Chronic cough: Causes persistent (persistent) cough

Everyone coughs sometimes, but some patients have to deal with 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 who have a chronic cough suffer from a more serious condition that requires medical treatment. Finally, persistent coughing that is left untreated occasionally causes complications.

  • Causes of persistent cough
  • Aspiration
  • Asthma
  • Antihypertensive medications
  • Bronchiectasis
  • Bronchiolitis
  • Bronchitis
  • Gastroesophageal reflux disease (GERD)
  • Heart disease
  • Infection
  • Lung cancer
  • Cystic fibrosis
  • Postnasal drip
  • Sarcoidosis
  • Risk factors of chronic cough
  • Types of persistent coughing
  • Dry cough
  • Wet cough
  • Symptoms
  • Alarm signals for chronic coughing
  • Medical emergency
  • Make an appointment with a doctor
  • Diagnosis and examinations
  • Treatment of persistent cough
  • Self-care
  • Professional medical care
  • Complications of persistent coughing

 

Causes of persistent cough

Aspiration

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

Asthma

Asthma occurs when a patient’s upper airways are especially 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

Antihypertensive medications

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

Bronchiectasis

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 inflammation of the bronchioles (small airways in the lungs), resulting in breathing problems.

Bronchitis

Chronic bronchitis (inflammation of the tracheal branches) causes a long-term inflammation of the airways that causes a cough. Chronic bronchitis (persistent inflammation of the tracheal branches) may be a 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 irritation in the throat, causing the patient to cough persistently. Adjusting lifestyle and taking medication reduce the effects of heartburn:

  • taking medications, such as ranitidine (Zantac), cimetidine (Tagamet), or famotidine (Pepcid)
  • sleep with the head higher than the legs
  • Do not lie down for two hours after eating
  • eat several small meals a day
  • avoiding 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 pumping of blood through the heart). The cough usually worsens when the patient lies completely flat.

Infection

A serious infection, such as pneumonia or the flu, is occasionally characterized by a persistent cough. The majority of the complaints disappear 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 coughing up bloody mucus are some of the hallmarks of cancer in the lungs.

Cystic fibrosis

Cystic fibrosis (cystic fibrosis with blockage of organs) causes excessive mucus in the lungs and airways, which causes a chronic cough.

Postnasal drip

With postnasal drip (postnasal drip), mucus drips down the back of the throat (throat mucus). This irritates the throat and causes a persistent cough reflex. Often the doctor prescribes decongestants (reducing swelling of the mucous membranes in the nose) or antihistamines (drugs for the treatment of an allergic reaction). The medicines dry up the mucus 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 exposure to smoke / Source: Geralt, Pixabay

Risk factors of chronic cough

Cigarette smoking increases the risk of developing a chronic cough. Patients are then more likely to suffer from smoker’s cough. Exposure to passive smoking is also a risk factor for persistent coughing. The smoke irritates the airways, causing coughing but also lung damage. In addition, exposure to chemicals in the air, such as working in a factory or laboratory, also causes prolonged coughing. Furthermore, the use of ACE inhibitors is an important risk factor for coughing. About one in five patients who take this medicine suffer from a persistent cough.

Types of persistent coughing

(Chronic) cough is wet or dry.

Dry cough

A dry cough (non-productive cough) does not produce mucus. Patients only experience a scratchy throat. Smokers and users of ACE inhibitors are more likely to 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 complaints appear in addition to the persistent coughing. The most common associated symptoms are:

  • coughing up blood (rare)
  • heartburn or a sour taste in the mouth
  • a runny nose or a stuffy nose
  • wheezing (stridor) and shortness of breath
  • hoarseness
  • postnasal drip
  • often a throat infection and sore throat

 

Alarm signals for chronic coughing

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 a 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 a doctor

In some cases, a chronic cough hinders a patient’s daily activities. When the following signs occur in combination with the chronic cough, it is important to have the underlying cause determined by the doctor:

  • a loss of appetite
  • night sweats
  • unexplained weight loss
  • coughing up a lot of mucus
  • fatigue

 

Diagnosis and examinations

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 the cough and also which factors improve or worsen the chronic cough. Furthermore, the doctor wants information about the patient’s medical history and lifestyle.Physical examination The doctor takes his stethoscope and performs an auscultation (listening to body sounds). He wants to get an idea of the health of the patient’s lungs.Diagnostic examination The doctor sometimes needs to carry out further examinations to determine the underlying cause:

  • imaging tests, such as X-rays or a CT scan (determines signs of lung disease or inflammation)
  • a bronchoscopy (internal examination of the airways) (checks for signs of irritation or disease)
  • 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 lead a healthy lifestyle: don’t smoke and drink enough. In addition, it is possible to suck on hard candies, which helps to relieve a dry cough and soothe an irritated throat. Using a humidifier or taking a warm shower is also helpful.

Professional medical care

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

Complications of persistent coughing

Chronic coughing interferes with a patient’s daily life. 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

 

read more

  • Smoker’s cough: Persistent cough with mucus due to smoking
  • Cough: Causes, types and treatment of cough
  • Cough remedies: Types of medication for relieving coughs
  • Wet (productive) cough: Causes of coughing with phlegm
  • Dry cough (tickling cough): Causes and treatment

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