Overview

A chronic cough is a cough that lasts in adults 8 weeks or longer or 4 weeks in children.

A chronic cough is something more than just annoyance. A chronic cough may disturb your sleep and fatigue you. Chronic cough may cause serious cases of vomiting, lightheadedness and even rib fractures.

Although the issue that triggers chronic cough can often be difficult to recognize, the most common causes are tobacco use, postnasal drip, asthma, and acid reflux. Luckily, the chronic cough usually vanishes when the underlying condition is treated.

Symptoms

• A chronic cough can develop with other signs and symptoms, including:
• A runny or stuffy nose
• A feeling of blood flowing down the back of the throat (postnasal drip)
• Frequent throat clearing and sore throat
• Hoarseness
• Wheezing and shortness of breath
• Heartburn or a bad taste in the mouth
• In rare cases, coughing up blood

When to see a doctor

If the cough lasts for more than three weeks see your doctor. Also, call them if you experience symptoms like unplanned weight loss, fever, coughing up blood, or having trouble sleeping.

During your doctor’s appointment, your doctor will ask about your cough and other symptoms. You may need to have one of these tests to find the cause of your cough:

• Acid reflux tests measure the amount of acid in the fluid inside your esophagus.
• Endoscopy uses a flexible, lighted instrument to look into the esophagus, stomach, and small intestine.
• Sputum cultures check the mucus you cough up for bacteria and other infections.
• Pulmonary function checks see how much air you can take out, along with other lung behaviour. The doctor can diagnose COPD and any other lung disorders using these examinations.
• X-rays and CT scans can find signs of cancer or infections like pneumonia. You might also need an X-ray of your sinuses to look for signs of infection.

If these tests don’t help your doctor identify the cause of your cough, they might insert a thin tube into your throat or nasal passage to see the insides of your upper airways.

Bronchoscopy uses a scope to view the lining of your lower airway and lungs. Your doctor can also use bronchoscopy to remove a piece of tissue to test. This is called a biopsy.

Rhinos copy uses a scope to show the nasal passages from inside.

Causes

An occasional cough is normal—it helps clear up irritants and secretions from lung and prevents infection.

A cough that lasts for weeks, however, is usually the result of a medical condition. In many cases, that involves more than one cause.

The following factors are responsible for the majority of chronic cough cases, whether alone or in combination:

Postnasal drip: If your nose or sinuses produce extra mucus, it will leak your throat back down and stimulate your cough reflex. This disorder is also called upper airway cough syndrome (UACS).

Asthma: An asthma-related cough can come and go with the seasons, occur after an infection of the upper respiratory tract or get worse when you are exposed to cold air or certain chemicals or fragrances. A cough is a principal symptom in one form of asthma (cough-varying asthma).

Gastroesophageal reflux disease (GERD): Stomach acid flows back into the tube which connects your stomach and throat (esophagus) in this common condition. The continuous irritation can cause chronic coughing.  In turn, coughing worsens GERD — a vicious cycle.

Infections: A cough can persist long after other symptoms of pneumonia, flu, cold, or other upper respiratory tract infections have vanished. For adults, pertussis is a widespread but under-recognized cause of chronic cough, also known as whooping cough. Chronic cough may also occur with fungal infections of the lung, tuberculosis (TB) infection or lung infection with nontuberculous mycobacterial organisms.

Chronic obstructive pulmonary disease (COPD): COPD involves chronic bronchitis and emphysema, a chronic inflammatory lung condition that induces obstructed airflow from the lungs. Chronic bronchitis can cause coloured sputum to develop in a cough. Emphysema causes shortness of breath and destroys lung (alveoli) air sacs. Most people suffering from COPD are current or former smokers.

Blood pressure drugs: In certain people, angiotensin-converting enzyme (ACE ) inhibitors, typically prescribed for high blood pressure and heart failure, are known to cause a chronic cough.

• Less commonly, chronic cough may be caused by:
• Aspiration (food in adults; foreign bodies in children)
• Bronchiectasis (damaged, dilated airways)
• Bronchiolitis (inflammation of the very small airways of the lung)
• Cystic fibrosis
• Lung cancer
• Eosinophilic nonasthmatic bronchitis (airway inflammation not caused by asthma)
• Sarcoidosis (collections of inflammatory cells in different parts of your body, most commonly the lungs)

Risk factors

One of the main risk factors for chronic cough is being an active or former smoker. Frequent exposure to second-hand smoke can also cause coughing and damage to the lungs.

Complications

Having a persistent cough can be exhausting. Coughing can cause a variety of problems, including:

• Sleep disruption
• Headache
• Dizziness
• Vomiting
• Excessive sweating
• Loss of bladder control (urinary incontinence)
• Fractured ribs
• Passing out (syncope)

Prevention

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 diets high in fruit fibre and flavonoids can prevent chronic cough that is productive.
5. Make sure you and your child get whooping cough (pertussis) vaccine.