Chronic Cough

• Chronic cough is a cough that persists over time. Chronic cough is not a disease in itself, but rather a symptom of an underlying condition.
• Causes and risk factors for chronic cough include:
  • smoking,
  • chronic bronchitis,
  • common colds,
  • flu,
  • emphysema,
  • dry mouth,
  • asthma,
  • allergies,
  • hay fever (allergic rhinitis),
  • sinus problems and post-nasal drip,
  • GERD,
  • cystic fibrosis,
  • whooping cough (pertussis)
  • infections,
  • medication side effects,
  • chronic obstructive pulmonary disease (COPD),
  • bronchiectasis, and
  • lung cancer.
• Other symptoms that may accompany chronic cough include:
  • sore throat,
  • postnasal drip runny or stuffy nose,
  • hoarseness,
  • heartburn, and
  • a bad taste in the mouth.
• Treatment for chronic cough is to identify the cause and treat it.
• Home remedies to ease symptoms of chronic cough include:
  • staying hydrated,
  • gargling with warm saltwater,
  • cough drops,
  • honey, and
  • ginger.
• Chronic cough may be prevented by not smoking, and managing medical problems such as asthma, postnasal drip, GERD, and getting vaccinated against whooping cough.

Chronic cough is a cough that persists over time. Chronic cough is not a disease in itself, but rather a symptom of an underlying condition. Chronic cough is a common problem and the reason for many doctor visits.

Some common causes and risk factors for chronic cough include asthma, allergic rhinitis, sinus problems (for example sinus infection), esophageal reflux of stomach contents, medications such as ACE inhibitors, and whooping cough. In rare cases, chronic cough may be the result of inhaling foreign objects into the lungs (usually in children). It is important to see a doctor who may order a chest X-ray if a chronic cough is present. Common causes of chronic cough include:

• Cigarette smoking is the most common cause of a constant, chronic cough.
• Asthma is a disease of the airways, resulting in difficulty breathing or wheezing often characterized by abnormal breathing tests. Some asthma sufferers have chronic cough as their only symptom. They may even have normal lung functions tests. This is often referred to as cough-variant asthma. Asthma symptoms can be aggravated by cold air, exposure to air pollutants, pollen, smoke, or perfumes.
• Gastroesophageal reflux disease (GERD) refers to acid reflux, or backward flow, of stomach acid and other contents into the esophagus. If stomach acid moves backward up the esophagus, reflexes result in spasm of the airways that can cause shortness of breath and coughing. In some instances, acid reflux can be so severe that substances can be inhaled (aspirated) into the lungs and cause similar symptoms as well as damage to lung tissue. In some individuals, no sensation of heartburn is felt and their only symptom may be chronic cough.
• Sinus problems and postnasal drip also are causes of chronic cough with mucus. This condition can be difficult to detect. Sometimes CT scan of the sinuses is necessary for diagnosis. Affected individuals often complain of a "tickle in their throat" and frequent throat clearing.
• Infections such as bronchitis or pneumonia can cause acute cough or a chronic cough. These infections can be caused by viruses, bacteria, or fungus. Viral infections do not respond to antibiotics. The common cold and the flu often produce a dry cough. Viral upper respiratory tract infections often result in a prolonged cough even after the infection has cleared in people with asthma. Acute bronchitis and chronic bronchitis are common causes of coughing up blood (hemoptysis).
• A particular strain of bacterial pneumonia, called Mycoplasma, may cause a chronic cough with fatigue, weakness, shortness of breath, and sputum production. This infection is sometimes referred to as "walking pneumonia," and commonly affects young and healthy people.
• Whooping cough (pertussis) is an acute, highly contagious respiratory tract infection caused by the bacterium Bordetella pertussis. It can cause violent, rapid, constant coughing (often a high-piched cough with a “whoop” sound at the end) and it can be life-threatening in young children. Whooping cough commonly affects infants and young children, but can be prevented by immunization with pertussis vaccine. In adults, whooping cough can be a cause of chronic cough.
• Chronic cough in children is uncommon. Foreign material obstructing the airways of the lungs, asthma, and allergies need to be evaluated by a pediatrician.
• Certain medications, like ACE inhibitors (enalapril [Vasotec], captopril [Capoten] etc.) used in treating high blood pressure can cause chronic cough.
• Less common causes of chronic cough include allergies, tumors, sarcoidosis, congestive heart failure, or other lung diseases such as chronic obstructive disease (COPD) or emphysema. Lung diseases also can cause coughing up blood.

If chronic cough persists, it is important to be evaluated by a doctor. The health-care professional will consider the possibility of asthma, postnasal drip, esophageal reflux, drug side effects, interstitial lung disease, lung cancer, or other unusual infections.

A chronic cough may be accompanied by other cold symptoms, including:

• Sore throat
• Postnasal drip
• Runny or stuffy nose
• Hoarseness
• Heartburn
• A bad taste in the mouth
• Phlegm

See a doctor immediately if you have a chronic cough and experience the following serious symptoms:

• Wheezing or difficulty breathing
• Fever
• Chest pain
• Coughing up blood or yellow or green phlegm
• Coughing so hard it makes you vomit
• You have a cough with unexplained weight loss

There are several different types of chronic (or persistent) cough. Examples include:

1. Dry cough: is a persistent dry cough is a cough that does not produce any mucus, is irritating to the lungs and throat, and may be a sign of a viral infection or sinus problems
2. Chronic wet cough: is a cough that produces mucus (sputum), and depending on the color, may indicate a bacterial infection or fluid in the lungs (congestive heart failure)
3. Stress cough: a reflexive spasm of the airways caused when you are under stress. It usually produces no mucus and is not generally related to infections.
4. 'Barking' cough': is usually found in children, and may be associated with croup or other viral illness. The harsh, barking sound of a croup cough is caused by a swollen windpipe (trachea).
5. Whooping cough: is a cough that causes a 'whooping' sound after the cough may be indicative of a serious infection and should be evaluated by a doctor. Whooping cough (pertussis) is a highly contagious respiratory disease that can be deadly for babies under 1 year of age.

