Go Away Chronic Cough — I Don’t Want to Live With You Anymore.Posted: February 16, 2011
If you have a nagging cough, you may be tempted to just “live with it.” Don’t make that mistake. Even though most chronic coughs (persisting for eight weeks or longer) are not caused by a serious illness, an unresolved cough can disrupt sleep and interfere with work, home and social life.
Good news: With the right combination of treatments, chronic cough almost always can be cured.
WHY WE COUGH
Coughing protects the airways from foreign particles. But a persistent cough usually indicates that something is stimulating your cough reflex unnecessarily.
Important finding: In a study of 102 chronic-cough patients, 26% were found to have two or more causes for their cough. Since any number of factors can be blamed for a chronic cough — and often, multiple factors occur at once — diagnosis is usually not straightforward. The type of cough (such as dry or sputum-producing) is not always a reliable indicator of the cause.
CONDITIONS TO RULE OUT
If your primary care doctor is unable to diagnose and/or treat the cough, he/she can refer you to a pulmonologist (a medical doctor who specializes in treating diseases that affect the lungs).*
Recent development: Since pertussis (whooping cough) is on the rise — in part among adults whose immunity from childhood vaccinations has worn off — your doctor may order a nose or throat culture and/or blood tests to check for it.
In addition to also giving you a chest X-ray to rule out tuberculosis, a lung tumor or an illness, such as pneumonia, the doctor will test your breathing function with a spirometer. This small, plastic device measures the force and volume of your exhalation to detect any lung disease, such as asthma, emphysema or chronic bronchitis, that impairs your ability to breathe.
Among the questions your doctor will ask you…
Do you take an angiotensin-converting enzyme (ACE) inhibitor for blood pressure? One in five people who take an ACE inhibitor, such as enalapril (Vasotec) or benazepril (Lotensin), develops a chronic cough — sometimes up to a year after starting it. Newer hypertension drugs, such as irbesartan (Avapro) and losartan (Cozaar), are less likely to have this side effect.
Do you have symptoms of a systemic illness? These may include sudden weight loss, coughing up blood and/or unusual fatigue. Such symptoms could signal cancerous tumors in the lung or tuberculosis.
WHAT’S CAUSING YOUR COUGH?
If your cough is not due to one of the causes described above, it is likely due to…
Postnasal drip. If nasal secretions that normally run down the back of the throat are thicker or more excessive than usual, post-nasal drip can lead to coughing.
Allergies. A cough that occurs seasonally may be due to allergies. Over-the-counter drugs combining the antihistamine diphenhydramine and the decongestant pseudoephedrine (such as Benadryl Allergy & Cold) and prescription intranasal steroid medication, such as fluticasone (Flonase) or budesonide (Rhinocort), often help. Give any medication two weeks to have an effect.
Caution: Do not use these medications if you have high blood pressure — they may increase your stroke risk.
Sinus infection. This is another common cause of cough. Steroid nasal spray and antibiotics may help treat this condition. Studies also have shown daily saline rinses, such as Neil Med Sinus Rinse or Ayr Sinus Rinse Kit, to be extremely effective at reducing symptoms of sinus infections.
Helpful: Warm the mixture by microwaving for 30 seconds, but test the temperature first on your wrist.
Little-known fact: A small percentage of coughs are caused by nasal secretions triggered by exercise, cold air or hot or spicy foods. For this group, ipratropium (Atrovent), a nasal spray that dries up excessive runny nose, works well.
Caution: Do not use if you have glaucoma or enlarged prostate — it can worsen these conditions.
Gastroesophageal reflux disease (GERD). A form of chronic heartburn, GERD is usually associated with burning in the esophagus. However, for many people with GERD, a persistent cough — a reflex caused by acid in the esophagus — is the only symptom.
If GERD is believed to be causing a chronic cough, an acid-suppressing proton pump inhibitor medication, such as omeprazole (Prilosec) or esomeprazole (Nexium), is often tried for up to eight weeks — to give the esophagus time to heal. Other measures include eliminating coffee and fatty and acidic foods and losing weight.
Asthma. With asthma, a preventive daily inhaled corticosteroid, such as budesonide (Pulmicort) or budesonide and formoterol (Symbicort), may help. Potential allergic triggers, such as dust, cigarette smoke and pet dander, also should be avoided.
Surprising: Beta-blockers, such as metroprolol (Lopressor) or hadolol (Corgard), taken for high blood pressure and migraines — or even in eyedrop form for glaucoma and other eye conditions — can trigger asthma-related coughing.
Irritable larynx syndrome. Even most health-care professionals are not aware of this condition, which often starts with a cough due to a cold, sinus infection, GERD or asthma. Since the larynx (the air passage located in the front of the neck) has relatively small muscles that can become sore from the strain of repeated coughing, you may compensate by unknowingly tensing your larynx, which in turn triggers the cough reflex.
If a cough persists after taking medication for asthma or GERD, try resting your larynx by doing absolutely no speaking, coughing voluntarily or clearing the throat for two days. If this doesn’t help, see a laryngologist (a medical doctor who specializes in treating the larynx and vocal cords) for an evaluation.
Helpful: Whatever the cause of your chronic cough, ask your doctor about working with a respiratory therapist to help manage its treatment under your doctor’s supervision. Sessions are covered by most insurance plans.
*To find a pulmonologist near you, consult the American Lung Association, 800-548-8252, www.LungUSA.org.
Source: Diane Conley, RRT, CRE, a registered respiratory therapist and certified respiratory educator with the Calgary COPD & Asthma Program, a clinical group in Calgary, Alberta, Canada, that works with local hospitals and family practitioners’ offices. She assisted in developing the Chronic Cough Clinic at Foothills Medical Centre in Calgary and is coauthor of two recent studies published in Chest and the Canadian Respiratory Journal on managing chronic cough.
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