Chronic cough

Coughing is a protective reflex with which the body clears the airways. It becomes a problem when it does not stop. In adults, we speak of a chronic cough when it lasts more than eight weeks; a cough lasting three to eight weeks is usually a prolonged cough after an infection.

A long-lasting cough is exhausting even when there is no serious illness behind it. It disturbs sleep, causes chest wall pain and headaches, and in some people also urine leakage and social embarrassment. All of these are valid reasons for an examination, not just fear of a more serious diagnosis.

What most often causes it

In non-smokers with a normal chest X-ray, chronic cough is most often caused by three conditions. The first is mucus from the nose and sinuses dripping down the back of the throat, which irritates it. The second is asthma or its coughing form without wheezing. The third is stomach acid flowing back into the gullet, which often occurs without heartburn.

In smokers and former smokers, a common cause is chronic bronchitis or chronic obstructive pulmonary disease. A cough with phlegm that lasts for months is not a normal companion of smoking here, but a sign of disease.

An often overlooked cause is blood pressure medicines from the group of ACE inhibitors. A dry, tickly cough may appear only months after starting them, and disappears within a few weeks after the medicine is changed.

In some people, several causes are present at the same time. That is exactly why treating just one of them sometimes brings only partial improvement.

What the character of the cough tells you

A few hints are useful. A cough that wakes you at night and comes with wheezing points towards asthma. A cough after meals, when lying down or with a taste of acid in the mouth points towards reflux. A cough with bringing up mucus and constant throat-clearing points towards nasal drip.

Even so, the cause often cannot be determined from the description alone. A dry cough is no proof that the lungs are unaffected, and thick phlegm is no proof of infection.

It helps to keep a note for a few days before the examination of when you cough, what triggers it and whether anything helps. Such a record often does more than an additional test.

When a cough should not wait

Call 112 immediately if you have sudden severe shortness of breath, chest pain with a feeling of not getting enough air, blue lips, or if you cough up large amounts of blood.

You need an examination within a few days, not in a few months, if you cough up blood even in small amounts, lose weight for no reason, have recurring fever or night sweats, increasing breathlessness, or hoarseness that lasts more than three weeks.

The same applies to a smoker or former smoker whose long-standing cough has changed in character or frequency. A change in the pattern matters more than the cough itself.

If something is stuck in the airway, that is, sudden choking while eating or playing, act as you would for choking and call 112.

What the assessment involves

The assessment begins with a thorough conversation and a clinical examination that also includes the nose, throat and ears. Information about smoking, exposure to dust and fumes at work and a list of all your medicines is important.

The basic tests are spirometry and, depending on the doctor's judgement, a chest X-ray. An X-ray is not needed for everyone; but when the cough comes with weight loss, fever or blood in the phlegm, it is usually needed quickly.

If needed, this is followed by allergy testing, tests for reflux or referral to an ear, nose and throat specialist. Sometimes, instead of further tests, a trial treatment of the most likely cause is tried first, and the response to it is itself diagnostic.

Treatment means treating the cause

A chronic cough settles once its cause is dealt with: asthma is brought under control, reflux is treated, inflammation of the nasal lining is addressed, a medicine that causes the cough is changed.

Cough syrups and lozenges ease the irritation but do not remove the cause. With a long-lasting cough they can be a short-term help but are not a solution; cough suppressants are generally not recommended for a cough with phlegm.

For smokers, stopping smoking is the measure with the greatest effect. In the first weeks after stopping, the cough may even get temporarily stronger, but in many people it then settles within a few months.

In some people, no cause can be found despite a full assessment. In that case, treatment focuses on reducing the sensitivity of the cough reflex and on techniques that interrupt coughing; discuss the options with the pulmonologist.