Chronic cough: Causes persistent (persistent) cough

Everyone sometimes coughs, but some patients have a persistent cough. This symptom has a mild to serious cause (sometimes multiple causes) and, if left untreated, may disrupt daily activities. In addition, complications may arise from the underlying problem that leads to the chronic cough. Most patients with a chronic cough can be treated well, usually with self-care techniques. Some patients with chronic cough suffer from a more serious condition that requires medical treatment. Persistent coughing eventually causes untreated complications.
  • Causes of persistent cough
  • Aspiration
  • Asthma
  • Blood pressure-lowering drugs
  • Bronchiectasia
  • Bronchiolitis
  • Bronchitis
  • Gastroesophageal reflux disease (GERD)
  • Heart disease
  • Infection
  • Lung cancer
  • Mucoviscidosis
  • Postnasal drip
  • Sarcoidosis
  • Risk factors of chronic cough
  • Types of persistent cough
  • Dry cough
  • Wet cough
  • Symptoms
  • Alarm signals for chronic cough
  • Medical emergency
  • Make an appointment with the doctor
  • Diagnosis and investigations
  • Treatment of persistent cough
  • Self-care
  • Professional medical care
  • Complications of persistent coughing

Causes of persistent cough

Aspiration

When food or saliva flows through the respiratory tract instead of through the food pipe, aspiration occurs. This leads to respiratory irritation. Sometimes aspiration leads to pneumonia.

Asthma

Asthma occurs when a patient's upper respiratory tract is particularly sensitive to cold air, airborne irritants, or exercise. One type of asthma, known as cough variant asthma, causes chronic coughing.
A persistent cough is sometimes caused by medication use / Source: Stevepb, Pixabay

Blood pressure-lowering drugs

ACE inhibitors (angiotensin-converting enzyme inhibitors) may contribute to a persistent cough in some patients. The doctor uses these drugs to lower blood pressure. Patients who cough by taking ACE inhibitors may receive other medication prescribed by the doctor.

Bronchiectasia

Excessive mucus production causes dilated and irritated airways, resulting in a chronic cough.

Bronchiolitis

Bronchiolitis is a common respiratory infection in children. A virus causes an inflammation of the bronchioles (small airways in the lungs) which results in breathing problems.

Bronchitis

Chronic bronchitis (inflammation of the windpipe branches) causes a long-term inflammation of the airways that involves a cough. Chronic bronchitis may be part of chronic obstructive pulmonary disease (COPD), which is often present as a side effect of smoking (smoker's cough).

Gastroesophageal reflux disease (GERD)

GERD occurs when acid flows back from the stomach into the throat. This results in chronic throat irritation, making the patient persistent in coughing. Adjusting the lifestyle and taking medication reduce the effects of heartburn:
  • taking medicines such as ranitidine (Zantac), cimetidine (Tagamet) or famotidine (Pepcid)
  • sleeping with the head higher than the legs
  • do not lie down until two hours after eating
  • eat several small meals a day
  • avoid foods known to lead to gastroesophageal reflux such as caffeine, citrus fruits, tomato-based foods, high-fat foods, chocolate or peppermint

Heart disease

Coughing and shortness of breath sometimes indicate heart disease or heart failure (poor circulation of blood through the heart). The cough usually worsens when the patient is completely flat.

Infection

A serious infection, such as pneumonia or the flu, is occasionally characterized by a persistent cough. The majority of the complaints have disappeared after a while, but the airways sometimes remain inflamed for a longer period of time.

Lung cancer

Very rarely, a persistent cough occurs with lung cancer. Chest pain and bleeding mucus coughing up are some of the cancers in the lungs.

Mucoviscidosis

Mucoviscidosis (cystic fibrosis with clogging of organs) causes excessive mucus in the lungs and airways, causing a chronic cough.

Postnasal drip

With postnasal drip (postnasal infusion), mucus drips down the back of the throat (throat mucus). This irritates the throat and causes a persistent cough reflex. The doctor often prescribes decongestants (reducing swelling of the mucous membranes in the nose) or antihistamines (medicines for the treatment of an allergic reaction). The drugs cause mucus to dry up and reduce inflammation that may lead to postnasal drip. Steroid nasal sprays can also be used.

