Chronic Cough

Coughing helps clear your airways of irritants like smoke or mucus. Chronic cough is considered a lung disorder if the persistent cough lasts more than eight weeks in adults or four weeks in children. If you cough up blood, seek medical attention immediately.

A chronic cough can make you feel tired, prevent you from sleeping well and interfere with work and socializing. A chronic cough also can cause headaches, chest pain, loss of bladder control, sweating and — although uncommon — fractured ribs.

While the symptoms of chronic cough can be treated, identifying and treating the underlying cause is the goal of management.
 
Symptoms of Chronic Cough
A chronic cough can be accompanied with these signs and symptoms:

• A runny or stuffy nose
• A feeling of liquid running down the back of your throat
• Frequent throat clearing and sore throat
• Hoarseness
• Wheezing and shortness of breath
• Heartburn or a sour taste in your mouth

Causes of Chronic Cough
Coughing occurs when the nerve endings in your airways become irritated, according to the National Heart, Lung and Blood Institute.
 
Three causes, alone or in combination, are responsible for 90 percent of cases of chronic cough:

• Postnasal drip (due to mucus that drips down the back of your throat and triggers your cough reflex)
• Asthma 
• Gastroesophageal reflux disease (GERD, where acid from your stomach backs up into your throat); treating GERD may resolve the coughing

Chronic cough has many other common causes:

• Irritants, such as smoking or secondhand smoke; air pollution; scented products like perfumes or air fresheners
• Allergens (if you are allergic), such as dust or animal dander; mold or pollen from trees, grasses and flowers
• Medications, such as ACE inhibitors used to treat high blood pressure; beta blockers used to treat HBP, migraine headaches and glaucoma

Underlying medical conditions can cause chronic coughing and may include the following:

• Bronchiectasis (damage to the airways causes them to widen and become flabby and scarred)
• COPD (especially chronic bronchitis, inflammation of the large airways)
• Heart failure (if fluid builds up in the lungs, it can cause a chronic cough)
• Lung cancer
• Sinus or other respiratory tract infection

Diagnosing Chronic Cough
Your medical history and physical examination help determine which tests your doctor will order to identify the underlying cause of your chronic cough. Some doctors will try treating you for one of the common causes of chronic cough and begin testing for more unusual causes only if the treatments are not successful.
 
Determining the cause of chronic cough is crucial to effective treatment and may include the following test.

• A chest X-ray, which may be used to rule out lung cancer, pneumonia and other lung diseases
• An X-ray or computerized tomography (CT) scan of your sinuses, which can reveal evidence of a sinus infection

Your doctor may test for the cause of your cough with a thin, flexible tube equipped with a light and camera inserted into your windpipe (trachea) and bronchi to look for abnormalities. In addition, a biopsy of the inside lining of your airway (mucosa) may be needed to look for any cellular abnormalities.

Treating Chronic Cough
Some treatments relieve the cough symptoms but do not affect any underlying cause if the chronic cough. Common treatments include:

• Prescription cough suppressants, also called antitussives
• Expectorants to loosen mucus and make it easier to cough up
• Bronchodilators to relax your airways
• Other treatments (humidifiers, drinking liquids) to relieve an irritated throat and loosen mucus

There is no evidence showing that over-the-counter cough suppressants are effective or that cough and cold medicines help children recover more quickly from colds.
 
Common medications prescribed to treat chronic cough may include the following:

• Acid blockers
• Antihistamines and decongestants
• Inhaled asthma drugs (steroids and bronchodilators)
• Antibiotics

Chronic cough is complex and requires a comprehensive approach by specialists devoted to its evaluation and management. The experienced pulmonologists and other health care professionals at Houston Methodist pulmonary services are devoted to care and research for patients with chronic cough.