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Cough

Updated 18 September 2018

What should you do about that persistent cough?

Your cough is not clearing up and it’s certainly not caused by a cold. What could it be and what should you do about it? We have some tips.

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Coughing is such a common physical reaction that we've come to accept it as part of life. It’s either caused by irritation in the airways or the symptom of a cold. A cough usually doesn't last for more than a week or two – but sometimes it lingers.   

A chronic cough is described as a cough that lasts for longer than three weeks, sometimes persisting for months or even years. According to Harvard Medical School, chronic cough is one of the most common reasons for seeing a doctor.

A chronic cough is annoying and can impact the quality of your life – it interrupts sound sleep and can lead to anything from urinary incontinence to sore ribs.

Harvard Medical School identified the top five common causes of a chronic cough. 

1. Postnasal drip

Why it causes coughing: Not only is your nose responsible for smell, but it’s also the entrance to your respiratory system and filters everything you breathe in before it gets to the lungs. Unfortunately, this also means that the nasal membranes can get irritated by things like dust particles and chemicals. This leads to increased mucus production, which may drip back down the throat.

What to do: If your doctor suspects that your cough is caused by postnasal drip, you will be given a treatment such as a nasal decongestant or antihistamine rather than antibiotics. You can also try home remedies, such as inhaling steam or nasal irrigation.

2. Asthma

Why it causes coughing: Shortness of breath and wheezing are not the only symptoms of asthma. In some cases of asthma, a chronic cough is one of the main symptoms. This is called cough-variant asthma.

What to do: If you struggle with a chronic dry cough that produces no phlegm or mucus, it could be asthma. Your doctor will be able to determine this through a lung-function test. According to Harvard Health, another approach a doctor could take is to see if your cough responds to asthma treatment and they might prescribe an inhaled cortisone steroid.

3. Gastroesophageal reflux disease (GORD)

Why it causes coughing: This is an often overlooked caused of cough, as people usually look out for heartburn symptoms before coughing. GORD occurs when the lower oesophageal sphincter (the muscular ring at the lower end of the oesophagus, or gullet, near the diaphragm) is too relaxed and allows the stomach's acidic contents to flow back into the oesophagus. This usually causes a burning sensation, but the acid can also trigger a cough reflex without any other symptoms. 

What to do: It can be hard to diagnose GORD if you don’t suffer from pain or heartburn. If you haven’t responded to any other cough treatments and suspect GORD, your doctor can do an oesophagoscopy or a barium swallow X-ray. Avoid eating large meals before you go to bed and elevate your head when you sleep to avoid reflux. 

4. Chronic bronchitis

Why it causes coughing: Chronic bronchitis is a condition that falls under chronic obstructive pulmonary diseases (COPD) and involves permanent inflammation of the bronchial tubes. If someone has a mucus-producing cough most days of the month for three months of the year for at least two successive years, they are suspected of having chronic bronchitis if there is no other explanation for the presence of the cough. This condition may precede or accompany pulmonary emphysema and is usually brought on by smoking.

What to do: If you are a smoker, you need to quit to avoid the later onset of emphysema. If you suspect that you may have chronic bronchitis, it’s important to seek help from your doctor as soon as possible, as you can develop further lung damage. It’s especially crucial to go to the doctor if your chronic cough is accompanied by a fever, chills, shortness of breath and discoloured mucus.

5. ACE inhibitors

Why it causes coughing: Angiotensin-converting enzyme (ACE) inhibitors is a group of medications commonly prescribed to treat high blood pressure. These medications can cause chronic cough because they alter the way the kidneys filter impurities out of the blood. As your body struggles to clear the impurities, it will try to expel them through a dry, tickly, annoying cough. 

What to do: If you take ACE inhibitors, ruled out other causes for chronic cough and suspect that it might be a side-effect of these medications, you can consult your doctor to weigh up your options. Quitting your ACE inhibitors is not ideal, but the cough can be treated through pharmacological options such as cough inhibitors.

And if it’s not any of the above?

The causes mentioned are the most common causes of chronic cough, but there are some less likely causes of chronic cough. If your chronic cough doesn’t fit any of the above reasons, the following might be probable causes:

  • Lung infection
  • Lung cancer
  • Heart failure
  • Whooping cough (pertussis)

When to go to the doctor immediately 

If you do experience a chronic cough and experience any of these symptoms, you need to see a doctor urgently:

  • Coughing up blood
  • Weight loss
  • High or prolonged fever
  • Shortness of breath or wheezing

Treating a cough correctly will always depend on the cause; it is therefore important to determine the origin of your cough.

Image credit: iStock 

 

Ask the Expert

Cough Expert

Professor Keertan Dheda has received several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others. Read his full biography at the University of Cape Town Lung Institute.

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