Have you ever experienced a persistent cough? A persistent and chronic cough can be exhausting and tiring. The causes of these sorts of cough are often related to the common cold but sometimes it can be more complex.
Let’s dive in and further discuss this condition.
Definition of persistent cough
The definition of persistent cough is straightforward. It is a cough that simply does not want to stop. It is also relentless and continuous. Over the counter medications often cannot stop this nuisance. There are many different reasons that could cause this condition.
Here is a list of conditions that could result in lingering cough:
- Sore throat
- Upper respiratory infections
- Emphysema and COPD
- Acid reflux (GERD)
- Lung cancer
- Bacterial infection (e.g. whooping cough)
- Foreign bodies
What is a chronic cough?
The definition of chronic cough is different from a persistent cough. Chronic means lasting. By definition, a cough that lasts longer than eight weeks is called chronic. Most of the causes listed above could also cause a chronic cough.
How does coughing happen?
Stimulation and irritation of so-called cough receptors could result in a cough. These receptors are located in the upper and lower airways, stomach, esophagus and diaphragm. Any irritants, including heat, cold and acid could activate these receptors.
Which medications could cause cough?
As mentioned before, there are numerous causes of a cough. However, one of the most important causes, that is often unrecognized, is a medication- induced cough. The most commonly known medication causing a cough is a blood pressure medication (Angiotensin Converting Enzyme or ACE inhibitor). However, there are other lesser-known medications that could cause the same problem. I dedicated one post to discuss this important issue. I consider it to be a must read article. Click here and discover more.
Cough in children
Did you know that asthma is the most common cause of cough in children?
Coughing in children is often a chronic condition. For instance, coughing and wheezing sounds with exercise could be an indication of underlying asthma or a chronic productive cough could be suggestive of cystic fibrosis.
This is why a comprehensive evaluation of the causes of cough in children is crucial. If this is not done, many diseases could be undetected until adolescence or adulthood.
Most common causes of cough in children
- Whooping cough
- Chlamydia infection
- Cystic fibrosis
- Fungal infection
- Post-nasal drip
Whooping cough or pertussis is another cause of cough that should be mentioned. Because of vaccination, the rate of this infection is now significantly lower than it was few decades ago. This infection is caused by a bacteria called Bordetella Pertussis. The symptoms include persistent whooping cough followed by vomiting.
In the early stages of the disease, the diagnosis of whooping cough is done through blood culture and polymerase chain reaction (PCR).
This disease can be treated with azithromycin or trimethoprim-sulfamethoxazole.
Acid reflux or gastro-esophageal (GERD) reflux is another common reason for a cough. It usually produces a dry cough and is worse at night when you lay down. It is interesting that a large number of patients who suffer from heartburn of GERD, deny having acid reflux (~40%). This is one of the reasons why diagnosing the accurate cause of a cough could sometimes be challenging and requires a degree of experience and expertise.
Cough at night
Most common causes of cough at night are related to GERD and post-nasal drip. That is why, in addition to appropriate treatment, I always suggest that my patients elevate the head of the bed which can provide some symptom relief.
There are many ways to treat a cough. However, I prefer to treat the causes of cough directly rather than symptom management. Managing the symptoms might relieve the problem, but the cough reflex will continue. I am not a fan of cough syrup except when a patient’s symptoms are unbearable and result in a lower quality of life.
Here is the list of remedies and non-drug options to treat the causes of the cough:
Some of the medications that can treat the causes of a cough include:
- Nasal corticosteroids (fluticasone, Nasonex)
- Nasal decongestants (Sudofed, Afrin)
- Acid lowering medications (Prilosec, Nexium, Prevacid, Zantac, Tums)
- Oral antihistamines (Claritin, Zyrtec, Allegra)
- Albuterol (Proair, Proventil, Proventil)
- Expectorants (Mucinex)
- Cough medicine (Tessalon, Delsym)
Many of you might find coughing as a bother and an annoying reflex. However, coughs are helpful in cleaning the airway system from foreign bodies and secretions. Therefore, a little coughing off and on is not a bad thing to have.