What Is Chronic Cough?
A cough is considered “chronic” when it lasts longer than 8 weeks in adults or more than 4 weeks in children. Chronic cough is common and can affect daily life, causing tiredness, trouble sleeping, and even embarrassment in social situations.
What Causes Chronic Cough?
Most chronic coughs are caused by one or more of the following conditions:
– Upper airway cough syndrome (sometimes called “post-nasal drip”): This happens when mucus from the nose or sinuses drips down the back of the throat, triggering a cough.
– Asthma: This lung condition can cause coughing, especially at night or with exercise.
– Gastroesophageal reflux disease (GERD): Stomach acid can flow back up into the throat, causing irritation and cough.
– Nonasthmatic eosinophilic bronchitis: This is a type of airway inflammation that causes cough without the typical symptoms of asthma.
– Medications: Some medicines, especially those called ACE inhibitors (used for high blood pressure), can cause chronic cough.
– Environmental or occupational irritants: Smoke, dust, or chemicals at home or work can trigger coughing.
How Is Chronic Cough Evaluated?
Doctors usually start with:
– A detailed history and physical exam
– A chest X-ray to check for lung problems
– Breathing tests (spirometry) to look for asthma or other lung diseases
Your doctor may also ask about your medications, smoking history, and possible exposures at work or home. If you are taking an ACE inhibitor, your doctor may recommend stopping it to see if the cough improves.
When Should I Be Concerned?
Some symptoms, called “red flags,” may suggest a more serious problem. Tell your doctor if you have:
– Coughing up blood
– Unexplained weight loss
– Night sweats
– Fever that won’t go away
– Shortness of breath or chest pain
These symptoms may need more urgent testing.
How Is Chronic Cough Treated?
Treatment depends on the cause:
– Upper airway cough syndrome: Treatments may include nasal sprays, antihistamines, or decongestants.
– Asthma: Inhalers or other asthma medicines may help.
– GERD: Lifestyle changes (like weight loss, raising the head of the bed, and avoiding meals before bedtime) and medications to reduce stomach acid may be recommended, especially if you have heartburn or regurgitation.
– Nonasthmatic eosinophilic bronchitis: Inhaled steroids may be used.
If the cough does not improve after treating these common causes, your doctor may refer you to a specialist for more tests, such as a CT scan or a look inside your airways (bronchoscopy).
What If My Cough Won’t Go Away?
Sometimes, cough continues even after all common causes have been treated. This is called “refractory chronic cough.” In these cases, the cough may be due to increased sensitivity of the nerves in the throat and airways. Treatments that may help include:
– Speech and language therapy: Special exercises to control cough
– Medications: Some medicines, such as gabapentin or low-dose morphine, may be tried if other treatments do not work. These are used carefully and only under close supervision.
What Can I Do to Help My Cough?
– Avoid smoking and secondhand smoke
– Stay away from things that make your cough worse (like dust or strong smells)
– Take your medicines as prescribed
– Follow up with your doctor as recommended
When to See Your Doctor Again
If your cough lasts more than 8 weeks (adults) or 4 weeks (children), or if you have any red flag symptoms, make an appointment for further evaluation.
Remember: Most chronic coughs can be managed once the cause is found. Work with your healthcare team to find the best treatment for you.