Sarcoidosis

Sarcoidosis is an inflammatory condition that causes small growths in the lungs, lymph nodes, eyes and skin. Some patients also suffer from a chronic cough.
Chronic coughing is often caused by smoking and the exposure to smoke / Source: Geralt, Pixabay

Risk factors of chronic cough

Cigarette smoking increases the risk of developing a chronic cough. Patients will in fact be more likely to cope with smoker's cough. Exposure to passive smoking is also a risk factor for persistent coughing. The smoke irritates the respiratory tract, which causes cough but also lung damage. In addition, exposure to chemicals in the air, such as working in a factory or a laboratory, also causes prolonged coughing. Furthermore, the use of ACE inhibitors is an important risk factor for coughing. Approximately one in five patients who take this medicine suffers from a persistent cough.

Types of persistent cough

(Chronic) coughing is wet or dry.

Dry cough

A dry cough (non-productive cough) does not cause mucus. Patients only experience a tickling throat. Smokers and users of ACE inhibitors more often have a dry cough.

Wet cough

A wet cough is accompanied by mucus formation (sputum). Postnasal drip or cystic fibrosis cause this type of cough.

Symptoms

Usually one or more symptoms appear in addition to persistent coughing. The most common associated symptoms are:
  • coughing up blood (rare)
  • heartburn or a sour taste in the mouth
  • a runny or stuffy nose
  • a wheezing (stridor) and shortness of breath
  • hoarseness
  • postnasal drip
  • often a sore throat and sore throat

Alarm signals for chronic cough

Chest pain is an alarm sign / Source: Pexels, Pixabay

Medical emergency

A chronic cough is sometimes a medical emergency. When a patient has one or more of the following symptoms in combination with the persistent cough, it is important to seek medical attention as soon as possible:
  • coughing up blood
  • high fever
  • shortness of breath or breathing problems
  • chestpain

Make an appointment with the doctor

In some cases, a chronic cough hinders the daily activities of a patient. When the following signs occur in combination with the chronic cough, it is important to have the underlying cause discovered by the doctor:
  • a loss of appetite
  • night sweats
  • unexplained weight loss
  • cough up a lot of mucus
  • fatigue

Diagnosis and investigations

Diagnostic criterion
A chronic cough occurs when the cough lasts longer than eight weeks in adults or four weeks in children.
Interview
The doctor asks the patient about the start of coughing and also which factors improve or actually aggravate chronic cough. The physician also wants information about the patient's medical history and lifestyle.
Physical examination
The doctor takes hold of his stethoscope and performs auscultation (listening to body sounds). He wants to get an idea about the health of the patient's lungs.
Diagnostic research
The doctor sometimes has to perform further examinations to find out the underlying cause:
  • imaging studies, such as X-rays or a CT scan (determines signs of a lung disease or inflammation)
  • a bronchoscopy (internal viewing of the airways) (checks for signs of irritation or a disease)
  • a spirometry (lung function measurement)
  • a sputum culture (checks whether blood or cancer cells are present in the mucus)

Treatment of persistent cough

Self-care

It is important to maintain a healthy lifestyle: do not smoke and drink enough. In addition, it is possible to suck on hard sweets, which helps to relieve a dry cough and soothe an irritated throat. Taking a humidifier or a hot shower is also useful.

Professional medical care

The cause of the chronic cough is important because the doctor adjusts his treatment accordingly. It is often possible to reduce symptoms with medication. Some patients require surgery to resolve the underlying problem.
Antibiotics
The doctor treats antibiotics with a bacterial infection that causes a persistent cough.
Antihistamines, glucocorticoids and decongestants
These drugs are the standard treatment for allergies and postnasal drip.
Inhaled asthma medications
The most effective treatments for asthma-related cough are glucocorticoids and bronchodilators (bronchodilators), which reduce inflammation and open the airways. The patient inhales these medicines (inhalation).
Cough suppressants
Sometimes the doctor is unable to determine the cause. He then prescribes cough suppressants so that the patient can sleep again and perform his daily activities.
Heartburn inhibitors
These drugs treat gastroesophageal reflux; they inhibit acid production.
Headache, exhaustion and sleeping problems are complications of a persistent cough / Source: Concord90, Pixabay

Complications of persistent coughing

Chronic coughing interferes with the daily life of a patient. The following complications occur:
  • concentration problems at work and at school
  • dizziness
  • fainting (rare)
  • broken ribs (rare)
  • headache
  • excessive sweating (hyperhidrosis)
  • sleep problems
  • urinary incontinence (rare)
  • daytime fatigue / exhaustion

Video: Chronic coughing: Possible causes and treatment (February 2020).

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