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Why is my cough not going away? – Chronic Cough

Chronic cough widely affects people, and several causes can prompt it. However, the identification of them very often is not that easy. And this is a big issue because before a patient receives treatment, there needs to be a specific cause. Chronic cough can impose a substantial burden on people’s lifestyles, causing psychological harm.

This article would help you understand and obtain essential knowledge of this condition, chronic cough. Why, in a first instance, that acute cough did not go away? All the possibilities are going to be a matter of discussion here. The last updates of the disease support this article, and the insights would be directly from a doctor.

What is a cough?

Cough is a quick expulsion of air from the lungs, that could either be on purpose or an involuntary reflex of the body (cough reflex). This mechanism clears the throat and the airway from any kind of stuff that should not be there, as microbes, lung irritants, excessive mucus, or foreign particles.

The cough reflex has three components, first, the cough receptors which are throughout the airway, from the pharynx to the bronchial tubes. However, most of them are in the upper airway, concentrated in the larynx. These receptors respond to all kinds of stimuli; after sensing them, they travel through particular nerves to the brainstem. From there, a coordinated response would emerge in an orchestrated chain of actions that end in cough.

Furthermore, cough also occurs in three phases, one is inhalation, so the air gets into the lungs. Then, there is an increase in pressure by some unique mechanisms, and lastly, an explosive coming out of the air when these mechanisms open.

Even though most of the cough causes are transient and mild, there are situations in which they stay or are severe. For that, there are definitions of distinct types of cough based on their length because most of the time, it would narrow the list of possible causes. There are acute cough, persistent or subacute cough, and chronic or prolonged cough. This article will focus on chronic causes.

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What is a chronic cough?

Chronic cough exact definition is a cough that lasts at least eight weeks. It is a widespread and bothering condition, affecting approximately 12% of the global population. Chronic coughing is twice as common in females as in males. The classical scenario is a female patient in their fifty’s with a dry cough that, by the moment of the medical consultation, has many years going on. However, this disease can hit people of any age.

Interestingly, chronic cough has open doctors’ minds regarding how to approach this condition. The classical airway division in upper and lower parts has no place in chronic cough. The reason for this is that an upper airway disease can trigger inflammation downstream. Therefore, very often is needed the attention of doctors that take care of the upper and lower airways, otolaryngologist, and pulmonologist, respectively. For example, It has been found that patients with upper airway conditions as postnasal drip syndrome and cough variant asthma. They are in a relationship with lower airways swelling, which is something to worry about due to the possibility of converting in a long-lasting disease.

Cough, as a symptom, is the most common cause of seeking medical attention worldwide. And, yes, nearly everyone can have an acute cough for 1 to 3 weeks. But chronic cough lasts at least eight weeks and persistently impact on the lifestyle of a person.

The broad idea is that there is an abnormal increase in the response capacity from the cough reflex to unimportant stimulus. So, the cough could exist from many triggers as temperature changes, strong smells, dust, and tobacco smoke. However, the possibility of an underlying disease, alone or in combination with others, is also likely.

What differentiates a chronic cough from an acute cough?

Many factors differentiate them, but let’s begin with an easy one, the length. The duration of the acute cough is way less, it should not pass the four weeks, and the mean duration usually is two weeks. Therefore, it is transient. On the contrary, chronic cough begins at eight weeks of cough, and the total length is usually months or years of this bothering symptom.

The causes are also widely different. The infectious causes, being a little more specific, the respiratory tract infection is the leading cause of acute cough. While for chronic cough are the noninfectious diseases as asthma, smoking, or Gastroesophageal reflux disease (GERD). And that is the reason why it is not going away, the cough source.

An infection could be defeated by the body’s immune system or antibiotics. What I am trying to point out here is that this acute cough usually goes away. On the other hand, the chronic cough is not going anywhere unless what is triggering it receives treatment.

There are situations in which the cough starts as an acute infectious cough and can last quite long, like whooping cough. This bacterial infection by Bordetella pertussis is a significant cause of disease and death in children below two years. The infection has a standard duration of six weeks minimum, and the cough could continue for many weeks.

That is why, and you are going to see it in the further sections, there needs to be a thorough assessment of chronic coughs because sometimes they are easy to diagnose, and sometimes not.

What causes a chronic cough?

The extensive list of possible causes, from the nose to the very end of the lung, can convert the cough diagnosis process into a nightmare. However, some cases are obvious, as the people who smoke tobacco or use ACE inhibitors (an essential drug for hypertension disease therapy). Your doctor would also consider the possibility that is not one cause, but two, sadly, the diseases can overlap.

In overall healthy people, that do not smoke, three conditions are the leading causes in nearly all the cases. The three of them are postnasal drip (now named Upper airway cough syndrome), asthma, and gastroesophageal reflux disease; it means that if nonsmoker, the doctor will first look for these three diseases. Then, there is nonasthmatic eosinophilic bronchitis (NAEB), which is also common, so it should be a consideration in the early phase of the diagnosis.

Upper airway cough syndrome is an entity that comprises many other diseases. It refers to sinus or nasal drip into the throat; the patient has the constant needing to clear its throat. It includes a broad range of nose and sinus diseases, as sinus infection, acute sinusitis, chronic sinusitis, allergic rhinitis, and nonallergic rhinitis, among others.

Several other causes of chronic cough exist, and of course, the lungs play a leading role. Pulmonary diseases such as bronchitis, either acute bronchitis or chronic bronchitis, chronic obstructive pulmonary disease, cystic fibrosis, eosinophilic bronchitis, interstitial lung disease, and bronchiectasis, to a major or lesser extent, have its implications on chronic cough.

