What is it?
Coughing is the body’s method to help clear particles and secretions from the airways to prevent infection. However, when a cough lingers it can be a frustrating and exhausting problem for patients. Chronic cough can cause muscle fatigue, dizziness, hoarseness, and sleep disturbance, to name a few. A chronic cough is defined as a cough that continues for more than 8 weeks and is not a disease in itself but rather a symptom of an underlying condition.
There most common causes of chronic cough are postnasal drip, asthma, and acid reflux from the stomach. Less common causes include respiratory infections like sinusitis and bronchitis. Certain medications, specifically ACE inhibitors, can also cause a chronic cough. ACE inhibitors are a medication used to lower blood pressure, and cause a cough in about 20 percent of patients. Although less common, lung cancer can cause coughing and should be considered especially if the patient has a significant smoking history.
How is it diagnosed?
The diagnosis of chronic cough is based on the clinical presentation of a cough that has persisted for more than 8 weeks. However, the history and physical exam should be focused on discerning the cause of the cough. Breathing tests may be ordered if asthma or chronic bronchitis is suspected. Providers may order a procedure that looks at the esophagus if they are suspicious of reflux. An X-ray or CT scan may be ordered to look for lung nodules or scarring.
How is it treated?
The treatment of chronic cough should be directed at getting rid of the cause. Providers will often try one treatment at a time in an effort to discern the underlying cause. For example, a cough due to postnasal drip may improve with the use of an antihistamine, a steroid, or a nasal spray. If the cough is due to asthma, the patient may be started on a medication to relax the airways and reduce inflammation. Patients with acid reflux will benefit from lifestyle changes and a medication that slows the production of acid in the stomach. Certain types of bronchitis may benefit from inhaled corticosteroids. If a cause cannot be determined, then a cough suppressant may be appropriate. There are various over the counter and prescription options available. Narcotic medications may also be effective when other treatments fail but should be used with caution and for a limited period of time.
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