Chronic Cough

According to the Center for Disease Control and Prevention, a cough is the most common presenting symptom for a patient to a primary care doctor’s office. Coughs, though, can have a variety of etiologies. The most usual cause of a cough is a viral illness such as the common cold.These coughs typically are associated with runny noses or sore throats and last only a few days although they can linger up to two or three weeks.

A more bothersome cough is the chronic cough which, in adults, is defined as a cough that lasts longer than eight weeks. Although a chronic cough is only rarely serious or life-threatening, it can cause fatigue, loss of sleep, muscle pain, and even depression. A chronic cough has many possible origins, but most are uncommon and only a few conditions cause the vast majority of cases.

Associated symptoms are important in evaluating each person to determine the cause. Is there a history of cigarette smoking, weight loss, excessive shortness of breath, environmental exposures, fevers, or asthma? Occasionally, a chest x-ray might be helpful in finding the etiology.

Overall, the most common cause of a chronic cough is the “upper airway cough syndrome”, more commonly known as post nasal drip. Usually, patients with this problem will complain of nasal congestion or of drainage in the back of their throats. Its treatment may include anti-histamines, decongestants, saline nose rinses, steroid nose spray, and occasionally antibiotics. Improvement with treatment usually occurs within a few days.

About one quarter of chronic coughs are produced by asthma even when wheezes are absent. Treating asthma with inhalers or oral steroids relieves the cough. A condition called non-asthmatic eosinophilic bronchitis is an allergic condition in the airways which is also a frequent cause for a chronic cough. Like asthma, this type of cough improves with inhaled or oral steroids. GERD, or acid reflux, causes heartburn, hoarseness, sour taste, and occasionally, a chronic cough. Weight loss, raising the head of the bed, and medications to decrease gastric acid production can relieve the cough associated with GERD. Other, less common causes of chronic cough, include medications like Lisinopril or Enalapril, chronic lung disease, environmental triggers, and aspiration. The causes for a chronic cough are varied and are only uncommonly related to an infection. Through a careful evaluation, effective treatment can almost always be recommended.