Understanding Chronic Cough: Causes, Treatments, and When to Seek Help
A persistent cough can be more than just an annoyance; it can be a sign of an underlying medical issue that requires attention. If you’ve been dealing with a cough that lasts for 8 weeks or longer, you might have what’s known as a “chronic cough.” Unlike a cough caused by a common cold or respiratory infection, chronic coughs are often more complex and need proper evaluation and treatment.
Here, we’ll explore the potential causes of a chronic cough and the corresponding treatments, ensuring you have the knowledge to address this condition effectively.
Identifying Chronic Cough
A chronic cough, lasting 8 weeks or more, is a significant medical condition that should not be ignored. While it may have initially started as a minor annoyance, a persistent cough warrants a visit to the doctor to determine its cause and receive appropriate treatment.
Common Causes and Their Treatments
The causes of a chronic cough can range from treatable conditions to more serious underlying issues. The choice of treatment depends on the underlying cause:
Postnasal Drip: Also known as upper airway cough syndrome, postnasal drip can lead to a prolonged cough. Allergies, viral infections, dust, chemicals, or inflammation can irritate the nasal passages, resulting in excess mucus that drips down the throat and triggers coughing. This often worsens when lying down.
- Treatment: Decongestants, nasal or oral antihistamines, nasal glucocorticoids, or nasal sprays can be effective treatments based on your symptoms and medical history.
Asthma: Asthma involves the tightening of airway muscles, swelling of airway linings, and increased mucus production. Coughing in asthma is the body’s response to restricted airways, triggered by various factors, including allergies, infections, smoke, medications, exercise, and emotions.
- Treatment: Standard asthma treatments typically include inhaled glucocorticoids to reduce airway inflammation and bronchodilators to open up airways, especially if wheezing or shortness of breath is also present.
Infections: Coughs may persist even after recovering from respiratory infections like colds, flu, COVID-19, or pneumonia. Pertussis (whooping cough) can be an overlooked cause of chronic cough, requiring a blood test to measure immunity.
- Treatment: Infections often require time to heal as the lungs recover and regenerate cough receptors. In some cases, antibiotics may be prescribed.
Gastroesophageal Reflux Disease (GERD): GERD occurs when stomach acid flows back into the esophagus due to a weak esophageal muscle, potentially reaching the lungs and causing irritation.
- Treatment: Lifestyle changes like avoiding acid-inducing substances, weight loss, smoking cessation, and proton pump inhibitor medications can help. Relief may take several weeks, and further testing may be necessary if the cough persists.
Blood Pressure Drugs: Some individuals using angiotensin-converting enzyme (ACE) inhibitors for high blood pressure may experience a chronic, dry, hacking cough as a side effect.
- Treatment: Adjusting the medication or switching to an alternative can resolve this side effect.
Smoking: Smoking damages the lungs, often leading to a persistent cough as the body tries to eliminate harmful substances. This is commonly referred to as the “smoker’s cough.”
- Treatment: While quitting smoking is essential for overall health, the cough may not clear up immediately or at all, as the lungs need time to repair themselves.
Chronic Obstructive Pulmonary Disease (COPD): COPD encompasses conditions like emphysema, chronic bronchitis, and chronic obstructive asthma, making it challenging to breathe and leading to excessive mucus production and coughing.
- Treatment: COPD can be managed with rescue inhalers, inhaled or oral steroids, and oxygen therapy when necessary.
Lung Cancer: While less common, lung cancer can manifest as a persistent cough, particularly if located in the airway’s less-sensitive parts.
- Treatment: Depending on the size and location of the cancer, treatment may involve surgery, chemotherapy, radiation therapy, targeted drug therapy, or immunotherapy.
Diagnosing the Cause of a Chronic Cough
To identify the underlying cause of your chronic cough, your doctor will conduct a thorough assessment, including:
- Evaluating when the cough began.
- Identifying potential triggers.
- Assessing the presence of phlegm, mucus, or blood in your cough.
- Inquiring about recent contact with individuals with similar symptoms or respiratory infections.
- Inquiring about smoking history, allergies, postnasal drip, and new medications.
- Physical examination, including listening to your lungs and heart.
Depending on your symptoms, your doctor may suggest a trial treatment. If the cough improves, further testing may not be necessary. However, if the cough persists or the diagnosis remains unclear, additional tests may be recommended:
- Throat swab for infection testing.
