Chronic Cough

A persistent, nagging cough that lingers for weeks can be more than just an annoyance- it can significantly impact one's quality of life. Chronic cough, a cough lasting eight weeks or more in adults, is a common condition that affects millions worldwide. This relentless symptom can disrupt sleep, cause physical discomfort, and even lead to social embarrassment, making it crucial to understand its underlying reasons and available treatments. Finding the correct chronic cough remedy for those experiencing chronic coughing at night can be particularly crucial to ensure restful sleep and overall well- being. 

What is Chronic Cough? 

A chronic cough is a persistent cough. It lasts for eight weeks or longer in adults. It is a complex reflex involving coordination between various muscles and neural pathways. While coughing is generally a protective response for the respiratory system, helping to keep the airways clear of potentially harmful substances, a chronic cough indicates an underlying systemic issue.

Unlike acute coughs, which typically last less than three weeks and are often caused by colds or flu, chronic coughs require medical attention. They can have a significant impact on an individual's quality of life, leading to lack of sleep, mental & physical exhaustion, and social stigma.

Symptoms of Chronic Cough 

Chronic cough manifests with various symptoms, including: 

• The primary symptom is a persistent, nagging cough that doesn't go away. 
• This cough can be either dry or tickly, producing no mucus or accumulation of phlegm to clear the airways. 
• .Individuals with chronic cough may experience additional symptoms, including: 
  • A stuffy or runny nose 
  • Postnasal drip causing a tickle in the back of the throat 
  • Frequent throat clearing or a sore throat 
  • Heartburni 
  • A low-grade fever 
  • The constant coughing can cause physical discomfort, including muscle aches and, in severe cases, even rib fractures. 
  • Some individuals may develop headaches, dizziness, or experience urinary incontinence due to persistent coughing. 

Causes and Risk Factors of Chronic Cough 

The most prevalent chronic cough causes include: 

• Asthma, particularly cough-variant asthma, can manifest solely as a persistent cough without other typical symptoms. 
• GERD or gastroesophageal reflux disease may cause chronic cough due to throat irritation 
• Postnasal drip, often resulting from allergies or sinus conditions, irritates the throat and triggers coughing. 
• Chronic obstructive pulmonary disease (COPD), chronic bronchitis & TB, medically known as tuberculosis. 
• Adverse or side effects of certain medications such as angiotensin-converting enzyme (ACE) inhibitors 
• Less common but serious causes may include lung cancer, bronchiectasis, and interstitial lung diseases. 

Risk factors for chronic cough include: 

• Smoking doubles or triples the risk compared to non-smokers. 
• Age and gender also play a role, with women and individuals aged 60-69 being more susceptible. 
• Occupational exposure to dust, allergens, and toxic gases increases the risk by 40%. 
• Environmental factors like air pollution and irritants have been linked to chronic cough. 
• Obesity, particularly abdominal obesity, has been suggested as a potential risk factor, but evidence is inconsistent. 

Complications of chronic cough 

Some of the complications are: 

• Chronic cough can cause physical exhaustion, disturbed sleep patterns, and increased stress levels, ultimately affecting overall well-being. 
• Prolonged coughing episodes may result in musculoskeletal issues, such as chest pain & soreness in the abdominal muscles. 
• Chronic Cough may lead to the development of headaches. 
• Dizziness is another potential issue, as the constant jolting movements can disturb the balance organs in the inner ear, sometimes leading to nausea and vomiting. 
• Fainting spells may occur due to interference with blood flow, particularly during forceful coughing episodes. 
• The chest contractions associated with chronic cough can be powerful enough to cause fractured ribs. 
• The strain of coughing may contribute to hernias, where an internal organ projects out through a muscle wall. 
• Chronic cough may also cause unintended weight loss in some people. 

Diagnosis 

• Medical History: The doctor will ask questions related to the duration and characteristics of the cough, any associated symptoms, and potential triggers. They may ask about smoking habits, environmental exposures, and current medications, particularly ACE inhibitors, which can cause chronic cough. 
• Diagnostic Tests: 
  • A chest X-ray is the initial diagnostic imaging test for chronic cough, especially if the patient is a non-smoker or has stopped taking ACE inhibitors. 
  • This imaging can help rule out conditions such as bronchiectasis, persistent pneumonia, and tuberculosis. 
  • High-resolution computed tomography (CT) of the chest 
  • Pulmonary function tests (PFTs) to determine how well your lungs are working. 
  • Spirometry measures lung capacity and airflow, which can help diagnose conditions like asthma or chronic obstructive pulmonary disease (COPD).

