Why do I have a Chronic Cough?

We all know about the acute cough that accompanies an upper respiratory infection.

It can certainly be a bothersome symptom but is a familiar, even expected, physical reaction.  It is rendered tolerable with over the counter suppressants and assurance that the cough will eventually resolve as our bodies fight off the offending infection.  But what about the cough that lasts several months or even years, interrupting our sleep, speech, and even meal times, seemingly without end?  As the cough’s duration extends, worrisome questions can arise: Do I have a serious infection; or worse, do I have cancer?

There are numerous causes for why the body executes the forceful expulsion of air we know of as the common cough.

In acute illnesses, coughing serves to expel mucus, infection, and foreign material.  Chronic cough can be a more complicated entity with a myriad of possible causes.  Statistics point to airway irritants as the most common triggers: smoking, acid reflux, asthma and allergies.  But the list of culprits can grow to include medication side effects, aspiration (wherein food or drink enters the airway), chronic bronchitis and emphysema, neurogenic or habitual patterns, and indeed, in some cases a tumor or growth in the upper or lower airways.  Since chronic cough is best treated by addressing its underlying cause, we as ENT physicians are often tasked with the initial investigation.  ENT physicians use a methodical approach to testing and evaluation of various parts of the airway and related body systems.

An attentive history of the cough helps to direct the evaluation: factors that worsen or improve it; time of day affecting frequency; and medication history, particularly blood pressure medications.  X-ray imaging of the lungs can identify inflammatory changes and lesions in the lung requiring further evaluation.  Endoscopy of the upper or lower airways can be performed to identify signs of irritation.  And lung function testing can be ordered to assess for airflow obstruction, as seen emphysema and chronic bronchitis cases; the same testing can be done with inhaled medications to check for the reversible obstruction of asthma.

Identifying the underlying cause of the chronic cough.

Identifying the underlying cause of the chronic cough can shed light on an obscure and often troubling symptom and allows for treatment to be directed toward the specific triggers: acid blockers for reflux, inhalers for asthma, antihistamines for allergies.  In this way worries can be addressed and physical relief obtained.

—Roger D Sequeira, MD

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