An occasional cough, whether intentional or involuntary, is a natural reflex that can be normal and beneficial in preventing infection by clearing the throat of irritants. The acute coughing that accompanies colds, flu and other upper respiratory infections usually subsides within a week or two without any lasting effect.
Chronic cough, however, is defined as a cough that persists longer than 8 weeks in an adult or 4 weeks in a child. Persistent cough is not only a frustrating condition that can have a significant impact on quality of life, but it can also be harmful for your larynx (voice box).
Chronic Cough Causes
Possible causes of chronic cough can include:
- Pulmonary disease such as asthma or chronic obstructive pulmonary disease (COPD)
- Smoking
- Allergies/sinus issues with or without post-nasal drip
- Gastroesophageal reflux (GERD) or laryngopharyngeal reflux (LPRD)
- Medication side effects
- Dehydration
Cough can also be triggered by environmental irritants, strong odors/perfumes, changes in weather/humidity, exercise or physical exertion, stress, laughing, or even voice use. In some cases, cough can become habitual due to hypersensitivity in the voice box (irritable larynx syndrome).
Symptoms, Signs, Diagnosis of Chronic Cough
Symptoms of chronic cough may include
- Dry “hacking” cough
- Prolonged episodes of coughing that result in shortness of breath
- “Tickle” or warning sensation in the throat
- Throat clearing, which may or may not be productive of phlegm
- Sensation of post nasal drip
- Hoarseness or other voice changes
Diagnosis of chronic cough may require evaluation with several specialized medical providers. Chronic cough is not a disease; it’s a symptom. In order to stop the cough, we have to determine the cause.
A primary care physician is your best resource to begin an evaluation and to coordinate a multidisciplinary treatment plan. Your physician will take a methodical approach in investigating the cause of a chronic cough. The evaluation will include a physical examination and a review of your medical history, family history and personal habits, plus any potential environmental factors.
In the majority of cases, this process enables doctors to determine the reason for your nagging cough. Depending on your circumstances and symptoms, you may benefit from additional diagnostic procedures, including:
- Imaging of the chest, sinuses, or esophagus
- Gastroenterology work-up
- Allergy testing
- Lung function testing
- Flexible laryngoscopy
- Laryngeal control evaluation
Chronic Cough Treatment
Treatments for chronic cough vary based on multiple potential etiologies of cough and are unique to each patient. Treatments range from laryngeal control therapy targeting behavioral modifications to address cough, trials of corticosteroids, decongestants, acid blockers, antihistamines, and medications or injections for neuropathic disorders that can help reduce the frequency and severity of cough.
Treating a chronic cough may involve specialists from one or more of many areas of medicine including allergy and immunology, ENT, pulmonology, gastroenterology, cardiology and speech-language pathology. Through multidisciplinary evaluation and treatment, patients are often able to find effective therapies for virtually all of the underlying causes of a chronic cough.