Chronic cough

Subject: Chronic cough Thu Jan 20, 2011 3:03 pm

Chronic cough
Filed under: Respiratory Health
Chronic cough — one lasting eight weeks or longer — is more than just an
annoyance. In addition to being physically draining, a chronic cough
can alienate your family and co-workers, ruin your sleep, and leave you
feeling angry and frustrated. Chronic cough is one of the most common
complaints that people bring to their health care providers.

While it can sometimes be difficult to pinpoint the problem that's
triggering your chronic cough, the most common causes of chronic cough
are postnasal drip, asthma and acid reflux — a frequent symptom of
gastroesophageal reflux disease (GERD). Chronic cough typically
disappears once the underlying problem is treated.

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Symptoms

A chronic cough can occur with other signs and symptoms, which may include:

* A runny or stuffy nose
* A sensation of liquid running down the back of your throat
* Wheezing and shortness of breath
* Heartburn or a sour taste in your mouth
* In rare cases, coughing up blood

When to see a doctor
A chronic cough is often defined as a cough lasting eight weeks or more,
but any persistent cough can disrupt your life. See your doctor if you
have a cough that lingers, especially one that brings up sputum or
blood, disturbs your sleep, or affects your work or relationships.

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Causes

A cough begins when an irritant — stomach acid, mucus, hair spray,
perfume, even spicy food — stimulates nerves in your respiratory tract.

An occasional cough is normal — it helps clear foreign substances and
secretions from your lungs and prevents infection. But a cough that
persists for long periods of time is usually the result of an underlying
problem. Examples include:

Postnasal drip
Every day, glands in your nose, sinuses and throat produce mucus, which
cleans and moisturizes your nasal passages. Normally, you swallow the
fluid without knowing it, but when there's more than usual — from
allergies, a cold or sinus infection — you may feel it accumulating in
the back of your throat.

This excess mucus, commonly called postnasal drip, can cause irritation
and inflammation that trigger your cough reflex. If the postnasal drip
is chronic, your cough is likely to become chronic, too. Though
postnasal drip is often obvious, it's possible to have the condition
without ever having symptoms.

Asthma
This is a common cause of chronic cough in adults and the leading cause
in children. Most often, the cough occurs with wheezing and shortness of
breath, but in one type of asthma, cough is the only symptom. An
asthma-related cough may come and go with the seasons, appear after an
upper respiratory tract infection, or become worse when you're exposed
to cold air or certain chemicals or fragrances. This type of asthma is
frequently referred to as "hyperactive airways disease."

Gastroesophageal reflux disease (GERD)
In this common condition, stomach acid flows back into the tube that
connects your stomach and throat (esophagus). The constant irritation in
your esophagus, throat and even your lungs can lead to chronic
coughing. Acid reflux often causes heartburn and a sour taste, yet close
to half the people whose cough is due to reflux have no other symptoms.

Respiratory tract infection
A cough can linger long after most symptoms of a cold, flu, pneumonia or
other infection of the upper respiratory tract have gone away. In some
cases, this may occur because the infection is lingering. Sometimes,
even if the infection is gone, your airways may remain inflamed and
therefore especially sensitive to irritants.

Blood pressure drugs
Angiotensin-converting enzyme (ACE) inhibitors, which are commonly
prescribed for high blood pressure and heart failure, are known to cause
chronic cough in about 20 percent of the people taking them. Most
often, the cough begins within a week after starting therapy, but it
sometimes may not develop for up to six months. And though the cough
usually goes away a few days after the drug is stopped, it can linger
for a month or more.

Chronic bronchitis
This long-standing inflammation of your major airways (bronchial tubes)
can cause congestion, breathlessness, wheezing and a cough that brings
up discolored sputum. Because most people with chronic bronchitis are
current or former smokers, the cough is usually a sign of damage to the
lungs and airways.

Bronchiectasis
This is a serious, chronic lung condition in which abnormal widening of
your bronchial tubes affects their ability to clear mucus from your
lungs. It is almost always preceded by pneumonia, although the pneumonia
may not be serious enough to prompt a visit to your doctor. Signs and
symptoms include a cough that may bring up discolored sputum or blood,
shortness of breath and fatigue.

Lung cancer
Only a small percentage of people with a chronic cough have lung cancer,
and most are current or former smokers. If you smoke now, smoked at one
time or your sputum contains blood, see your doctor.

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Risk factors

Anyone can develop a chronic cough, but these factors make you more susceptible:

* Smoking. Being a current or former smoker is one of the leading
risk factors for chronic cough. Frequent exposure to secondhand smoke
also can lead to coughing and lung damage.
* Your sex. Because women tend to have more sensitive cough reflexes, they're more likely to develop a chronic cough.

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Complications

Having a persistent cough can be exhausting. The physical action of
coughing depletes your energy reserves and disrupts your sleep. A
chronic cough can also cause:

* Headache
* Dizziness
* Excessive sweating
* Urinary incontinence
* Fractured ribs, especially in women with fragile bones

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Preparing for your appointment

While you may initially consult your family physician, he or she may
refer you to a pulmonologist — a doctor who specializes in lung
disorders.

