When A Cough Turns Chronic
If coughing persists for more than two
months, it can be a sign of a serious condition requiring a doctor’s
up phlegm, infectious agents, and foreign matter is one of
the ways that the lungs protect themselves. Occasional
coughing is normal, as is coughing associated with a cold. Any
cough that lasts more than two months, however, is defined as
chronic and requires medical attention. A chronic cough needs
to be evaluated even if it occurs only in the morning, at night,
or during certain times of the year.
Severe coughing may signal
a respiratory disease. Obstructive diseases of the lungs (asthma
and chronic bronchitis) and lung
cancer often cause a person to cough up phlegm. Yellow or green
phlegm may signal a lung infection. Coughing up blood (hemoptysis)
may suggest a benign problem such as bronchitis or a potentially
life-threatening disease like lung cancer or pulmonary embolism.
Hemoptysis is a serious sign, especially in current or former
smokers. Other symptoms that may occur as a result of chronic
cough include fatigue, irritability, headaches, sleeping problems,
urinary incontinence, and sore throat.
Chronic cough is not a
disease; rather, it is considered a symptom of another condition,
and your doctor will need to diagnose the
underlying cause. The doctor will most likely ask when the cough
started, if you are coughing up any phlegm or blood, whether
the cough has changed pattern recently, and whether it is worse
at certain times of the day. He or she may examine your ears,
nose, throat, and chest, as well as perform some diagnostic tests
such as a lung function test or a chest x-ray. Treating the underlying
cause will usually resolve a chronic cough.
Causes of and Treatment
for Chronic Cough
Chronic cough associated with a normal chest
x-ray most often results from postnasal drip, asthma, or gastroesophageal
(GERD, the flow of stomach acid into the esophagus), or a combination
of these conditions. Other common causes include smoking, chronic
bronchitis, and certain medications.
Interstitial lung disease,
bronchiectasis (persistent dilatation of the bronchi or bronchioles),
and pneumonia—all of which
produce inflammation or scarring of the lungs—are less
common causes of coughing. Lung cancer is usually suspected only
when a person with a history of smoking has an abnormal chest
Postnasal drip. Postnasal drip—characterized
by a runny nose, a feeling that fluid is draining down the back
throat, and a frequent need to clear your throat—is the
most common cause of chronic cough. In turn, postnasal drip is
most commonly caused by sinusitis (an infection of the sinuses)
or allergies. When postnasal drip is caused by allergies, treatment
usually involves taking a decongestant such as dexbrompheniramine
with pseudoephedrine (Drixoral). Treatment also may involve a
first-generation antihistamine such as chlorpheniramine with
pseudoephedrine (Deconamine); this medication can cause drowsiness,
so you will need to be carefully monitored by your doctor. Postnasal
drip caused by sinusitis is treated with antibiotics. Inhaled
nasal corticosteroids also may be helpful. Once treatment has
begun, chronic cough should clear up in a few weeks to two months.
Asthma. Asthma, the second most
common cause of chronic cough, usually is associated with shortness
of breath. However, some
people with asthma have chronic cough as their only symptom.
This type of asthma (called cough-variant asthma) can be difficult
to diagnose because the physical exam and pulmonary function
tests usually are normal; however, it is often triggered by cold
air, strong fumes, or exercise. A cough that begins after starting
therapy with a beta-blocker (a medication typically used for
high blood pressure and heart disease) may also be due to asthma,
as beta-blockers can trigger asthma symptoms in some people.
Treating the asthma (and switching to another blood pressure
medication, if necessary) should help relieve chronic cough.
GERD. GERD is the third most common
condition responsible for chronic cough. About 40% of people
with GERD do not have the
traditional symptoms of heartburn and indigestion—instead,
a cough is their only symptom. If GERD is suspected, treatment
of the disorder may be used to determine whether it is the cause
of your chronic cough; if the cough is relieved, GERD was the
culprit. Treatment for GERD usually includes lifestyle changes
such as avoiding large meals, acidic or fatty foods, caffeine,
alcohol, and smoking, as well as sleeping with the head of your
bed elevated. Medications for GERD may include antacids, histamine-receptor
antagonists (also known as H2-blockers), mucosal protectants,
proton pump inhibitors, and prokinetic agents. Reduction in cough
may occur only after several months of treatment.
chronic bronchitis. Chronic bronchitis is suspected as
the cause of a chronic cough if you have a history of smoking
and have had a productive cough (one that produces phlegm) on
most days of the week for at least three months in the past two
years. If you still smoke and have chronic bronchitis, quitting
can help relieve your cough. Medications called bronchodilators
(which promptly open airways by relaxing bronchial smooth muscles)
also may be necessary to help reduce coughing.
medications, particularly ACE inhibitors (commonly
used to treat high blood pressure), can cause a chronic cough.
In fact, approximately 25% of people who take ACE inhibitors
develop a dry, hacking cough. Discontinuing the ACE inhibitor
for several weeks (under your doctor’s supervision) can
help determine whether it is causing your cough. (The cough usually
takes one to four days to resolve after discontinuing the medication,
but it can persist for up to four weeks). Switching to another
type of blood pressure medication may be helpful.