Persistent Cough – General Medicine

Persistent Cough – General Medicine

A persistent cough is a cough that lasts for more than eight weeks in adults and more than four weeks in children. While occasional coughing is normal and helps clear the airways, a prolonged cough can be a sign of an underlying medical condition. It can interfere with daily life, causing discomfort, fatigue, and even disturbed sleep. Understanding the causes, symptoms, diagnosis, and treatment of a persistent cough is essential to manage and treat the condition effectively.

Causes of Persistent Cough

Several factors can contribute to a long-term cough. Some of the most common causes include:

1. Respiratory Conditions

• Chronic Bronchitis: A type of chronic obstructive pulmonary disease (COPD), where long-term inflammation of the airways leads to mucus buildup and persistent coughing.
• Asthma: Characterized by airway inflammation and narrowing, leading to wheezing and persistent coughing, especially at night or early in the morning.
• Postnasal Drip (Upper Airway Cough Syndrome): When excess mucus from the nose drips down the throat, it can trigger coughing.
• Pneumonia or Tuberculosis (TB): Infections that affect the lungs can lead to a chronic cough, often with phlegm or blood.

2. Gastroesophageal Reflux Disease (GERD)

Acid reflux can cause irritation in the throat, leading to a chronic cough, often worse at night or after eating.

3. Smoking and Environmental Irritants

Long-term exposure to tobacco smoke, pollution, dust, strong odors, and chemicals can trigger a persistent cough.

4. Infections

• Whooping Cough (Pertussis): A bacterial infection that causes severe, uncontrollable coughing.
• Viral Infections: Some viral infections, like the flu or COVID-19, may leave a lingering cough that persists for weeks.

5. Medications

Certain medications, particularly angiotensin-converting enzyme (ACE) inhibitors used for high blood pressure, can cause chronic coughing as a side effect.

Symptoms of Persistent Cough

A chronic cough is often accompanied by other symptoms depending on the underlying cause:

• Dry or Wet Cough: A dry cough produces no mucus, while a wet cough may bring up phlegm.
• Wheezing: A whistling sound while breathing, often linked to asthma or COPD.
• Shortness of Breath: Difficulty breathing, especially with exertion.
• Chest Pain or Tightness: May indicate inflammation in the airways or lungs.
• Hoarseness: Chronic irritation of the throat can lead to voice changes.
• Runny Nose or Sinus Congestion: Common in postnasal drip-related coughs.
• Heartburn or Acid Reflux: Often associated with GERD-related coughs.
• Coughing Up Blood: A serious symptom that requires immediate medical attention.

Diagnosis of Persistent Cough

To diagnose the cause of a persistent cough, doctors may perform the following:

1. Medical History & Physical Examination
   
   • Identifying lifestyle habits, exposure to allergens, and medical conditions.
   • Listening to lung sounds and checking throat irritation.
2. Diagnostic Tests
   
   • Chest X-ray or CT Scan: To check for lung infections, tumors, or chronic conditions.
   • Lung Function Tests (Spirometry): Used to assess asthma or COPD.
   • Sputum Test: Analyzing mucus for infections like TB.
   • Allergy Tests: To detect triggers causing an allergic cough.
   • pH Monitoring for GERD: Evaluates acid reflux as a possible cause.

Treatment of Persistent Cough

The treatment depends on the underlying cause:

1. Medications

• Antihistamines and Decongestants: Help treat postnasal drip and allergies.
• Inhalers or Bronchodilators: Used for asthma and COPD to open airways.
• Proton Pump Inhibitors (PPIs): Reduce stomach acid for GERD-related coughs.
• Antibiotics: Only prescribed if a bacterial infection is the cause.

2. Lifestyle Changes & Home Remedies

• Quit Smoking: Essential for lung health.
• Stay Hydrated: Drinking plenty of fluids helps thin mucus.
• Use a Humidifier: Adds moisture to the air, easing dry coughs.
• Avoid Irritants: Reduce exposure to dust, smoke, and strong odors.
• Elevate Head While Sleeping: Helps with GERD-related coughs.

3. Medical Procedures

• Surgery: In rare cases, surgery may be needed for lung abnormalities.
• Allergy Immunotherapy: Helps desensitize the immune system to allergens.

When to See a Doctor?

Seek medical attention if a persistent cough:

• Lasts longer than eight weeks.
• Produces blood or thick mucus.
• Causes chest pain or breathing difficulty.
• Is associated with unexplained weight loss or night sweats.