Overview of Chronic Cough
What is chronic cough?
Chronic cough is usually defined as a cough that lasts more than 8 weeks. Chronic cough is one of the most frequent reasons for visits to the doctor. Chronic cough is not a disease itself. It is a health problem that results from other health conditions.
What are some of the health problems that cause chronic cough?
Chronic cough is usually caused by these health problems:
- Smoking -- Smoking is the number one cause of chronic cough.
- Asthma -- This is the second most frequent cause of chronic cough. Shortness of breath and wheezing are by-products of asthma. These breathing difficulties can result in a chronic cough. On the other hand, chronic cough may be the only symptom of asthma.
- Acid reflux -- Gastroesophageal reflux disease (GERD) occurs when stomach acid backs up into the esophagus. Symptoms of GERD include heartburn, chest pain, wheezing and shortness of breath. Irritation caused by these symptoms can lead to chronic cough.
- Sinusitis and post nasal drip -- Recurrent sinus infections can cause post-nasal drip, sometimes called ‘a tickle in the back of the throat,’ drainage can trigger chronic cough. The ‘tickle’ occurs when a larger-than-normal amount of mucus runs down the back of the throat.
- Allergies -- Chronic cough can result from inhaling dust, pollen, pet dander, chemical/industrial fumes (over many years), molds, freshly cut grass, and other irritants.
- Bronchitis - Inflammation of these airway passages can trigger shortness of breath and wheezing and result in chronic cough.
- Upper respiratory infections -- Lengthy bouts of colds, the flu, pneumonia or other infections can lead to the development of chronic cough. Whooping cough (pertussis) occurs more commonly in infants and young children.
- Chronic obstructive pulmonary disease (COPD) -- This is a lung condition that occurs most often in smokers. It is caused by a build-up of mucus in the lungs, which the body tries to clear by coughing. COPD includes the related conditions, emphysema and chronic bronchitis.
- High blood pressure drugs -- ACE inhibitors are a specific category of drugs used to treat high blood pressure. A side effect of these drugs is chronic cough. Some common ACE inhibitors are lisinopril (Prinivil®, Zestril®), enalapril (Vasotec®), peridopril (Aceon®), captopril, (Capoten®), and ramiparil (Altace®).
- Lung or other airway cancers – Rarely, chronic cough can be a sign of either a lung cancer or cancer in the upper airway.
What are the symptoms of chronic cough?
Often, the cough itself is the only symptom of chronic cough.
Other symptoms can include:
- A runny/stuffy nose
- Post-nasal drip (‘tickle’ in the back of the throat)
- Wheezing/shortness of breath
- Weight loss without any effort
- Coughing up phlegm or blood
- Throat pain
- Frequent throat clearing
- Hoarse voice
- Fever (higher than 101°F®)
- A drenching overnight sweat
How is chronic cough diagnosed?
Diagnosing the cause of chronic cough can be difficult. This is because many patients have more than one cause of their cough. Therefore many types of tests are used to diagnosis the causes. The other symptoms present will help determine which tests are needed.
Lab tests: These tests help determine if bacteria are present (a sign of an infection) and are causing the cough.
Lung function studies: These tests measure your breathing pattern -- from inhaling to exhaling.
Imaging tests: These tests include x-rays, CT and MRI scans, ultrasound and nuclear testing. X-rays reveal the more common reasons for chronic cough, such as a build-up of fluids in the areas that help breathing, as well as lung diseases and lung cancer. All of the other imaging tests provide more detailed views of areas of the body that affect breathing.
Scoping studies: In these tests, a scope is passed into the areas that might reveal the cause of chronic cough. For example, a scope can be passed up through the nostrils to look for signs of infection or blockages in the nasal passages. A scope passed through the nose into the voice box area can look for signs of acid reflux, post nasal drip, and abnormalities in the upper airway. A scope can be passed down the esophagus and into the stomach to measure the level of acid, which would help determine if acid reflux is the cause of chronic cough. A scope down the windpipe and into the bronchial tubes can show blockages and signs of infections in the lung.