Treatment for Chronic Cough 

The treatment for chronic cough depends on identifying and addressing the underlying cause.

• Asthma: For chronic cough caused by asthma, inhaled corticosteroids and bronchodilators are often prescribed. These medications reduce inflammation & open up the airways, providing relief from coughing, especially chronic coughing at night. 
• Postnasal Drip: Doctors may recommend antihistamines and decongestants to manage allergy symptoms and reduce mucus production. 
• Gastroesophageal Reflux Disease (GERD): Doctors recommend proton pump inhibitors or H2 blockers to reduce stomach acid production. Lifestyle modifications can also manage GERD-related chronic cough. These may include elevating the head while sleeping and avoiding trigger foods. 
• Bacterial Infections: Doctors recommend antibiotics to control infection. 
• ACE Inhibitors: Switching to alternative medications can often resolve the issue. 
• Symptomatic Relief: Chronic cough treatment may also include cough suppressants or expectorants to provide symptomatic relief. 

When to See a Doctor 

Immediate medical attention is necessary if:

• An individual experiences shortness of breath, breathing difficulties, or chest pain alongside a cough. 
• Coughing up blood is another serious symptom that warrants urgent medical evaluation. 
• Unexplained weight loss, a persistent change in voice, or lumps and swellings in the neck also warrant immediate medical attention. 
• Medical attention should be sought if a child under three months has a temperature of 38°C or above or if a child older than three months has a temperature of 39°C or above. 

Home Remedies for Chronic Cough 

Several home remedies can provide chronic cough relief and complement medical treatments. 

• Honey is a popular & potent remedy for suppressing coughs. Having a spoonful of honey or adding it to warm herbal tea can help soothe the throat and reduce coughing, especially chronic coughing at night. 
• Ginger, known for its anti-inflammatory properties, may help ease dry or asthmatic coughs. Drinking ginger tea or adding fresh ginger to meals can be a simple yet highly potent way to incorporate this remedy into one's routine. 
• Steam inhalation is another effective chronic cough treatment, particularly for wet coughs that produce mucus. Taking a hot shower or creating a steam bowl with hot water and herbs like eucalyptus can help loosen mucus and relieve chronic cough. 
• Saltwater gargles are also a time-tested remedy that can help alleviate sore throats and loosen mucus. 
• Other Solutions: Consume pineapple juice for its bromelain content, use thyme in teas or syrups, and try marshmallow root or slippery elm for their soothing properties.

Conclusion

Addressing chronic cough requires a multi-faceted approach. There are various strategies to tackle this issue, from seeking medical advice to exploring the underlying causes to trying out home remedies for symptom relief. Remember, while a chronic cough can be frustrating, it's possible to find effective solutions and improve overall well-being with 
the right approach and patience. If symptoms persist or worsen, consult a pulmonologist for proper diagnosis and treatment. 

FAQS 

1. What is the leading cause of chronic cough? 

Chronic cough has multiple causes, with the most common being asthma, postnasal drip, and gastroesophageal reflux disease (GERD). Other potential causes include chronic bronchitis, certain medications like ACE inhibitors, and environmental irritants. In some instances, chronic cough indicates more serious conditions such as lung cancer or heart failure. 

2. Is chronic cough harmful? 

While chronic cough is often a symptom rather than a disease itself, it can significantly impact an individual's quality of life. Persistent coughing can lead to physical exhaustion, sleep disturbances, and social embarrassment. Rarely, it may cause complications such as rib fractures, headaches, or urinary incontinence. Chronic cough can also exacerbate underlying respiratory conditions. 

3. Why is coughing worse at night? 

Coughing worsens at night due to several factors. When lying down, mucus can pool in the back of the throat, stimulating the cough reflex. This position also makes it more challenging for the body to naturally clear mucus. For those with GERD, lying down can cause acid in the stomach to flow back into the oesophagus, irritating the throat and causing coughing, Additionally, the body's circadian rhythm affects immune function, potentially increasing nighttime coughing as part of the immune response to infections or irritants. 

4. What blood test is done for chronic cough? 

There is no specific blood test for chronic cough itself. However, blood tests may be part of the diagnostic process to identify underlying causes or rule out certain conditions. 
These may include investigations like complete blood count (CBC) to check for infections or allergies, tests for inflammatory markers, or specific tests for suspected conditions like autoimmune diseases.

Dr. Suhas P. Tiple

MBBS, TDD, DNB (Respiratory Diseases), CTCCM (ICU Fellowship), CCEBDM
Ganga CARE Hospital Limited, Nagpur

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