However, numerous patients after an exhaustive study do not have an apparent cause for the chronic cough. In fact, there are some cases where it comes from the mind, as the psychogenic cough, although rarer, still is a possibility.

Why is it so important gastroesophageal reflux disease in this condition?

Gastroesophageal reflux disease (GERD) exists when gastric juice goes back to the esophagus, causing its damage and characteristic symptoms. Two mechanisms explain how GERD, a disease of the digestive system, can develop a chronic cough.

Firstly, the esophageal reflux prompts the cough reflex by stimulating one of the nerves that cause it. Secondly, there is an aspiration of acid reflux into the respiratory structures; the name for this is laryngopharyngeal reflux. This last disease can be in up to three-quarters of the patients with chronic cough and often occurs silently.

What serious illness could cause chronic cough?

Lung disease can be due to infection, inflammation, or even cancer, and although they are not among the most common causes. They can prompt a chronic cough. Lung cancer, or an infectious one, as tuberculosis is amidst the worst-case scenario for patients with chronic cough. COPD is also a condition that has no regression or cure, which could severely impair a patient’s quality of life.

Heart diseases as congestive heart failure could also source a chronic cough in a patient with a long history of other conditions as hypertension and diabetes. It is worthy to note that these patients with severe diseases, they have many other symptoms that highly suggest their situation. It is not usual to find a patient in the late stage of a disease with just a dry cough, albeit in the early phases, in some of them, it is.

What are the symptoms of chronic cough?

Chronic cough is defined as a cough of eight weeks or more, to differentiate it from self-limiting acute (less than three weeks) or subacute (less than eight weeks) cough. Both acute and subacute tend to have infectious and post-infectious diseases as common causes, respectively. On the contrary, as we saw, to chronic cough.

Cough’s characteristics would depend on the underlying disease, like the other symptoms that could accompany it. It could be a dry cough without mucus production in most cases unless the disease prompting the cough causes it, for example, chronic bronchitis. It typically has a cough with a vast amount of mucus production.

Then, the most common symptoms would be an array of the three diseases that more frequently source the chronic cough as asthma, GERD, and sinusitis. So there could be dry or productive cough, heartburn, chest pain, runny nose, throat clearing, hoarseness, shortness of breath, wheezing, and more.

Furthermore, other symptoms, in association with a decreased quality of life, are fatigue and disturbed sleep. More than half of female patients also have urinary incontinence. Mood disorders are also frequently pointed out, including anger, anxiety, and depression. These symptoms should not be overlooked. They mean that people struggle due to this condition.

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What are the complications of chronic cough?

The chronic cough, after treatment, sometimes can diminish but not entirely disappear. So, a refractory chronic cough is a complication that could arise. Its exact definition is a cough that persists despite stepwise treatment from the medical guidelines. Sadly, it can affect up to a third of the patients that visit a cough specialist. This complication suggests the high complexity of this condition. Thankfully, for this complication, the scientific community is currently developing multiple treatment options that would aid in decreasing its impact.

What is the treatment for chronic cough?

The most basic chronic cough treatment includes advice on smoking cessation, stopping the ACE inhibitor by switching to alternative anti-hypertensive medicine, and avoidance of identified triggers as possible (mostly in allergic patients). The smoking cessation will suppress the cough in more or less four weeks while stopping ACE inhibitor medication will do it in about two weeks, although it can vary.

The available over the counter medication for cough is in overall ineffective. The cause must be exhaustively looked, for then, focus the treatment efforts to it. However, most of the time, doctors would try the treatment for the three most common diseases. The possible medications include antibiotics (if a bacterial infection is suspected), stopping nasal decongestants (because of rhinitis medicamentosa), first-generation antiallergics, antiacid drugs, and lifestyle modifications.

A subset of chronic coughs needs to be defined because they benefit from the same treatment. So differentiating between cough due to eosinophilic airway diseases (as for asthma and NAEB) and noneosinophilic chronic cough (all the others) is essential. The former has an airway inflammation that is easily diagnosed by analyzing the mucus of the patient. And it is vital to do so, because both diseases, asthma, and NAEB, benefit from inhaled steroids. For seeing all the asthma treatment click here.

The problem is for chronic cough with no cause, chronic idiopathic cough.  There are approaches with and without drugs. Without drugs, utilizes behavioral techniques by therapists such as education, cough suppression strategies, vocal hygiene training, and psychoeducational training. The drug approach tries to modulate the nerves involved in the cough reflex. Many have been used, such as gabapentin, pregabalin, morphine, and amitriptyline. Even though these drugs showed some improvement in several studies, their secondary effects limit widespread use.

Which types of doctors it?

First, a primary physician would assess the chronic cough, its particular characteristics, and its most probable cause. If the doctor thinks it is mostly an upper way cause, then it is going to refer you to an otolaryngologist. On the contrary, if the source of the disease is lung based, then the referral will be to a pulmonologist.

However, many other types of doctors can participate in the medical management of a patient with chronic cough. The list includes gastroenterologists due to GERD, allergist, immunologist, neurologist, and speech therapist; it would depend on the underlying cause of the cough.

What should I do if I think I have it?

Consultation of your symptoms is a must. Please, feel free to utilize this chronic cough symptoms checker. It will help you to assess your symptoms and verify if it indeed, your symptoms are a chronic cough.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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