How is chronic cough treated?
Treatment decisions are made based on the cause of the cough.
- If the cause is asthma, drugs such as inhaled bronchodilators and/or steroids are prescribed. These drugs help reduce airway inflammation and wheezing.
- If the cause is GERD, several non-drug treatments and prescription medications are tried. Non-drug treatments include using pillows to prop up the head when lying down, avoiding foods that cause acid reflux (such as chocolates, colas, red wines) and not eating right before bedtime. Prescription medicines, such as cimetidine (Tagamet®), famotidine (Pepcid®), ranitidine (Zantac®), esomeprazole (Nexium®), lansoprazole (Pravacid®), and omeprazole (Prilosec®), are prescribed to reduce stomach acids.
- If the cause is bacterial pneumonia or bronchitis, antibiotics, such as azithromycin (Azithrocin®, Zithromycin®), cefuroxime (Ceftin®) or cefprozil (Cefzil®), are prescribed.
- If the cause is post-nasal drip, over-the-counter decongestants, such as diphenhydramine or pseudoephedrine, may help relieve post-nasal drip symptoms. Antibiotics may be prescribed if the cause of the chronic cough is sinusitis. Nasal spray, such as ipratopium (Atrovent®) can relieve runny nose, sneezing and post-nasal drip. A nasal glucocorticoid, such as fluticasone (Flonase®) can also reduce post-nasal drip.
- If the cause is the use of specific high blood pressure medicines (ACE inhibitor drugs), other high blood pressure drugs can be prescribed instead.
- If other treatments have failed and the chronic cough is severe, a cough suppressant such as codeine may be prescribed.
What are the complications of chronic cough?
- Physical exhaustion
- Insomnia (inability to sleep)
- Disruption of the daily routine
- Muscle discomfort
- Hoarse voice
- A drenching sweat
- Urinary incontinence (loss of bladder control)
- Minor bleeding in the eye
- Broken ribs
What can I do to prevent or relieve the symptoms of chronic cough?
To prevent chronic cough:
- Quit smoking, or don’t start smoking, since this is the most common reason for chronic cough.
- Avoid contact with anyone you know who may have bronchitis or pneumonia.
- Eat fruit and foods that contain fiber. Research suggests that a combination of fiber and flavonoids found in fruit may prevent chronic cough.
To relieve the symptoms of chronic cough:
- Drink plenty of water (at least eight 8-ounce glasses a day)
- Gargle with warm saltwater to help remove any mucus
- Inhale steam
- Avoid inhaling dust, smoke or other pollutants as much as possible
- Use extra pillows at night to prop up your head and upper body
- Try cough lozenges
- Try OTC cough medicines that contain guaifenesin and/or dextromethorphan
When should I call my doctor?
Call your doctor if you are:
- coughing up blood or phlegm
- running a fever (temperature greater than 101°F)
- losing weight without trying
- having a drenching sweat overnight
- American Academy of Family Physicians. Chronic Cough Fact Sheet. familydoctor.org Accessed 7/15/2011.
- Chung KF, Widdicombe JG. Causes and Treatment of Acute and Chronic Cough. In: Mason, ed. Murray and Nadel's Textbook of Respiratory Medicine, 5th ed.; Philadelphia, Pa: Saunders Elsevier; 2010: Chapter 29.
- Dweik RA. Cough – Etiology. In: Carey, WD, ed. Cleveland Clinic: Current Clinical Medicine 2010.2nd ed.; Philadelphia, Pa: Saunders Elsevier; 2010: section 12.
- Kelkar P, Weldon D. Approach to the Patient with Chronic Cough. In: Adkinson FM, et al. Middleton’s Allergy: Principles and Practice. 7th ed.; St. Louis: Mosby; 2008: Chapter 79.
- National Institutes of Health. Cough and Chronic Cough Fact Sheet. www.nhlbi.nih.gov Accessed 7/15/2011.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/25/2012…#15048