What you can do
You may want to write a list that includes:

* Detailed descriptions of your symptoms
* Information about medical problems you've had
* Information about the medical problems of your parents or siblings
* All the medications and dietary supplements you take
* Questions you want to ask the doctor

What to expect from your doctor
A thorough medical history and physical exam can provide important clues
about a chronic cough. Your doctor may ask some of the following
questions:

* Do you now or have you ever smoked tobacco?
* Do you take blood pressure medicine? If so, what type do you take?
* When does your cough occur? After meals? At night?
* Does anything relieve your cough?
* Do you get more short of breath with exertion? Or on exposure to cold air?

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Tests and diagnosis

Because the top three causes of chronic cough — postnasal drip, asthma
and acid reflux — are so common, doctors can often pinpoint the
underlying problem through your response to treatment rather than by
tests. If your cough goes away with treatment for a particular problem,
the diagnosis is confirmed. Treatments include:

* Antihistamines and decongestants for postnasal drip
* Inhalers or nasal sprays for asthma
* Acid-reducing medications for acid reflux

If this approach fails or you become frustrated with the trial-and-error
process, you may need one or more of the following tests.

Imaging tests

* Chest X-ray. Although a routine chest X-ray won't reveal the most
common reasons for a cough, such as postnasal drip or acid reflux or
asthma, it may be used to check for lung cancer and other lung diseases.
* Computerized tomography (CT scan). A CT scan takes X-rays from
many different angles and then combines them to form cross-sectional
images. This technique can provide more detailed views of your lungs. CT
scans also may be used to check your sinus cavities for pockets of
infection.

Lung function tests
These simple, noninvasive tests measure how much air your lungs can hold
and how fast you can inhale and exhale. Sometimes you may also have an
asthma challenge test, which checks how well you can breathe before and
after inhaling a drug called methacholine.

Scope tests
These tests use a thin, flexible tube equipped with a light and camera
to visualize structures within your body. The procedure is always
preceded by spraying your nose or throat with a numbing agent like
lidocaine. You may be given sedatives or pain relievers to make the
procedure less uncomfortable.

* Nasal endoscopy. This test involves inserting a small fiberoptic
scope into your nostrils to better assess the status of the nasal mucosa
and the openings to your sinuses. A sinus CT scan is usually done
first.
* Upper endoscopy. In this test, the scope is passed down your
throat into your esophagus to check for signs of acid reflux in your
stomach and esophagus.
* Bronchoscopy. In this test, the scope is passed down your windpipe
to check your bronchial tubes for signs of infection or obstruction.

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Treatments and drugs

Treating a chronic cough with a known cause is usually straightforward.
When the cause can't be determined, treatment becomes more problematic
and frustrating.

Antihistamines and decongestants
Antihistamines and decongestants are usually given in combination as the
standard treatment for allergies and postnasal drip. Older, sedating
antihistamines may be more effective in treating cough than the newer
generation of drugs that don't make you drowsy.

Inhaled corticosteroids
These anti-inflammatory drugs are the most effective treatment for
asthma and asthma-related cough, but the use of inhaled bronchodilators
may also be required. Long-term use of corticosteroids may increase the
risk of skin thinning, bruising, osteoporosis and cataracts.

Medications to treat acid reflux
When lifestyle changes don't take care of acid reflux, you may be
treated with a proton pump inhibitor, which blocks acid production and
allows esophageal tissue time to heal. Prescription-strength proton pump
inhibitors include:

* Esomeprazole (Nexium)
* Lansoprazole (Prevacid)
* Omeprazole (Prilosec)
* Pantoprazole (Protonix)
* Rabeprazole (Aciphex)

Other treatments
When the reason for your cough isn't known, your doctor may prescribe a
cough suppressant or a type of medication that relaxes the air passages
in your lungs.

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Lifestyle and home remedies

Smoking
Many types of chronic coughs are caused or worsened by smoking. Quitting
cigarettes can help dramatically, as can avoiding secondhand smoke.
Talk to your doctor about a comprehensive smoking cessation program that
includes:

* Social support
* Nutritional counseling
* Nicotine gum or patches
* Medications that help ease withdrawal

Acid reflux
A cough caused by acid reflux can often be treated with lifestyle changes alone. These include:

* Maintaining a healthy weight
* Eating smaller, more frequent meals
* Avoiding heartburn triggers such as alcohol, chocolate, mint and fried foods
* Waiting three to four hours after a meal before lying down
* Raising the head of your bed

Cough suppressants
Some over-the-counter products may help control coughs, but they do nothing for the underlying cause. Examples include:

* Chest rubs containing camphor or menthol
* Cough syrups, especially those containing dextromethorphan
* Cough drops
* Honey, especially in hot water or tea

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