Chronic cough in adults

Coughing from time to time helps clear particles and secretions from the lungs and helps to prevent infection. A chronic cough is usually defined as a cough that lasts for eight weeks or longer.
A man infected with a bad cough. / Net photo.
A man infected with a bad cough. / Net photo.

Coughing from time to time helps clear particles and secretions from the lungs and helps to prevent infection. A chronic cough is usually defined as a cough that lasts for eight weeks or longer.

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Dr. Ian Shyaka.

Although coughing is not usually a sign of a serious problem, it can be irritating. Coughing frequently can be embarrassing, can make you physically tired, make it hard to sleep, and causes you to be dizzy, hoarse, can strain muscles, make you sweat, and at times leak urine, especially in women.

 

Some of the causes of a chronic cough

 

Post-nasal drip occurs when secretions from the nose drip or flow into the back of the throat from the nose. These secretions can irritate the throat and trigger a cough. Postnasal drip can develop in people with allergies, colds, rhinitis, and sinusitis. Symptoms of postnasal drip include a stuffy or runny nose, sensation of liquid at the back of the throat that gives you a sensation of frequently wanting to clear your throat.

 

Asthma is the second most frequent cause of chronic cough in adults, and leading cause in children. In addition to cough, you may however wheeze or feel short of breath. Some people have a condition called ‘cough variant of asthma’ in which cough is the only symptom of asthma. Asthma related cough is usually seasonal, may follow an upper tract infection, or gets worse with exposure to cold, dry air, or certain fumes.

Acid reflux, also called gastroesophageal reflux disease (GERD), occurs when acid from the stomach flows back into the esophagus (tube that connects the throat to the stomach). Most people with cough due to acid reflux have a heart burn or sour taste in the mouth though some people present with cough as their only symptom.

Respiratory tract infections can cause a long standing cough. Upper respiratory tract infection, such as a cold and other bacterial infection such as pneumonia and Tuberculosis, can cause a chronic cough. The cough is usually productive, and can be blood stained in case of Tuberculosis. Cough as a result of TB is usually associated with other symptoms such as weight loss, excessive sweating especially at night, fever.

Certain drugs are known to cause a chronic cough. Some drugs used for controlling high blood pressure cause a dry and hacking cough in about 20% of the patients, and when switched to other medications usually improves the outcome in about one to two weeks.

Chronic bronchitis, a condition in which the airways are irritated, causes a cough. Most people with chronic bronchitis are current or past smokers.

Lung cancer can cause coughing, and, though rarely, can result into a chronic cough. If you are a smoker and your cough changes suddenly, and you begin to cough out blood, or if you continue to cough more than a month after quitting smoking, it could be a sign of cancer, and is more common in the elderly. 

Certain heart conditions such as heart failure can cause a chronic dry irritating cough that worsens on lying down and improves with sitting upright.

Based on the history of the cough and the clinical examination findings, treatment can be given without testing. If you improve with treatment, no further testing may be needed but if no improvement or your diagnosis is initially unclear, further testing is required. Sputum may be taken for laboratory analysis, chest X-ray or CT scan imaging if infectious causes or lung cancer is suspected, lung functioning tests if Asthma is suspected. A probe may be inserted in the esophagus to determine the acid level of the fluid in the esophagus or an endoscopydone (small camera attached to a flexible tube into esophagus) and a piece of esophagus taken off for analysis, if acid reflux is the suspected cause of your longstanding cough.

The treatment for the chronic cough depends on the cause.

A cough related to postnasal drip may improve with the use of a decongestant, nasal or oral antihistamine, and nasal steroid spray.

If the cough is caused by Asthma or cough variant Asthma, you may be prescribed a steroid and an inhaler to improve your breathing

Cough related to acid reflux usually responds to lifestyle changes such as avoiding substances that increase reflux such as fatty meals, chocolate, red wine, acidic juices or alcohol consumption, avoiding eating two to three hours before sleeping, elevating the head of the bed, losing weight and quitting smoking.

At times, cough suppressing medications are prescribing especially for dry irritating cough

Oral antibiotics or anti-TB drugs for bacterial and TB causes of the cough respectively are prescribed.

Cough as a result of an existing heart disease usually improves when the patient is put on medication for the heart condition.

Dr. Ian Shyaka is a General practitioner based in Kigali.

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