Diagnosis and treatment
While a cough might not be life-threatening – everyone coughs and coughing can help clear the airways of irritants – a chronic cough can signify other health conditions.
When a cough becomes persistent, it can be annoying and exhausting. A chronic cough can interrupt sleep and cause light-headedness, vomiting, urinary incontinence, and even rib fractures. This is more reason why you should see a doctor if you experience a chronic, persistent cough.
What is a chronic cough?
A chronic cough is a cough that lingers for more than three weeks. Sometimes, chronic cough in adults or children can last for months or even years. It can be worrisome, especially if you do not know the cause of the cough.
Around 12% of people in the UK experience chronic cough daily or weekly, while about 30 million people annually visit outpatient clinics due to cough issues in the United States.
Most times, chronic cough occurs alongside other signs and symptoms. These symptoms can include:
- Wheezing and shortness of breath
- Hoarseness of voice
- A runny nose
- Chest soreness
- Frequent throat clearing
- Chronic night-time cough
- Loss of sleep due to coughing
There are many possible causes, including pre-existing medical conditions or smoking. While less likely, a persistent cough could also be caused by a serious health condition, such as cancer. That’s why it’s important to see a doctor if your cough continues, and if brings up phlegm or blood.
Causes of a recurrent lingering cough include:
- Asthma (including severe asthma)
- Chronic bronchitis (severe, long-term inflammation and irritation of the bronchi)
- Postnasal drip (the extra mucus secreted from the nose that drains down the throat, causing you to cough)
- Gastrointestinal reflux disease (GERD)
- Sinusitis (inflammation of the sinuses, hollow cavities in the head that help to filter and humidify the air we breathe in)
- Chronic obstructive pulmonary disease (COPD)
- Lung infections
- Lung cancer
- Air pollutants
- Whooping cough (pertussis)
- Aspiration (breathing in foreign objects or particles)
- ACE inhibitors (drugs used to treat high blood pressure)
Diagnostic tests can include:
Imaging tests may be carried out to find out the cause. While an X-ray may not reveal common causes like asthma or postnasal drip, it can be used to identify diseases like sinus infection and pneumonia. They may also detect other lung diseases that increase the risk of developing a chronic cough. Computerized tomography (CT) scans can be used to check the lungs and sinuses for infections.
Lab tests are used when evaluating a chronic cough with phlegm. If you experience a chronic cough with mucus that is colored – yellow, red, brown, green, or even white – your family doctor might take a sample of the mucus to test for bacteria. Colored mucus could point towards a particular viral or bacterial infection, such as bronchitis, tuberculosis, or pneumonia.
Lung function tests
Lung function tests check how well you can breathe and are usually non-invasive. They are often used to diagnose conditions like COPD and asthma.
The most common lung function test is the spirometry test, in which you’ll be asked to take a full breath in and then exhale as forcefully as possible. The spirometer will be attached to a mouthpiece that you will breathe into, and this will measure how much air you can breathe out in one second and the volume of the total air you can breathe out in one breath.
Other tests include lung volume tests, diffusing capacity tests, and exercise tests.
In cases where your family doctor is unable to determine the cause of your cough, they may order special scope tests such as rhinoscopy and bronchoscopy. This will involve the insertion of a thin tube with a light and lens in either the nose or mouth. A biopsy can be taken from these places to check for abnormalities.
- Rhinoscopy involves using a rhinoscope to view the sinuses, nasal passageways, and upper airway
- Bronchoscopy uses a bronchoscope to view the airways and lungs.
Diagnosing in children
In the case of chronic cough in children, spirometry and a chest x-ray are usually conducted to determine the cause of the cough. You and your child will also be asked questions about their health, such as when the cough started, how they feel, the nature of the cough (whether it is a chronic dry cough or a chronic cough with mucus), and what may have triggered the cough.
It is important to know the cause before starting treatment. In some cases, it can be caused by multiple underlying conditions.
Chronic cough treatment might involve the following:
- Use of chronic cough medications: Various medications can be used to treat chronic cough. Your family doctor might prescribe you medications such as antibiotics (if bacteria is the cause of your cough), asthma drugs, acid blockers (to treat acid reflux), antihistamines, or corticosteroids (for treating allergies).
- Cough suppressants: Diagnosing chronic cough and its cause might take a while, so your family doctor might prescribe cough suppressants to ease your symptoms while you wait for your test results. Do not use over-the-counter medications to treat cough in children younger than six unless the medicine is for pain relief or to reduce fever.
