Chronic Cough

Coughing from time to time is normal and is often linked to a cold or flu virus. Coughing in fact serves a purpose as it helps your body to bring up germs, mucus, dust and other irritants from your lungs that may make you sick. To this extent coughing helps prevent infection.

However, when a cough persists for weeks, or months, with no signs of improvement, it is usually linked to a wider medical issue that needs specialist diagnosis and treatment.

Facts about chronic coughs:

  • A chronic cough is determined as lasting more than eight weeks in adults, or four weeks in children
  • Smoking is a key risk factor with chronic cough, as is passive smoking
  • However, asthma, allergies, COPD, infections, certain medications and acid reflux can also be common causes
  • Women are more likely to develop a chronic coughs as they have more sensitive cough reflexes
  • The majority of referrals from GPs to our respiratory health clinic are related to chronic coughs
  • The good news is most chronic coughs can be treated once the cause is determined
  • Chronic coughing can be a sign of lung cancer, which is why is should never be ignored
  • Whilst eight weeks is considered a chronic cough, general medical guidelines suggest you should see a doctor if you have been coughing for more than three weeks
  • Coughing blood is also a symptom of lung cancer

Symptoms of a Chronic Cough

There are many types of cough. Some may seem to be more located in the throat, others in the chest. A chronic cough is more than just an irritation; symptoms will be frequent and persistent.

Common symptoms that accompany chronic cough include:

  • A runny or blocked nose
  • Sore throat
  • A feeling that liquid is running into your throat
  • Hoarseness of voice
  • Frequently needing to clear your throat
  • Wheezing and breathlessness
  • Heartburn, also known as acid reflux

A chronic cough can in severe cases, also cause:

  • Rib fractures – from coughing very hard
  • Dizziness and fainting
  • Headaches
  • Anxiety and frustration
  • Exhaustion, from sleep disturbance
  • Urine leakage

If you are experiencing any symptoms of a chronic cough then seek the help of a medical specialist that can help determine your options.

What causes Chronic Cough?

Chronic coughing occurs as a defence by your body to protect you against long-term harm. Whilst uncomfortable, your body is trying to rid your lungs and airways of toxins, infection or anything it deems as dangerous.

There are several common causes of chronic coughing, including:

  • Smoking – smoking is one of the main causes of respiratory disorders and disease. It can also be a symptom of COPD so diagnosis is necessary.
  • Allergies – an allergic reaction to a substance can cause coughing. However, persistent coughing even when not in contact with the allergen could indicate another cause.
  • Asthma – other symptoms, such as wheezing and a tight chest usually accompany asthma. In “cough-variant asthma” a cough is the key symptom.
  • Infection – sometimes a cough can hang around following a respiratory tract infection such as acute bronchitis, pneumonia, a cold or flu, even after all other symptoms have disappeared. Whooping cough in adults can be a linked cause to chronic coughing, even though it is commonly not recognised.
  • Chronic bronchitis – this is a long-term condition that falls under a group of conditions known as COPD. Chronic bronchitis inflames and narrows your airways and causes the lungs to produce thick, coloured phlegm. It is typically caused from smoking
  • Postnasal drip – known as upper airway cough syndrome (UACS), this is where mucus from the back of the nose drips into the throat, triggering your cough reflex. It is caused by conditions such as sinusitis or rhinitis.
  • Gastro-oesophageal reflux disease (GORD) – here stomach acid leaks into the oesophagus and throat causing an acidic taste in the mouth. It is common and can lead to chronic coughing.
  • Blood pressure medication – some prescribed medication to treat high blood pressure or cardiovascular disease, such as Angiotensin-converting enzyme (ACE) inhibitors, can cause a chronic cough in some people.

Less common causes of Chronic Cough

There are a number of less common causes of Chronic Cough, including:

  • Bronchiectasis – results in an abnormal widening of the airways to the lungs, due to damage
  • Bronchiolitis – an infection of the bronchioles, the tiny airways into the lungs
  • Cystic fibrosis – an inherited condition, causing damage to the lungs
  • Whopping cough
  • Laryngopharyngeal reflux
  • Nonasthmatic eosinophilic bronchitis
  • Sarcoidosis
  • Lung cancer

Whilst lung cancer is a less common cause of chronic coughing it is very serious. If you have had a persistent cough, for more than three weeks, seek assessment by a doctor to rule out the risk of lung cancer.

A specialist consultation gives your health the attention it deserves.

Diagnosing and treating Chronic Cough

Diagnosing the cause of your cough is the first step to managing your symptoms and considering your treatment options.

During diagnosis your doctor will discuss your symptoms, medical history and conduct a physical examination. Tests that are used to determine the cause of a chronic cough include:

  • Lung function tests, such as a spirometry will determine your lung capabilities and capacities. This test is commonly used to diagnose COPD and also sometimes in the early stages of assessing for lung cancer.
  • Acid reflux tests measure the acid levels in your oesophagus to see if this could be the cause.
  • Lab tests, so your mucus can be tested for bacteria.
  • Chest X-rays may show signs of infections such as pneumonia. They also search for early signs of lung cancer. Some results come back abnormal, resulting in further testing by CT scan.
  • Sinus X-rays may be used to check for sinus infections.
  • CT-scans may also indicate the cause of your chronic cough.
  • Scope tests use a thin, flexible tube with a light and camera to investigate your lungs and airways.
    • A bronchoscope can also take a biopsy inside your airways, which can be sent to a lab for analysis.
    • A rhinoscope can view your nasal passages to asses your upper airways

Treatments for a chronic cough will depend largely on the cause as it is generally a case of treating the underlying problem.

Treatments may include:

  • Allergy related – can be treated by avoiding allergens, taking anti-histamines or other medication to treat symptoms.
  • Asthma related – can be treated with inhaled steroids that reduce inflammation
  • Bacterial infections may be treated with antibiotics
  • GORD may be treated with antacids, to reduce acid production in your stomach. Lifestyle changes can also help reduce symptoms of acid reflux.
  • Chronic bronchitis may be treated with bronchodilators, which help widen your airways
  • Decongestants and nasal sprays may be used to reduce mucus if you have a postnasal drip, helping to remove mucus and reduce inflammation in the nasal passages.
  • Medication, that is stronger than those purchased over-the-counter, such as benzonatate, may be prescribed. With some medication though side effects such as drowsiness may be apparent and therefore not suitable.

Often surgery is combined with chemotherapy to ensure remaining cancer cells are destroyed. A specialist consultant will discuss a treatment plan with you, ensuring you are fully informed of all options, tests and any treatment decisions, including side effects.

Seek the right help to feel your best

To feel our best is ultimately everyone’s goal in life.

Often it is only when a condition arises, leaving us feeling unwell, that it becomes clear as to the value of our health.

Expert help is available to help you to better understand, manage and improve symptoms related to your respiratory health.

A specialist consultation gives your health the attention it deserves.