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Allergy & Asthma Advocate: Spring 2005
Cough is a natural defense mechanism of the body to remove foreign material or mucus from the lungs and throat. However, when severe or persistent, cough can significantly disrupt quality of life. More importantly, cough may be the first indication of a serious underlying disease. The good news is that in most people, the specific causes of cough can be successfully diagnosed and treated. Cough occurs when various irritants such as noxious fumes, allergens, or viruses and bacteria stimulate cough receptors, special nerve endings located in the upper and lower airways, ears, nose, sinuses, throat, esophagus and diaphragm. The cough receptors send signals to the brain, which then sends specific signals back to the respiratory muscles and airways. Cough is a symptom, not a diagnosis or disease, and treatment is directed at its underlying source. Whooping cough, sinusitis, allergies and asthma can cause both acute cough, that lasts less than two weeks, and subacute cough, that lasts between three and eight weeks. Chronic cough is defined as a cough that lasts more than four weeks in children, or eight weeks in adults. It may result from exacerbated acute cough as well as from acid-reflux diseases, chronic bronchitis and certain medications. Postnasal drip, characterized by a draining sensation at the back of the throat, is the most common cause of acute and chronic cough. It is generally treated with antihistamines, decongestants and nose sprays. Antibiotics are used to treat underlying sinus infections. Sometimes expectorants are used to help break and bring up mucous. Rarely, anti-tussives or cough suppressants may be needed for a very short period of time to relieve a dry hacking cough, until a diagnosis is made. Although it has many symptoms, asthma may manifest as “just cough.” Spirometry, a breathing test, will help diagnose asthma. The treatment can include a variety of medications, including inhalers (albuterol or steroid), nebulizers and pills to keep the lung airways open. Chronic cough may result from acid reflux disease, even if there is no heartburn. Its treatment includes elevation of the head of the bed, waiting two to three hours after eating before going to bed, and avoiding certain foods such as chocolate, alcohol and orange juice. Several good prescription medications are also available and can be added to the treatment regimen as well. More serious, rare disease entities may trigger cough, including bronchiectusis, lung cancer, congenital anomalies of lung and heart in infants, foreign bodies in the airways and tuberculosis. Sometimes a cough may be deemed a “habit” cough, which has no apparent organic or physical origin. It is important that your healthcare provider test to rule out other illness. You should seek treatment for any of the following:
To make a diagnosis, your healthcare provider will ask for a detailed medical history, including:
Later, a thorough physical examination will be done, and specific testing if necessary. Treatment is individualized based on the likely possibility of one or more causes.
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Persistent cough can be successfully diagnosed, treated
Certain blood pressure medications called ACE inhibitors may also induce chronic cough. It is important to note that cough can come on suddenly after using the medication for several years with no side effects. Stopping the medications will typically resolve the cough in 30 days or less. However, future use of these medications may produce cough again.