- Blood tests to assess immune responses.
- Chest X-ray or CT scan, especially for those with a history of smoking or other lung-affecting conditions.
- Lung function tests, such as spirometry or bronchoprovocation tests, to evaluate lung function and reactivity.
- Acid reflux testing, including pH monitoring and upper endoscopy, if acid reflux is suspected.
When to Seek Medical Attention
Coughing is a common symptom that can be caused by a variety of factors, including infections, allergies, asthma, or even irritants in the air. While many coughs are temporary and resolve on their own, there are times when it’s important to consult your doctor. It’s important to note that over-the-counter (OTC) medicines can provide temporary relief for coughs, but they should not be used as a substitute for professional medical advice, especially when certain warning signs or symptoms are present. Most common brands includes the following:
There are several over-the-counter (OTC) cough medicines available, each with different active ingredients targeting various types of coughs. Here are some common OTC cough medicine brands and their corresponding scientific names:
- Dextromethorphan (DXM): Robitussin, Delsym, Vicks DayQuil Cough
Dextromethorphan is the active ingredient used in these cough medicines to suppress coughing. It is commonly used for dry or unproductive coughs.
Guaifenesin: Mucinex, Robitussin Mucus + Chest Congestion
Guaifenesin is an expectorant that helps thin and loosen mucus in the airways, making it easier to cough up phlegm.
- Phenylephrine: Sudafed PE Cough, Theraflu
Phenylephrine is a decongestant commonly found in combination products to relieve coughs associated with nasal congestion.
- Benzonatate: Tessalon Perles
Benzonatate is a non-narcotic cough suppressant that helps relieve coughing by numbing the throat and lungs’ sensory nerves.
While primarily an antihistamine used for allergies and sleep aid, diphenhydramine can also help relieve coughs caused by allergies or postnasal drip.
- Chlorpheniramine: Coricidin HBP Cough & Cold
Chlorpheniramine is another antihistamine that can help alleviate coughs associated with allergies.
- Pseudoephedrine: Sudafed (Note: This is a decongestant often found in combination products for cold and cough relief)
Pseudoephedrine is used to relieve nasal congestion, which can indirectly help ease coughing due to mucus buildup.
Please note that the availability of specific brands and their active ingredients may vary depending on your location and local regulations. Additionally, it’s essential to read the label and follow the dosing instructions carefully when using OTC cough medicines, as improper use can lead to side effects or interactions with other medications you may be taking. If you have any doubts or concerns about which OTC cough medicine to use or if your cough persists or worsens, consult with a healthcare professional for guidance and personalized recommendations.
If you experience a persistent cough that lasts for more than a few weeks, it’s advisable to reach out to your doctor. Chronic coughs can be indicative of underlying health conditions such as chronic bronchitis, asthma, or gastroesophageal reflux disease (GERD). These conditions may require specific treatments or lifestyle adjustments, and your doctor can help you determine the appropriate course of action.
Another crucial factor to consider is the nature of your cough. If your cough produces green or yellow mucus, blood, or a foul-smelling discharge, this can be a sign of a bacterial infection, which might necessitate antibiotics. Additionally, if you develop a high fever along with your cough, it could indicate a more severe infection, such as pneumonia, and requires prompt medical attention. OTC cough medicines with brand names like Robitussin or Mucinex may provide some relief from the symptoms but should not be relied upon exclusively.
Coughing that is accompanied by chest pain or difficulty breathing can be a cause for concern and should be evaluated by a healthcare professional. These symptoms may be associated with conditions like pleurisy, pneumothorax, or pulmonary embolism, which require immediate medical intervention.
Furthermore, if you have a persistent cough and a history of smoking or exposure to environmental toxins, it’s essential to consult your doctor for a thorough evaluation. Coughing can be an early sign of lung diseases such as chronic obstructive pulmonary disease (COPD) or lung cancer, and early detection can significantly impact the success of treatment.
In summary, while over-the-counter cough medicines can provide relief from cough symptoms, they should be used with caution and not as a replacement for professional medical advice. If you have a persistent cough, especially one accompanied by concerning symptoms such as chest pain, difficulty breathing, fever, or changes in the color or consistency of mucus, it’s crucial to contact your doctor promptly. Your healthcare provider can conduct a comprehensive evaluation, diagnose the underlying cause, and recommend appropriate treatments or interventions to address your specific condition and provide relief from your cough.