Chronic Cough: Symptoms and Treatment

by | Nov 28, 2024 | Speech Therapy for Adults

A chronic cough is a cough that persists for 8 weeks or longer in adults or 4 weeks in children. Unlike an acute cough, which is usually caused by a viral infection (like the common cold) and resolves in a few weeks, a chronic cough can be a sign of an underlying health condition. It can interfere with daily activities, cause discomfort, and be a source of distress for those experiencing it.

Common Symptoms of Chronic Cough

The main symptom of chronic cough is a persistent cough, but it may be accompanied by other symptoms depending on the underlying cause. These may include:

  • Dry or wet cough: A dry cough produces no mucus, while a wet (productive) cough brings up mucus or phlegm.
  • Wheezing: A high-pitched whistling sound during breathing, often heard during exhalation.
  • Shortness of breath: Difficulty breathing or feeling winded.
  • Throat clearing: A frequent urge to clear the throat.
  • Postnasal drip: Mucus dripping down the back of the throat, often leading to coughing.
  • Sore throat or hoarseness: Irritation in the throat caused by constant coughing.
  • Chest discomfort: Tightness or soreness in the chest area due to repeated coughing.

Possible Causes of Chronic Cough

Several underlying conditions can cause a chronic cough, and identifying the cause is crucial for effective treatment. Some of the most common causes include:

1. Postnasal Drip (Upper Airway Cough Syndrome)

  • Cause: Mucus from the sinuses or nasal passages drips down the back of the throat, irritating the airways and causing coughing.
  • Symptoms: Cough, throat clearing, nasal congestion, and a feeling of mucus in the throat.
  • Common Triggers: Allergies, sinusitis, rhinitis, or colds.

2. Asthma

  • Cause: Inflammation of the airways leads to narrowing and swelling, which can trigger coughing, wheezing, and shortness of breath.
  • Symptoms: Coughing, especially at night or early in the morning, wheezing, and shortness of breath. Often triggered by allergens, cold air, exercise, or respiratory infections.
  • Common Triggers: Allergens, respiratory infections, irritants like smoke or pollution.

3. Chronic Obstructive Pulmonary Disease (COPD)

  • Cause: A group of lung diseases (such as emphysema and chronic bronchitis) that cause long-term breathing problems and a persistent cough.
  • Symptoms: Chronic cough, often productive with mucus, wheezing, shortness of breath, and frequent respiratory infections.
  • Common Triggers: Smoking, environmental pollutants, and respiratory infections.

4. Gastroesophageal Reflux Disease (GERD)

  • Cause: Acid from the stomach leaks into the esophagus (acid reflux), irritating the throat and causing a chronic cough.
  • Symptoms: Heartburn, regurgitation, chest pain, sour taste in the mouth, and a chronic cough, especially at night.
  • Common Triggers: Spicy foods, citrus, chocolate, caffeine, and lying down after eating.

5. Medications (ACE Inhibitors)

  • Cause: Angiotensin-converting enzyme (ACE) inhibitors, commonly used to treat high blood pressure, can cause a persistent dry cough as a side effect.
  • Symptoms: Dry, persistent cough that doesn’t improve.
  • Common Triggers: ACE inhibitors (e.g., enalapril, lisinopril).

6. Infections

  • Cause: Persistent cough can occur after a respiratory infection like pneumonia, bronchitis, or a viral cold.
  • Symptoms: Cough, fatigue, fever, chest pain, and difficulty breathing.
  • Common Triggers: Respiratory infections or a history of recent illness.

7. Interstitial Lung Disease (ILD)

  • Cause: A group of lung disorders that lead to scarring (fibrosis) of the lung tissue, causing difficulty in breathing and persistent coughing.
  • Symptoms: Dry cough, shortness of breath, fatigue, and weight loss.
  • Common Triggers: Exposure to toxins (like asbestos), autoimmune diseases, or infections.

