Chronic Cough

Cough

We've all had bothersome bouts of coughing for a couple of weeks with typical colds, especially in the winter. But what if you've had a persistent cough for much longer (months or even years)? This could be a symptom of a treatable underlying condition. The three most common causes of a chronic cough in a non-smoker are post-nasal drainage, asthma, and acid reflux. Of course, smoking damage to the lungs can lead to a persistent cough, often with lots of phlegm production. There are numerous other causes of cough, but this article will focus on the most common causes of a chronic cough in a non-smoker.

Post-nasal drip (PND) or a frustrating sense of throat mucus very often causes a cough. People can frequently feel that the cough is triggered in the throat, rather than from deeper in the chest. The cough may be worse soon after lying down at night or in the morning when lots of secretions have collected in the back of the throat. Sometime phlegm is produced with the cough. Post-nasal drip can be caused by chronic rhinitis or sinusitis (nasal or sinus inflammation), both of which are often caused by allergies. An allergen trigger, like house dust or ragweed pollen, is inhaled and lands on the nasal lining. In an allergic individual, this sets off a cascade of inflammation leading to typical symptoms of runny nose, sneeze, congestion, itch and post-nasal drainage. Of course, that PND can trigger a cough. This post-nasal drip-cough may even be present without other symptoms like sneezing. There are medications, environmental controls, and allergy vaccines that can help control these nasal allergy symptoms. Occasionally, a persistent sinus infection can lead to PND and cough. This might lead to colored secretions and sinus pain and is treated with antibiotics.

Asthma is also a very common cause of a chronic cough that, unfortunately, is frequently undiagnosed. People generally think of asthma causing wheeze, while not realizing that a chronic cough without any other chest symptoms may still be due to asthma. This cough may be more "barky" in nature and may feel like it comes deeper from the chest. It usually comes in spasms (sudden spells of uncontrollable cough). People may awaken at night with a coughing spell. The cough may be wet or dry. Exercise very often triggers an asthma cough. Environmental allergy triggers cause inflammation in the lings as well as in the nose, so these exposures can cause both nasal and asthma symptoms. It is very important to recognize asthma as the cause of a persistent cough since treatments can control the symptoms, prevent loss of lung function and help avoid potentially life-threatening asthma flares. There are excellent medications for asthma. Allergy vaccines also help control asthma and can even help prevent the development of asthma if given to someone who only has nasal allergies (patients with nasal allergies are at higher risk for developing asthma and this risk is cut in half by allergy shots).

Finally, acid reflux can often lead to a chronic cough. A person may have other typical heartburn or acid reflux symptoms with a burning pain in stomach/chest or even regurgitation of food to the back of the throat. The acid in the esophagus (food pipe) often triggers a cough reflex. What many people don't realize is that this acid reflux can cause symptoms of throat mucus and cough even without any other more typical heartburn/reflux symptoms. This cough may be worse at night or after large meals. Specific tests are available to diagnose acid reflux, but are not always necessary. Some patients may need to see a gastroenterologist, too. Dietary and lifestyle changes can help, but very often strong acid-reducing medicine is required.

If you have a chronic cough, don't just keep living with it. Talk to your doctor about your symptoms and triggers. Acid reflux treatment might be your answer. Both post-nasal drainage and asthma cause cough and can be triggered by allergies. An allergy-immunology specialist can identify specific allergies causing the problems and can guide therapy with medicines and environmental controls. Additionally, allergy vaccines can treat symptoms and can help stop the progression of allergic disease. With appropriate diagnosis and treatment, your cough might soon be controlled.

By Penelope Ewbank, MD