Persistent Cough – Pulmonology

Persistent Cough – Pulmonology

A persistent cough, also known as chronic cough, is a common symptom that can indicate various underlying conditions affecting the respiratory system. A cough lasting more than eight weeks in adults or four weeks in children is classified as chronic. It can result from infections, lung diseases, allergies, or even gastrointestinal disorders. A persistent cough can significantly impact daily life, leading to sleep disturbances, fatigue, and discomfort. Understanding the causes, diagnosis, and treatment of persistent cough is crucial for effective management.

Causes of Persistent Cough

Persistent cough can be caused by various respiratory and non-respiratory conditions. The most common causes include:

1. Respiratory Infections:

• Tuberculosis (TB): A bacterial infection that causes a chronic cough, often accompanied by weight loss, fever, and night sweats.
• Pneumonia: Bacterial, viral, or fungal lung infections can lead to prolonged coughing, chest pain, and breathing difficulties.
• Bronchitis: Inflammation of the bronchial tubes may cause a prolonged cough with mucus production.
• Post-viral Cough: A lingering cough that persists after a viral respiratory infection.

2. Chronic Respiratory Conditions:

• Asthma: Characterized by wheezing, breathlessness, and a persistent dry or phlegm-producing cough.
• Chronic Obstructive Pulmonary Disease (COPD): Includes emphysema and chronic bronchitis, leading to frequent coughing and mucus production.
• Bronchiectasis: Permanent widening of airways causing a chronic cough with thick sputum.

3. Gastroesophageal Reflux Disease (GERD):

• Stomach acid reflux into the esophagus can irritate the throat, leading to a persistent dry cough, often worse at night.

4. Allergies and Environmental Irritants:

• Allergic Rhinitis: Postnasal drip caused by allergies can trigger chronic coughing.
• Exposure to Smoke or Pollution: Irritants such as cigarette smoke, dust, and chemical fumes can lead to prolonged coughing.

5. Medications:

• ACE Inhibitors: Commonly used for high blood pressure, these medications can cause a persistent dry cough as a side effect.

6. Lung Cancer:

• A chronic cough that does not resolve, especially in smokers, can be an early sign of lung cancer.

Symptoms Associated with Persistent Cough

Depending on the cause, a persistent cough may present with additional symptoms:

• Dry or productive cough (with or without mucus)
• Wheezing or breathlessness
• Chest pain or tightness
• Hoarseness or throat irritation
• Night sweats, fever, or unexplained weight loss (in cases like TB or cancer)

Diagnosis of Persistent Cough

A comprehensive medical evaluation is necessary to determine the cause of a persistent cough. Diagnostic steps include:

• Medical History and Physical Examination: Evaluating risk factors, smoking history, and associated symptoms.
• Imaging Studies:
  • Chest X-ray: Detects infections, lung diseases, or tumors.
  • CT Scan: Provides detailed images of the lungs to identify abnormalities.
• Laboratory Tests:
  • Sputum Culture: Identifies bacterial or fungal infections.
  • Allergy Tests: Helps detect allergic causes.
• Pulmonary Function Tests: Assess lung capacity and airflow in asthma or COPD.
• Bronchoscopy: Examines the airways for tumors, blockages, or infections.
• pH Monitoring and Endoscopy: Evaluates acid reflux-related cough.

Treatment of Persistent Cough

Treatment depends on the underlying cause:

• Infections: Antibiotics for bacterial pneumonia or TB, antiviral medications for certain viral infections.
• Asthma and COPD: Inhaled bronchodilators, corticosteroids, and lifestyle modifications.
• GERD: Antacids, proton pump inhibitors (PPIs), and dietary changes.
• Allergies: Antihistamines, nasal sprays, and avoiding allergens.
• Medication Adjustments: Switching or discontinuing ACE inhibitors if necessary.
• Cancer Treatment: Surgery, chemotherapy, or radiation for lung malignancies.

When to Seek Medical Attention

A persistent cough should not be ignored, especially if accompanied by:

• Coughing up blood (hemoptysis)
• Unexplained weight loss
• Severe breathlessness
• Chest pain or discomfort
• A cough lasting more than eight weeks

Conclusion

A persistent cough is a significant symptom that warrants medical evaluation, as it may indicate an underlying respiratory or systemic condition. Early diagnosis and appropriate treatment can help alleviate symptoms and prevent complications. Consulting a pulmonologist is essential for accurate diagnosis and effective management of chronic cough.