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Chronic Cough

As we are transitioning out of the most recent flu season and into allergy season, many individuals find themselves with a cough that has continued to linger and refuses to go away. If you have been coughing for over 8 weeks and no amount of cough medicine, cough drops, or tea has helped, there may be a strong association between your cough and your allergies. Some common causes of a chronic cough include postnasal drip, asthma, GERD, or lingering infection. Here are some symptoms to look out for and how to best assess your cough.

Postnasal Drip

Postnasal drip (PND) is the sensation of mucus running down the back of your throat. For many patients this may be in conjunction with nasal congestion; however, for others they may have the presence of PND without any signs of runny nose or congestion. PND is caused by excess mucus produced by the nasal mucosa which accumulates in the back of the throat and nose. Postnasal drip can result in upper airway cough syndrome. This cough is caused by the mucus tickling the nerves of the nasopharynx and has been the leading cause of lingering cough (https://www.health.harvard.edu/staying-healthy/that-nagging-cough). For many patients with a combination of nasal congestion, runny nose, PND, and a mucus-based cough, the PND may be the culprit.

Laryngopharyngeal Reflux Disease

Laryngopharageal Reflux Disease (LRD) is a digestive disorder that occurs when stomach acids, foods or fluids back up from the stomach into the esophagus resulting in heartburn, belching, or a sour taste in the mouth. Most people would not associate intestinal discomfort with respiratory issues, but the acid coming up from the stomach irritates the nerve in the lower esophagus which triggers the cough reflex. Some ways to reduce symptoms of GERD include eating small meals throughout the day rather than eating 1-2 large meals, waiting 2 hours before lying down after a meal, and reducing the intake of alcohol, acidic foods, and high fats. It is best to consult your doctor who can prescribe higher doses of acid reducers and a proper diet regiment.

Asthma/COPD

Asthma is commonly defined by wheezing and shortness of breath, but less commonly identified by persistent coughing. This would be a type of cough-variant asthma and could account for nearly 1/4 of all cases of chronic cough. This type of asthma most often results in a consistent, dry cough that may be triggered by allergic and non-allergic causes (e.g. dust mites, pollen, animal dander). It is best for individuals that already have asthma and have had a consistent cough, or those that have never been diagnosed with asthma, cough to see an allergist. An allergist will be able to best assess your symptoms, and prescribe the proper inhalers or nebulizer treatments to control the cough and any associated wheezing or shortness of breath.

It is important to also consider cases of chronic bronchitis. Chronic bronchitis, a subtype of chronic obstructive pulmonary disease (COPD), is a persistent inflammation of the bronchial tubes, which is usually caused by long-term exposure to industrial air pollutants or tobacco use. The persistent inflammation of the bronchial tubes that arises from chronic bronchitis irritates the airways and produces excess mucus, which in some cases could be darker and thicker, causing a chronic cough. Patients who experience chronic bronchitis may experience short-term relief from antibiotics and steroids, however it is best for you to follow-up with your doctor or allergist for further evaluation to find a regiment that will provide long-term relief and prevent future flare-ups.

Infection

For most individuals who get sick, a cough is the symptom that persists the longest, well past the sick period. However, a cough that has started from a form of infection, may be indicative of that lingering infection. In many cases patients will have to be prescribed antibiotics or other forms of medication to properly fight the infection. It is best to follow-up with your primary care physician in order to get the right regiment of medications.

ACE Inhibitors

ACE inhibitors, or angiotensin-converting-enzyme inhibitors have played a prominent role in decreasing blood pressure and have been integral in treating heart failure and heart attacks. Examples of common ACE inhibitors include enalapril and lisinopril. In up to 20% of people on consistent ACE inhibitors, a persistent cough develops. The cough is typically characterized as a dry cough with the feeling of a “throat tickle” and can begin nearly three weeks or even after a year of taking ACE inhibitors. If this is the cause of your persistent cough, your doctor could switch you to another hypertensive such as angiotensin-receptor blockers (ARBs).

Visiting an Allergist

Whether your chronic cough as been ongoing for 2 months or more, it is in your best interest to visit an allergist who can pinpoint the cause and properly direct your treatment accordingly. At AIRE Medical group, our allergists specialize in treating chronic cough.  Whether it is associated with asthma, allergies, or the several other factors listed above, we will be sure to provide you with the best care plan to provide you with the rescue you need from that lingering cough.

https://www.healthline.com/health/chronic-cough

https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/chronic-cough

https://www.health.harvard.edu/staying-healthy/that-nagging-cough