nose, wheezing, heartburn or sourness in the mouth, coughing up blood in rare cases.

Define

A chronic cough is called a cough that lasts eight weeks or longer. In addition to being physically disturbed, a chronic cough can alienate family and colleagues, disrupt sleep, and leave behind feelings of anger and frustration.

While it can sometimes be difficult to pinpoint the problem that is causing a chronic cough, the most common causes of a chronic cough are postnasal drip, asthma, and acid reflux - a common symptom of reflux disease gastroesophageal reflux disease (GERD). A chronic cough usually goes away when the underlying problem is addressed.

Symptoms

A chronic cough can occur with signs and symptoms, which may include:

Runny or stuffy nose.

Feeling of liquid running down the back of the throat.

Wheezing and difficulty breathing.

Heartburn or sour taste in the mouth.

In rare cases, there is coughing up blood.

A chronic cough is usually defined as a cough that lasts eight weeks or more, but any persistent cough can be life-threatening. See your doctor if a persistent cough, especially a cough with phlegm or blood, disturbs sleep, or interferes with work or relationships.

Causes

Coughing begins when irritants such as stomach acid, mucus, hair sprays, perfumes, and even many food spices irritate nerves in the respiratory tract.

Frequent coughing is normal, it helps to clear foreign substances and secretions from the lungs and prevent infection. However, a cough that lasts for a long time is often the result of an underlying problem. Examples include:

Postnasal drip

Every day, glands in the nose and sinuses produce mucus that enters the throat, cleaning and moistening the nasal passages. Usually, the secreted fluid is swallowed without knowing it, but when there is more than usual due to allergies, infections, colds, or sinuses it can be felt to accumulate in the back of the throat.

This excess mucus can cause allergies and inflammation that triggers the cough reflex. If the postnasal drip is chronic, the cough can become chronic. Although postnasal drip usually clears up, there may never be any symptoms.

Asthma

It is a common cause of chronic cough in adults and a leading cause in children. Usually, coughing occurs with wheezing and shortness of breath, but in asthma, coughing is only a symptom. The cough is related to the seasons, comes after an upper respiratory infection, or is made worse by exposure to cold air or certain chemicals or perfumes.

Gastroesophageal reflux disease (GERD)

Under unusual conditions, stomach acid flows back into the tube that connects the stomach and throat (esophagus). The constant irritation in the esophagus, throat, and even lungs can lead to a chronic cough. Acid reflux often causes heartburn and acidity, but nearly half of people with reflux have no symptoms of a cough.

Respiratory tract infection

Coughing may persist after the symptoms of a cold, flu, pneumonia, or other upper respiratory tract infections are gone. In some cases, this can happen due to prolonged illness. Sometimes, even when the infection is gone, the airways can remain inflamed and therefore particularly sensitive to irritants.

Blood pressure medication

Angiotensin-converting enzyme (ACE) inhibitor, commonly prescribed for high blood pressure and heart failure, is known to cause a chronic cough in about 20 percent of people taking the drug. Usually, the cough begins within a week of starting treatment, but sometimes it may not be coughed up for up to six months. And the cough usually lasts a few days after stopping the medicine, it can also last up to a month or more.

Chronic bronchitis

Long-term inflammation of the main airways (bronchial tubes) can cause congestion, shortness of breath, wheezing, coughing, and sputum discoloration. Because most people with chronic bronchitis are current or former smokers, coughing is often a sign of damage to the lungs and airways.

Bronchiectasis

This is a serious chronic lung condition in which abnormal enlargement of the bronchial tubes affects the ability of the lungs to clear mucus from the lungs. Pneumonia is nearly always present, although it may not be severe enough. Signs and symptoms include cough and sputum discoloration or blood in the sputum, shortness of breath, and fatigue.

Lung cancer

Only a small percentage of people with chronic cough develop lung cancer, and most are current or former smokers. If the sputum contains blood, see your doctor.

Risk factors

Anyone can develop a chronic cough, but these factors are risk factors:

Smoking

Current or former smoking is one of the leading risk factors for chronic cough. Regular exposure to secondhand smoke can also lead to coughing and lung damage.

