Q/ 1. Hello Doctor, I have had a recurring cough for over two months now. I treated and have taken most of the doctors’ recommended medicine, but it is persistent. What would you advise, and should I be worried? Patricia.
A/ Hello Patricia,
Cough is a protective reflex, serving a normal physiologic function of clearing excessive secretions and debris from the pulmonary tract.
Cough that persists for two months (8 weeks) or more is known as chronic cough. This kind of cough is estimated to occur in about 40 per cent of the population.
A chronic cough is more than just an annoyance. It can interrupt your sleep and leave you feeling exhausted.
Severe cases of chronic cough can cause vomiting, lightheadedness and even rib fractures.
Symptoms
A chronic cough can occur with other signs and symptoms, which may include:
– A runny or stuffy nose.
– A feeling of liquid running down the back of your throat (postnasal drip).
– Frequent throat clearing and sore throat.
– Hoarseness.
– Wheezing and shortness of breath.
– Heartburn or a sour taste in your mouth.
– In rare cases, coughing up blood.
Causes
An occasional cough is normal — it helps clear irritants and secretions from your lungs and prevents infection.
However, a cough that persists for weeks is usually the result of a medical problem. In many cases, more than one cause is involved.
The following causes, alone or in combination, are responsible for most cases of chronic cough:
– Postnasal drip- When your nose or sinuses produce extra mucus, it can drip down the back of your throat and trigger your cough reflex.
This condition is also called upper airway cough syndrome (UACS).
– Asthma -An asthma-related cough may come and go with the seasons, appear after an upper respiratory tract infection, or become worse when you are exposed to cold air or certain chemicals or fragrances. In one type of asthma (cough-variant asthma), a cough is the main symptom.
– Gastroesophageal reflux disease (GERD)-In this common condition, stomach acid flows back into the tube that connects your stomach and throat (esophagus).
The constant irritation can lead to chronic coughing. The coughing, in turn, worsens GERD — a vicious cycle.
– Infections -A cough can linger long after other symptoms of pneumonia, flu, a cold or other infection of the upper respiratory tract have gone away.
A common but under-recognized cause of a chronic cough in adults is pertussis, also known as whooping cough.
Chronic cough can also occur with fungal infections of the lung, tuberculosis (TB) or lung infection with non-tuberculosis mycobacterial organisms.
– Chronic obstructive pulmonary disease (COPD) – This is a chronic inflammatory lung disease that causes obstructed airflow from the lungs, includes chronic bronchitis and emphysema.
Chronic bronchitis can cause a cough that brings up colored sputum.
Emphysema causes shortness of breath and damages the air sacs in the lungs (alveoli). Most people with COPD are current or former smokers.
– Blood pressure drugs- Angiotensin-converting enzyme (ACE) inhibitors, which are commonly prescribed for high blood pressure and heart failure, are known to cause chronic cough in some people.
Less commonly, chronic cough may be caused by; aspiration (food in adults; foreign bodies in children), Bronchiectasis, Bronchiolitis, Cystic fibrosis, Laryngopharyngeal reflux (stomach acid flows up into the throat), Lung cancer, Non-asthmatic eosinophilic bronchitis, Sarcoidosis (collections of inflammatory cells in different parts of your body), Idiopathic pulmonary fibrosis (chronic scarring of the lungs).
Diagnosis
This is based on history taken from the patient and physical examination especially chest exam. Among the tests that can be done include:
– X-rays -It may be used to check for lung cancer, pneumonia, and other lung diseases. An X-ray of your sinuses may reveal evidence of a sinus infection.