8. Lung Cancer

  • Cause: Tumors in the lungs can irritate the airways or obstruct airflow, leading to coughing.
  • Symptoms: Persistent cough, blood in the mucus, weight loss, hoarseness, chest pain, and difficulty breathing.
  • Common Triggers: Smoking, environmental toxins, or a family history of cancer.

9. Vocal Cord Dysfunction

  • Cause: The vocal cords do not open or close properly, leading to difficulty breathing and coughing, often mistaken for asthma.
  • Symptoms: Noisy breathing, coughing, and a feeling of a lump in the throat or difficulty breathing during physical exertion.
  • Common Triggers: Stress, irritants, and exercise.

Treatment of Chronic Cough

The treatment of chronic cough depends on the underlying cause. Here’s a breakdown of common treatment strategies:

1. For Postnasal Drip

  • Medications: Antihistamines (e.g., cetirizine), nasal corticosteroids (e.g., fluticasone), and decongestants can help reduce mucus production.
  • Saline Nasal Irrigation: Using a saline spray or neti pot to rinse the nasal passages can help clear mucus.
  • Steam Inhalation: Inhaling steam from a hot shower or using a humidifier can help relieve congestion.

2. For Asthma

  • Inhalers: Bronchodilators (e.g., albuterol) to open the airways and corticosteroids to reduce inflammation.
  • Leukotriene Inhibitors: Medications like montelukast may help control asthma symptoms.
  • Allergen Avoidance: Identifying and avoiding triggers like pollen, dust, or pet dander.
  • Breathing Exercises: Techniques like pursed-lip breathing can help manage symptoms.

3. For GERD

  • Proton Pump Inhibitors (PPIs): Medications like omeprazole can reduce stomach acid production.
  • Antacids: Over-the-counter antacids like Tums can help neutralize stomach acid.
  • Lifestyle Changes: Avoiding large meals, lying down after eating, and elevating the head of the bed can reduce reflux. Avoiding trigger foods (spicy, fatty foods, chocolate, caffeine) is essential.

4. For Chronic Bronchitis (COPD)

  • Bronchodilators: Medications like albuterol or ipratropium can help open the airways.
  • Steroids: Inhaled corticosteroids can help reduce inflammation in the airways.
  • Oxygen Therapy: For those with severe COPD and low blood oxygen levels.
  • Pulmonary Rehabilitation: A program to improve lung function and overall quality of life.

5. For ACE Inhibitor-induced Cough

  • Switching Medications: If an ACE inhibitor is the cause of the cough, a healthcare provider may switch the patient to a different class of blood pressure medication, such as angiotensin II receptor blockers (ARBs), which are less likely to cause a cough.

6. For Lung Infections (Pneumonia, Bronchitis)

  • Antibiotics: If the cough is due to a bacterial infection, antibiotics may be prescribed.
  • Cough Suppressants: In cases of dry cough, medications like dextromethorphan or cough syrup may provide temporary relief.
  • Rest and Fluids: Adequate hydration and rest can help speed recovery.

7. For Lung Cancer

  • Treatment: If the cough is related to cancer, treatment options may include surgery, chemotherapy, radiation therapy, or palliative care, depending on the stage and type of cancer.

8. For Vocal Cord Dysfunction

  • Voice Therapy: Speech-language pathologists can teach techniques to help improve vocal cord function.
  • Breathing Exercises: Relaxation techniques and controlled breathing exercises can help improve symptoms.

When to Seek Medical Help

It’s important to see a healthcare provider if you have a chronic cough, especially if:

  • The cough lasts for more than 8 weeks.
  • You have a persistent cough with blood or rust-colored sputum.
  • You experience shortness of breath, chest pain, or wheezing.
  • You have a history of smoking or exposure to environmental toxins.
  • You experience unintended weight loss, fatigue, or night sweats.

A doctor will work with you to determine the cause of the chronic cough and provide an appropriate treatment plan based on the diagnosis.