The treatment of chronic cough is directed at the cause. Symptoms may be relieved with over-the-counter (OTC) cough medicines containing guaifenesin and/or dextromethorphan (these can be found as cough syrups in tablet form).

The following are treatments for chronic cough caused by medications, conditions, or diseases.

• Asthma: Inhaled bronchodilators and inhaled steroids are given to decrease inflammation of the airways, and reduce wheezing. In some cases, short-term oral steroids are prescribed to relieve chronic cough.
• Gastroesophageal reflux disease (GERD): Treatment for chronic cough of GERD includes avoiding foods that increase reflux, avoiding meals before lying down, elevating the head while sleeping, and taking medication such as famotidine (Pepcid, Zantac 360), cimetidine (Tagamet), omeprazole (Prilosec, Prilosec OTC), lansoprazole (Prevacid, Prevacid 24-Hour), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Nexium) to decrease stomach acidity.
• Sinus problems and postnasal drip: Use of decongestants such as pseudoephedrine (Sudafed) or antihistamines such as diphenhydramine (Benadryl) may improve symptoms of postnasal drip or runny nose, which can lead to a persistent, nagging, cough. Inhaled nasal steroids are very effective in treating allergic rhinitis (hay fever), a common cause of cough. Additionally, other nasal inhalers like ipratropium bromide (Atrovent) can relieve postnasal drip. Antibiotics may be prescribed if the cause is determined to be sinusitis.

In severe cases of chronic cough, a healthcare professional may prescribe codeine or other similar narcotic medications, which are effective as cough suppressants.

Infections: Bacterial pneumonia and bronchitis are typically treated with antibiotics such as cephalosporins, azithromycin (Zithromax), and other antibiotics. If the pneumonia is close to the chest wall inflammation of the surface of the lung can cause pain, known as pleurisy, and pain relievers (analgesics) can be helpful. Cough suppressants are used with caution in these situations because clearing the lung of the infected mucus by coughing helps clear the infection. Most bronchitis in adults is caused by viral infections. Therefore, treatment is much the same as that of the common cold including rest, fluids, pain relievers, and humidification. Some people find expectorant cough medicines containing guaifenesin helpful in alleviating their discomfort. Sometimes it is hard to differentiate viral bronchitis from bacterial bronchitis, and antibiotics are prescribed. In some cases, asthmatics can produce green mucus that looks infected. Your doctor can have the mucus examined to determine if an infection is present.

Medications: Patients with chronic cough who are taking blood pressure medicines called ACE inhibitors (angiotensin-converting enzyme), for example, enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil), etc. should talk to their doctor about switching medications. Patients should not stop taking medicine on their own because a marked elevation in blood pressure can result from discontinuation. Discuss any possible medication changes with your doctor. A newer generation of ACE inhibitor like medicines called ARBs (angiotensin receptor blockers, for example, valsartan [Diovan], losartan [Cozaar], etc.) can be alternatives that have less potential to cause chronic coughing. Many other drugs are available to manage blood pressure.

Chronic cough in adults can sometimes be treated with home remedies. Consult your doctor for the home remedies that might be best for you, and talk to your doctor before taking any herbal supplements or natural remedies for chronic cough as some may interact with medications you take.

1. Stay hydrated. Fluids can help thin secretions.
2. Gargle with warm saltwater to help cleanse the throat and rid it of mucus.
3. Elevate your head with extra pillows at night to ease a chronic dry cough.
4. Inhale steam in a shower, or use a cool-mist humidifier to relieve dry cough.
5. Cough drops may soothe an irritated throat.
6. Do not smoke or use tobacco products.
7. Avoid inhaled irritants such as smoke, dust, or other pollutants.
8. Honey often can be an effective treatment for a persistent cough. Add honey to hot tea, or even grape juice.
9. Ginger, prepared as a tea, is often used to help reduce symptoms of chronic cough and clear the nasal passages.
10. Other herbs such as eucalyptus or mint are often used to relieve cough symptoms.

1. Don't smoke, as smoking is the most common cause of chronic cough.
2. Talk to your doctors about managing your asthma, postnasal drip, or GERD to avoid chronic cough symptoms.
3. Stay away from others known to be sick with bronchitis or pneumonia.
4. Eat fruit. Research suggests that diets high in fruit fiber and flavonoids may prevent chronic productive cough.
5. Make sure you and your child get the whooping cough (pertussis) vaccine.

A primary care provider (PCP) such as a family practitioner or internist may initially diagnose and treat a persistent cough. If cough is severe, a person may be seen in a hospital's emergency department by an emergency medicine specialist.

People suffering from constant cough may be referred to different specialists depending on the underlying cause. A pulmonologist is a lung specialist who treats diseases of the airways. An allergist is an allergy specialist who may treat chronic cough due to allergies. Gastroenterologists specialize in diseases of the digestive tract and can treat chronic cough due to conditions such as gastroesophageal reflux disorder (GERD). Cardiologists specialize in diseases of the heart and circulatory system and may treat persistent cough that can be a secondary symptom of heart disease.