- Opiates: Over-the-counter medications are usually not recommended for treating chronic coughs because there is no significant evidence for their effectiveness. However, current treatments for chronic cough involve opiates such as codeine, morphine, and diamorphine. Opiates must be taken only when prescribed by your physician and in the right dosage, as directed.
- Gefapixant: This new Merck drug is currently under review by the US Food and Drug Administration (FDA). Trials of Gefapixant have shown promising results for treating chronic coughs, particularly refractory and unexplained chronic coughs, and it’s hoped it will become readily available as a treatment option in the not-too-distant future. As P2X3 receptors are found in the lining of the airways on sensory nerve fibers, the drug is a form of selective P2X3 receptor antagonist that works by binding to the receptors and reducing the activation of sensory nerves. This helps reduce chronic coughing. Two randomized, double-blind, placebo-controlled studies – called COUGH-1 and COUGH-2 – found that taking 45mg of Gefapixant twice daily reduced the severity of chronic coughs by nearly 50% and improved quality of life.
If you are a smoker, quitting or reducing your smoking intake could help to reduce symptoms. Talk to your doctor for advise and support on how to quit.
One of the side effects of taking ACE inhibitor medication can be a cough. If you are experiencing chronic cough and take these medications, your family doctor may prescribe another medicine for you.
If your cough has refused to stop despite receiving treatments, you might be having a chronic refractory cough (CRC). People with CRC are less able to suppress their cough. However, this kind of stubborn, unexplainable cough can be managed using both pharmacological and non-pharmacological methods.
Home remedies should not replace your family doctor’s prescription or medical guidelines for treating your condition. However, some home remedies can help ease your cough and speed up your recovery.
Below are some effective chronic cough remedies you might want to try.
- Use air moisturizers: Moisturising the air can help, especially with people that experience chronic dry cough. Take steamy showers or use a cool-mist humidifier.
- Drink lots of fluid: Fluids like water help thin the mucus in your throat while keeping you hydrated. You can also take warm liquids like tea and broth to soothe your throat if it is sore.
- Take honey: Honey is a natural remedy for chronic cough. Consuming one or two teaspoons of honey may help loosen your chronic dry cough. However, do not give honey to children under one as it may contain bacteria that are harmful to them.
- Avoid smoking tobacco: Smoking can irritate the lungs as it can trigger or worsen coughs. You should avoid smoking or breathing second-hand smoke.
- Eat chocolates: Studies show that theobromine contained in chocolate may suppress the vagus nerve activity, which causes coughing.
- Take mint: Mint helps loosen mucus in the lungs. One of the easiest ways to take mint is by drinking it in tea form.
- Menthol: Menthol is a common cough remedy. It helps to soothe chronic cough symptoms and is commonly found in lozenges.
- Consume turmeric: Turmeric helps to ease digestive problems. If GERD is the cause of your chronic cough, you might want to consider taking turmeric.
Can chronic cough be cured?
Yes, it can be cured. The biggest challenge with treating chronic cough is determining its cause.
Once the underlying cause of your cough has been identified, your doctor can commence the proper treatment immediately. Chronic cough typically disappears with the right treatment.
What kind of doctor treats chronic cough?
Different doctors can treat chronic cough. However, if you have a chronic persistent cough that has refused to go away, you should see your family doctor right away.
Primary care providers such as your family doctor usually start the initial diagnosis and treatment of chronic cough. However, in some cases, you may be referred to a specialist.
If you have a severe cough, you might be referred to the emergency department, where you can be treated by an emergency medicine specialist.
There are also specialists that treat chronic cough depending on the underlying cause.
- An allergist is in the best position to treat a patient with a chronic cough caused by allergies.
- A pulmonologist is a specialist in treating lung diseases and diseases of the airways.
- A gastroenterologist is a doctor that specializes in treating diseases of the digestive tract. If the underlying cause of your chronic cough is gastroesophageal reflux disorder (GERD), you might be referred to this doctor.
- An otolaryngologist is a doctor that specialises in diseases of the ear, nose and throat. They are often referred to as an ENT.
If you have a cough that has lasted for more than three to eight weeks, try not to panic. It is a cough that might have been triggered by environmental factors, lifestyle habits, or an underlying medical condition. It is best to see your family doctor as soon as possible.
If you are confused and feel like talking to someone or asking questions, feel free to reach out. Get in touch with GAAPP or one of our member organizations for any further inquiries.
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