Coughing is normal occasionally, especially if a person suffers from cold, allergies or flu. It has a purpose, as it is body’s way of keeping unwanted stuff from getting into the lungs i.e. it is a reflex action. Coughing helps clear extra mucus from the airways (small tubes in your lungs). This extra mucus could be caused by smoking, a cold, nasal or sinus problems, a lung infection or a lung disease like asthma or COPD.
A chronic cough is more than just an annoyance. Chronic cough is defined as lasting eight weeks or longer in adults, four weeks in children.
While it can sometimes be difficult to pinpoint the problem that’s triggering a chronic cough, the most common causes are tobacco use, postnasal drip, asthma and acid reflux — the backflow of stomach acid that can irritate your throat. Chronic cough typically disappears once the underlying problem is treated.
Chronic coughing is common, so frequent that it rates as one of the most common reasons for seeing a doctor. Although both patients and doctors rightly focus their attention on finding the cough’s cause, the cough itself is responsible for significant problems. In addition to worry about the diagnosis, patients experience frustration and anxiety, especially if diagnosis and treatment stretches out over weeks, which is often the case.
Coughing interrupts sleep, producing fatigue and impairing concentration and work performance. In this age of scary new viruses, social interactions are likely to suffer. And coughing can also have important physical consequences, ranging from urinary incontinence to fainting and broken ribs. Between medical tests, lost productivity at work, remedies that don’t help, and treatments that do, coughing is also expensive.
Causes
Chronic cough is usually caused by these health problems-
- Smoking – Smoking is the number one cause of chronic cough.
- Asthma – This is the second most frequent cause of chronic cough. Shortness of breath and wheezing are by-products of asthma. These breathing difficulties can result in a chronic cough. On the other hand, chronic cough may be the only symptom of asthma.
- Acid reflux – Gastroesophageal reflux disease (GERD) occurs when stomach acid backs up into the esophagus. Symptoms of GERD include heartburn, chest pain, wheezing and shortness of breath. Irritation caused by these symptoms can lead to chronic cough.
- Sinusitis and post nasal drip – Recurrent sinus infections can cause post-nasal drip, sometimes called ‘a tickle in the back of the throat,’ drainage can trigger chronic cough. The ‘tickle’ occurs when a larger-than-normal amount of mucus runs down the back of the throat.
- Allergies – Chronic cough can result from inhaling dust, pollen, pet dander, chemical/industrial fumes (over many years), molds, freshly cut grass, and other irritants.
- Bronchitis – Inflammation of these airway passages can trigger shortness of breath and wheezing and result in chronic cough.
- Upper respiratory infections – Lengthy bouts of colds, the flu, pneumonia or other infections can lead to the development of chronic cough. Whooping cough (pertussis) occurs more commonly in infants and young children.
- Chronic obstructive pulmonary disease (COPD) – This is a lung condition that occurs most often in smokers. It is caused by a build-up of mucus in the lungs, which the body tries to clear by coughing. COPD includes the related conditions, emphysema and chronic bronchitis.
- High blood pressure drugs – ACE inhibitors are a specific category of drugs used to treat high blood pressure. A side effect of these drugs is chronic cough. Some common ACE inhibitors are lisinopril (Prinivil, Zestril), enalapril (Vasotec), peridopril (Aceon), captopril, (Capoten), and ramiparil (Altace).
- Lung or other airway cancers – Rarely, chronic cough can be a sign of either a lung cancer or cancer in the upper airway.
Symptoms
A chronic cough can occur with other signs and symptoms, which may include –
- A runny or stuffy nose
- A feeling of liquid running down the back of your throat
- Frequent throat clearing and sore throat
- Hoarseness
- Wheezing and shortness of breath
- Heartburn or a sour taste in your mouth
- In rare cases, coughing up blood
- Fever (higher than 101°F®)
- A drenching overnight sweat
Complications
- Physical exhaustion
- Insomnia (inability to sleep)
- Disruption of the daily routine
- Muscle discomfort
- Hoarse voice
- Headache/dizziness
- A drenching sweat
- Urinary incontinence (loss of bladder control)
- Minor bleeding in the eye
- Hernia
- Broken ribs
Treatment
Medication
In case of Asthma – drugs such as inhaled bronchodilators and/or steroids are prescribed. These drugs help reduce airway inflammation and wheezing.
