A persistent cough lasting two months or more in adults fits the criteria of chronic cough. Children suffer from a chronic cough if their symptoms last longer than one month.
The symptoms are not only annoying but also interfere with your sleep quality. You wake up not feeling refreshed. In severe cases, you may also feel dizzy and nauseous or can even suffer from rib fractures.
What triggers a chronic cough can be hard to identify in some. Smoking, asthma, acid reflux, or excessive mucus are the most common culprits causing chronic cough. Once the underlying cause is identified and treated, the symptoms usually improve and fade away.
What Are the Symptoms of Chronic Cough?
When you have a chronic cough:
- You have a runny nose, stuffy nose, or excessive mucus production.
- Sore, itchy throat.
- Hoarse voice.
- Wheezing, shortness of breath.
- Sour taste in your mouth, heartburn.
- You cough up blood, which is rare.
When Should You See a Doctor for a Chronic Cough?
- When you have been coughing for several consecutive weeks, particularly with mucus and phlegm or blood, or when the symptoms worsen your sleep quality and school or work performance.
What Causes Chronic Cough?
Occasional coughing is not out of the ordinary. Coughing is how your body expels lung irritants or secretions to prevent infection. A persistent, chronic cough is usually due to one or more medical conditions.
Most chronic coughs arise from one or more of the following medical conditions:
- Upper airway cough syndrome (UACS) occurs when excessive mucus drips down the back of your throat, causing you to cough.
- If your coughing is from asthma, ambiance conditions may trigger your symptoms. When you have upper respiratory infections and are exposed to cold air, pollutants, or irritants, your allergies-related cough can be aggravated. Coughing is the main result of cough-variant asthma.
- When your stomach acid refluxes up your esophagus and irritates the lining of your throat, it can stimulate chronic coughing. Coughing, in turn, can aggravate GERD symptoms.
- After treatment for flu, a cold, pneumonia, or other upper respiratory tract infections, you may experience a lingering cough. Pertussis or whooping cough is a common but rarely identified cause of chronic cough in adults. Other lung infections such as fungal infection, tuberculosis (TB), or other mycobacterial infections can also be the underlying cause of chronic cough, particularly long COVID syndrome.
- Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema. It is a chronic inflammatory lung condition with lung airway obstruction. When you have chronic bronchitis, you have a cough with colored mucus. With emphysema, you have damaged alveoli, leading to shortness of breath. Most COPD patients are smokers or ex-smokers.
- Antihypertensive medicines such as angiotensin-converting enzyme inhibitors (ACEI) for patients with heart failure or hypertension can cause chronic cough in some patients.
Other less common causes of chronic cough include:
- Food aspiration in adults or foreign bodies in children
- Bronchiectasis
- Bronchiolitis
- Cystic fibrosis
- Idiopathic pulmonary fibrosis
- Laryngopharyngeal gastric reflux
- Lung cancer
- Nonasthmatic eosinophilic bronchitis
- Sarcoidosis
Risk Factors for Chronic Cough
One of the most common causes of chronic cough is smoking, including secondhand smoke. Both can predispose to coughing and lung damage.
Complications
A chronic cough can be exhausting. It can lead to other medical problems such as:
- Headache
- Dizziness and vomiting
- Sleep disturbance
- Fainting
- Rib fracture
- Urinary incontinence
- Sweating
How Is Chronic Cough Diagnosed?
By reviewing your medical history and conducting a physical exam, your doctor may find clues associated with a chronic cough. Doctors will prescribe treatment for common causes initially. If you do not respond to the initial remedies, the doctor may obtain other tests for further evaluation.
Imaging tests
- X-rays: Chest X-ray cannot diagnose asthma, acid reflux, or postnasal drip, but it could identify pneumonia, lung cancer, or other lung problems. A sinus X-ray can help diagnose sinusitis.
- CT scans can reveal underlying conditions of chronic cough or infected sinuses.
Lung function tests
They are simple and noninvasive, including spirometry to check asthma and COPD. The tests can measure your lung vital capacity and expiratory rate.
An asthma challenge test evaluates your lung function before and after the administration of methacholine.
Lab tests
If your sputum is yellowish or greenish, a sputum culture is required.
Bronchoscopy
If the cause of chronic cough is still a mystery, bronchoscopy to visualize the airways is in order. Your doctor may perform a biopsy to check abnormalities inside your airway.
Rhinoscopy is to view your nasal passageways, sinuses, and upper airway with a flexible fiberoptic scope.
Children
In children, doctors usually obtain chest X-rays and spirometry.
How to Treat Chronic Cough?
It is crucial to identify the cause of chronic cough for curative treatment. Commonly, a chronic cough results from multiple underlying conditions. If you are a smoker, your doctor may offer a program to help you quit smoking.
If your coughing is due to an ACE inhibitor, it is necessary to change the medication.
Type of antitussive medications
- Antihistamines, corticosteroids, and decongestants are usual medications for allergies and postnasal drip.
- Inhaled asthma drugs prescribed to patients with asthma-related cough can relieve inflammation and open air passages. These drugs are corticosteroids and bronchodilators.
- Antibiotics are effective for coughing caused by bacterial, fungal, or mycobacterial infections.
- H2-blockers suppress gastric acid production and alleviate reflux symptoms when lifestyle modification does not help relieve the symptoms. In some cases, surgery may be necessary.
- Some types of coughing require specific treatment, and consultation with a pulmonary medicine specialist is necessary.
Antitussives
Doctors may prescribe antitussives for symptom relief while investigating the cause and starting treatment. Over-the-counter cold and cough medicines can help relieve symptoms of common causes of chronic cough, not other underlying medical conditions. According to research, these medicines are not better than a placebo and may cause adverse events, such as overdoses in children younger than two years old.
It is not advisable to prescribe medicines other than antipyretics and pain relief to children younger than 6. The use of these medications in children younger than 12 should be carefully considered or avoided.
Chronic Cough with Phlegm and Throat Irritation: Home Remedies and Lifestyle Changes
You should follow the doctor's advice. At home, you can try the home remedies below.
- Drink warm liquids such as tea, juice, or clear broth to help expel mucus and soothe your sore throat.
- Lozenges or cough drops can relieve a sore throat and dry cough.
- Take a teaspoon of honey to relieve your cough. However, honey should not be fed to infants or children younger than one year old, as honey contains bacteria that are detrimental to infants.
- Use a humidifier to moisten air in your home, or take a hot shower to inhale the moisture.
- Avoid smoking or exposure to secondhand smoke because it can increase lung irritation and aggravate your symptoms caused by other factors. Consult your doctor to find the best way to help you quit smoking.
Preparing for your appointment
Before your appointment, take a note below:
- Your symptoms in detail
- Your medical history
- Your family health history
- Medications and dietary supplements you are taking.
- Your smoking habits
- Other questions you would like to ask your doctor.
What to expect from your doctor
Samples of questions your doctor may ask:
- What symptoms do you have, and when did they start?
- Have you experienced fever, cold, flu, or COVID-19 in the past week?
- Are you a current or ex-smoker?
- Are you exposed to secondhand smoke at home or workplace?
- Are you exposed to pollutants or irritants at home or work?
- Do you experience heartburn?
- Do you cough up blood or sputum? What color is it?
- Are you on blood pressure medication, and what type?
- When did you start coughing?
- What helps relieve your cough?
- Does exposure to cold air cause shortness of breath or wheezing?
- Have you traveled lately?
After consulting with your doctor, he might recommend you to see a pulmonologist.