Sex

Because women generally have a more sensitive cough reflex, they are more likely to develop a chronic cough.

Complications

A persistent cough may go away. The act of coughing depletes energy reserves and disrupts sleep. A chronic cough can also cause:

Headache.

Dizzy.

Too much sweat.

Unable to flush urine.

Broken ribs, especially in women with fragile bones.

Tests and diagnostics

The top three common causes of chronic cough - postnasal drip, asthma, and acid reflux, doctors can often identify the underlying problem by a response to treatment rather than examination. If the cough is treated for a specific problem, the diagnosis is confirmed. Treatment includes:

Antihistamines and decongestants for postnasal drip.

Inhalers or nasal sprays for asthma.

Medications to reduce acid reflux.

If this method becomes frustrated with testing, one or more of the following tests may be needed:

Chest X-ray. X-ray does not reveal the most common reason of cough, it can be used to check for lung cancer and other lung diseases.
 
Computed tomography (CT scan). CT scans take x-rays from different angles and then combine them to form cross-sectional images. This technique can provide more detail about the lungs. CT scans can also be used to check for cavities and sinus infections.

Lung function test. Simple, non-invasive. Sometimes an exercise test may also be performed when asthma is suspected, in which breathing testing may be performed before and after inhalation of methacholine.

Endoscopic. This test uses a flexible tube, equipped with a light, and a camera to visualize structures inside the body. This procedure uses an anesthetic such as lidocaine sprayed into the nasopharynx. You may be given a sedative or pain reliever to make the procedure less uncomfortable.

Nasal endoscopy. This test involves inserting a small optical cable into the nostrils to evaluate the condition of the lining of the nose and the openings to the sinuses. A CT scan of the sinuses is usually done first.

Gastroesophageal endoscopy. In this test, a scope is passed down the throat into the esophagus to check for signs of acid reflux in the stomach and esophagus.

Bronchoscopy. In this test, a bronchoscope is passed down the windpipe to check the bronchial tubes for signs of infection or blockage.

Treatments and drugs

Treating a chronic cough with a single cause is usually straightforward. When a cough cannot be identified the problem causing it, treatment becomes difficult to resolve.

Antihistamines and decongestants

Antihistamines and decongestants are often combined as standard treatment for allergic conditions and postnasal drip. Newer generation antihistamines may be more effective at treating coughs than older generations without causing drowsiness.

Inhaled corticosteroids

Anti-inflammatory drugs are most effectively treated for asthma and cough-related asthma, but the use of inhaled bronchodilators may also be required. Long-term use of corticosteroids can increase the risk of skin thinning, bruising, osteoporosis, and cataracts.

Medicines to treat acid reflux

When lifestyle changes don't work, treatment with proton pump inhibitors may be needed, which block acid production and allow time for esophageal tissue to heal. Proton pump inhibitor prescriptions include:

Esomeprazole (Nexium).

Lansoprazole (Prevacid).

Omeprazole (Prilosec).

Pantoprazole (Protonix).

Rabeprazole (Aciphex).

When the reason for the cough is not known, your doctor may prescribe a symptomatic cough suppressant or a medication that relaxes the airways in the lungs.

Lifestyle and Remedies

Smoking. Many types of chronic cough are caused or made worse by smoking. Quitting smoking can help significantly, as can avoiding secondhand smoke. Talk to your doctor about a comprehensive smoking cessation program that includes:

Social support.

Nutrition consulting.

Nicotine gum.

Medicine.

Acid reflux. Coughs caused by acid reflux can often be treated with lifestyle changes. These include:

Maintain a healthy weight.

Eat smaller meals and eat more often.

Avoid heartburn triggers like alcohol, chocolate, mint, and fried foods.

Wait 3-4 hours after a meal before lying down.

Raise the head of the bed.

Cough relief. Some over-the-counter products can help control coughs, but don't work for other causes. Examples include:

Rub your breasts with a substance containing camphor or menthol.

Cough syrups, especially those containing dextromethorphan.

Cough drops.

Honey, especially in hot water or tea.