Chronic cough

Overview

A chronic cough is characterized by a cough that extends for a period of eight weeks or more in adults, and four weeks in children.

This persistent cough has the potential to disrupt sleep and induce feelings of fatigue. In more severe instances, it can lead to vomiting, dizziness, and even fractures of the ribs.

While determining the precise trigger behind a chronic cough can be challenging at times, the most prevalent causes include tobacco use, postnasal drip, asthma, and acid reflux. The positive news is that addressing the underlying issue typically results in the disappearance of the chronic cough.

Symptoms

A chronic cough can occur with other signs and symptoms, which may include:

• Having a runny or blocked nose.
• Feeling like liquid is moving down the back of your throat (postnasal drip).
• Heartburn
• Fever
• Frequently clearing the throat and painful throat
• Persistent hoarseness
• Acid reflux or a bad taste in the mouth

More serious signs and symptoms include:

• Coughing up phlegm or blood
• Unexplained weight loss
• Overnight sweat
• Breathing difficulties like wheezing

If you experience a cough that lasts for several weeks, especially if it brings up mucus or blood, disrupts your sleep, or interferes with your school or work, it’s advisable to consult a doctor.

Causes

While an occasional cough is a natural mechanism to clear lung irritants and secretions and prevent infections, a persistent cough lasting for weeks typically signifies an underlying medical issue, often involving multiple contributing factors. The following causes, alone or in combination, are responsible for the majority of cases of chronic cough:

• Postnasal drip: When the nose or sinuses produce additional mucus, it can flow down the rear of the throat and activate the cough reflex. This condition is also known as upper airway cough syndrome (UACS).
• Asthma: Which is characterized by symptoms such as wheezing and shortness of breath, is the second most common cause of chronic cough. These respiratory issues can result in a persistent cough. Additionally, there is a type of asthma called cough-variant asthma, in which a chronic cough may be the sole symptom.
• Gastroesophageal reflux disease (GERD): In this common condition, stomach acid regurgitates into the tube that connects your stomach and throat (esophagus). The continuous irritation can result in persistent coughing, which, in turn, exacerbates GERD, creating a cycle of worsening symptoms.
• Infections: A cough can persist even after other symptoms of conditions like pneumonia, the flu, cold, or upper respiratory tract infections have subsided. In adults, a frequently overlooked yet common cause of chronic cough is pertussis, also referred to as whooping cough. Chronic cough can also be associated with lung fungal infections, tuberculosis (TB), or infections caused by nontuberculous mycobacterial organisms.
• Chronic obstructive pulmonary disease (COPD): Refers to a group of respiratory issues that include chronic bronchitis and emphysema. It can develop with or without tobacco use, leading to obstructed airflow due to chronic lung inflammation. Chronic bronchitis leads to a productive cough, while emphysema causes breathlessness and damage to the lung air sacs (alveoli). COPD is predominantly prevalent among current or former smokers.
• Blood pressure drugs: Angiotensin-converting enzyme (ACE) inhibitors, often prescribed for high blood pressure and heart failure, can induce chronic cough in certain individuals.

Additional factors contributing to chronic cough could involve:

• Laryngopharyngeal reflux, in which the throat is affected by stomach acid
• Nonasthmatic eosinophilic bronchitis, an inflammation of the airways unrelated to asthma
• Sarcoidosis, or groups of inflammatory cells in various body areas, most frequently the lungs
• Idiopathic pulmonary fibrosis, which causes the lungs to continuously scar
• Lung disease
• Bronchiolitis, or inflammation of the tiny pulmonary airways
• Bronchiectasis, or airway damage and dilating
• Aspiration
• Cystic fibrosis
• Lung cancer

Risk factors

Several factors may contribute to one’s risk of chronic cough, such as:

• Medical disorders: People with bronchiectasis, GERD, asthma, postnasal drip, pulmonary fibrosis, COPD, or other respiratory diseases are at a higher risk for having chronic cough.
• Tobacco consumption and exposure: Smokers are much more likely to acquire a chronic cough. Regular exposure to secondhand smoking can also harm the lungs and cause coughing.
• Obesity: People who are overweight are at a higher risk for chronic cough.
• Other factors: People with dust and chemical exposure or heightened airway sensitivity are also at a higher risk of chronic cough.