Cough medicines – Cough suppressants for a dry cough or expectorants for a wet, productive cough that brings up mucus, are available over the counter and by prescription.
Antihistamines – Can temporarily relieve a runny nose by drying up nasal secretions; they may help if your cough is due to allergies. Non-drowsy antihistamines available over the counter include loratadine (Claritin), fexofenadine (Allegra), and cetirizine (Zyrtec).
Bronchodilators – Increase airflow by opening airways and help make it easier to breathe.
GERD – several non-drug treatments and prescription medications are tried. Non-drug treatments include using pillows to prop up the head when lying down, avoiding foods that cause acid reflux (such as chocolates, colas, red wines) and not eating right before bedtime. Prescription medicines, such as cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac), esomeprazole (Nexium), lansoprazole (Pravacid®), and omeprazole (Prilosec), are prescribed to reduce stomach acids.
Bacterial Pneumonia or bronchitis, antibiotics, such as azithromycin (Azithrocin, Zithromycin), cefuroxime (Ceftin) or cefprozil (Cefzil), are prescribed.
Post-nasal drip, over-the-counter decongestants, such as diphenhydramine or pseudoephedrine, may help relieve post-nasal drip symptoms. Antibiotics may be prescribed if the cause of the chronic cough is sinusitis. Nasal spray, such as ipratopium (Atrovent) can relieve runny nose, sneezing and post-nasal drip. A nasal glucocorticoid, such as fluticasone (Flonase) can also reduce post-nasal drip.
High blood pressure medicines (ACE inhibitor drugs), other high blood pressure drugs can be prescribed instead.
Lifestyle
Avoid allergens -If the chronic cough can be traced back to nasal allergies, try to avoid the substances that cause your symptoms.
Quit smoking – The most common cause of chronic bronchitis, smoking irritates the lungs and can worsen coughs caused by other factors.
Reduce acid reflux – A cough caused by acid reflux can often be treated with lifestyle changes alone. This includes eating smaller, more frequent meals; waiting three to four hours after a meal before lying down; and elevating the head of the bed at night.
Alternative Treatment
Probiotics – These may help overcome underlying conditions. Research suggests that Lactobacillus may help prevent colds and flu, and possibly reduce allergy to pollen. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it is not possible to say whether the vitamins, minerals, or probiotics were responsible for the benefit.
Quercetin – Quercetin is a flavonoid, a plant pigment responsible for the colors found in fruits and vegetables. Studies suggest that quercetin inhibits the production and release of histamine, which causes allergy symptoms, such as a runny nose and watery eyes.
Bromelain – Some studies show that bromelain may help reduce symptoms of sinusitis and relieve swelling and inflammation caused by allergies.
Peppermint – Peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant.
Licorice – Licorice root is a traditional treatment for sore throat and cough, although scientific evidence is lacking. Licorice interacts with a number of medications.
Thyme – Thyme has traditionally been used to treat respiratory illnesses, such as bronchitis, and to treat cough. Two preliminary studies suggest that thyme may help treat acute bronchitis and relieve cough.
Phosphorous – For chest tightness associated with a variety of coughs, particularly a dry, harsh cough with a persistent tickle in the chest and significant chest pain; symptoms tend to worsen in cold air and when the individual is talking; this remedy is most appropriate for individuals who are often worn out and exhausted, suffer from unnecessary anxiety (even fear of death), and require a lot of reassurance.
Vitamins
Reference –
http://www.nationaljewish.org/healthinfo/conditions/cough/
http://www.emedicinehealth.com/coughs/article_em.htm
http://bestpractice.bmj.com/best-practice/monograph/69/diagnosis/differential-diagnosis.html
http://www.pdrhealth.com/diseases/cough
http://www.fpnotebook.com/lung/Sx/ChrncCgh.htm
http://www.aafp.org/afp/2011/1015/p887.html
http://www.everydayhealth.com/symptom-checker/cough
http://www.aaaai.org/conditions-and-treatments/conditions-dictionary/chronic-cough.aspx
http://www.avogel.co.uk/health/immune-system/cough/persistent/