A chronic cough is defined as a cough that lasts for greater than 8 weeks without relief. It can be caused by several pathologies. The most common causes of a chronic cough include the following: asthma, GERD, chronic bronchitis, allergies, chronic sinusitis, postnasal drip orMedication side effects.
For any cough lasting longer than 8 weeks, a primary care doctor should be seen to determine the underlying cause.
Asthma is a lung condition that causes narrowing and inflammation within the airways because of irritants. It is often diagnosed in childhood. It is often a concurrent diagnosis and more common in patients with eczema, allergic rhinitis, and allergies. Asthma will often presentas shortness of breath and cough during exercise and can be more prevalent at night before going to sleep.
Treatment for asthma involves using an inhaler to manage symptoms as well as avoiding triggers. Asthma diagnosed in childhood can often improve with age.
A cough caused by allergies can appear along with other symptoms including sneezing, sinus congestion, runny/stuffy nose, and itchy/scratchy throat. Allergies are caused by triggers which include pollen, pet allergies, certain foods, etc.
Treatment and avoidance of the underlying allergen can resolve this type of cough. Initial treatment with an anti-histaminergic such as Benadryl or Zyrtec can improve these symptoms. See your doctor for allergies that seem to be getting worse over time or that fail to respond to over-the-counter treatments. For severe allergic reactions that cause difficulty breathing, patients should be seen in the emergency room.
Gastroesophageal Reflux Disease (GERD) is caused by stomach acid backing up into the throat, causing heartburn, sour taste, or chest discomfort. Symptoms are especially present when laying flat and are worse after eating or consuming spicy foods. Throat irritation caused by GERD is the underlying cause of a cough in these patients.
Treatment of GERD should start by avoiding foods known to cause symptoms in the patient. Additionally, patients can try Tums and milk as conservative management. If symptoms do not improve the over-the-counter Omeprazole or Pepcid can be taken when symptomatic. See you PCP if symptoms remain uncontrolled despite these interventions.
A long-term cough with mucus, often caused by smoking or pollution. You’ll usually have a persistent cough, and it’s hard to breathe sometimes. Due to how long this cough is present and the impact on patient breathing, evaluation by your PCP is required to make this diagnosis to rule out other potential causes of the cough.
Treatment typically involves lifestyle modification such as smoking cessation which can improve symptoms. If symptoms fail to improve then inhalers may be warranted for treatment.
Chronic sinusitis is caused by a long-lasting sinus infection. Symptoms include facial pressure, congestion, thick nasal mucus, and a blocked nose. Patients usually present to their PCP early on due to the discomfort caused by these symptoms.
Initial treatment of congested sinuses involves nasal irrigation (saline rinse), decongestants, and over-the-counter nasal sprays. However, chronic sinusitis usually stems from an underlying infection you should see your PCP to determine the presence of an infection that would require treatment.
Postnasal drip can be caused by a number of underlying causes such as the others listed here. It occurs when excess mucus accumulates in the back of the throat and begins to elicit a sensation that it is dripping down the throat causing discomfort. This discomfort can cause coughing, sore throat, and a frequent need to clear the throat.
Postnasal drip may require long-term management and can recur frequently in affected individuals. Antihistamines, guaifenesin, saline sprays/rinses, humidified air are all helpful treatments for postnasal drip in an effort to treat the underlying causes.
Occasionally, starting a new medication can cause a cough. The most frequent medication that we see this with would be an ACE inhibitor such as lisinopril. If a new cough develops after starting any new medication, your PCP should be made immediately aware, and you may need to stop taking the medication or switch to a different type of medication.
Chronic coughs are a distressing and multifactorial cause of concern in many patients. A symptom that does not improve despite initial therapies and that fails to respond to typical over-the-counter medications can stem from several underlying causes not limited to the ones above.
All of these diagnoses are best made by a medical professional to rule-out any seriouscauses of cough, and understanding these different diagnoses can offer a great perspective to concerned patients and offer some reassurance of their symptoms. Understanding the possible causes also allows the patient to be an active and educated participant of their healthcare.
Dr. Fellers is a resident physician who sees patients of all ages and provides obstetrical services at Lone Star Family Health Center, a non-profit 501©3 Federally Qualified Health Center operating facilities in Conroe, Spring, Willis, Grangerland, and Huntsville, and serving as home to a fully integrated Family Medicine Residency Program to increase the number of Family Medicine physicians for Texas and our community.