Causes and Treatment of a Persistent Cough

What is a persistent cough?

It can be annoying to have a cough that lasts for more than a couple of weeks. A cough is considered chronic or persistent if it does not go away after four weeks in children and eight weeks in adults. However, most persistent coughs are due to colds, flu, infection, or other underlying medical conditions. 

Coughing might make a person feel uncomfortable, but it actually has a particular purpose. Germs, dirt, and mucus are expelled from the lungs when the person coughs. Some coughs are short-lived, but in some cases, coughs may linger for weeks, months, or years. When there is no obvious cause of coughing, then it might be a serious issue. Coughs caused by allergies or postnasal drip may not be serious, but sometimes, a cough may be a symptom of cancer or other life-threatening conditions.

A person with a persistent cough may find it difficult to sleep at night. Persistent coughing will prevent the person to function normally at work and during social events. It is recommended to consult a doctor if your cough lasts for more than a few weeks.

Causes of a Persistent Cough

1. Infection

Infection is the most common and predictable causes of chronic coughing. According to Norman H. Edelman, MD, the Chief Medical Officer of the American Lung Association, the aftermath of a cold or viral infection is irritated airways. Usually, the symptoms go away after a few days. However, since the airways can get swollen and oversensitive because of the viral infection, coughing may still persist even if the virus is gone.

2. Stress

Chronic stress can make colds and cough last longer. Slow down and relax. Sleep at least 7-8 hours at night.

3. Asthma

Asthma is a chronic respiratory disease. In this disease, the airways are mostly affected. When a person experiences an asthma attack, the airway gets constricted and causes inflammation of the mucous lining leading to the narrowing of airways. As a result, it becomes difficult to breathe through the respiratory passage. A difficulty in breathing along with a wheezing sound is usually observed in individuals with asthma.

Some people with asthma may experience a chronic cough. The irritation of the cough reflex is caused by the narrowing of the airways, which leads to persistent coughing. Usually, asthma coughs become worse with exercise and may suddenly wake a person in the middle of the night. People with asthma tend to have a dry cough. There are many people who have managed the symptoms and grew out of the disease as they get older, but some may have it for life. There is no cure for asthma, but effective disease management can be done.

4. Heart Disease

Fluid can accumulate in the lungs when the heart is unable to effectively pump blood, and when there is fluid in the lungs, a person will have a difficulty in breathing. The person may also experience asthma-like symptoms, which may be accompanied by wheezing. Coughing may result in a productive mucus cough. A person's cough may also get worse when lying down. Sometimes, a persistent dry cough can be caused by certain medications for heart disease.

If you have heart disease, do not delay and seek immediate medical attention if you continue to experience a persistent cough.

5. Lung Problem or Cancer

Coughing is the body's way of getting rid of unwanted foreign substances or mucus from the respiratory tract. It is normal for a person to cough more in an attempt to clear any irritation in the breathing passages.

Lung diseases include conditions such as sarcoidosis and emphysema. Emphysema causes an enlargement or bursting of small air sacs in the lungs. Thus, the expulsion of carbon dioxide from the body becomes difficult.

Sarcoidosis is a condition that affects various parts of the body. However, the disease commonly affects the lymph glands and lungs. Due to inflammation, lumps of abnormal cells grow in the affected organs of the body. Although there are people who may not experience any symptoms, some may develop a chronic cough along with wheezing. 

A sign of lung cancer is a persistent cough. For about 2 percent of people with lung cancer have a persistent cough. Lung cancer happens when there is an excessive or abnormal growth of cells that can start in one or both lungs. Smoking is also the leading cause of lung cancer.

6. Whooping Cough

The causative agent of a whooping cough is a type of bacteria called Bordetella pertussis. This contagious disease is often accompanied by a distinctive "whoop" sound when a person coughs. This condition is no longer common these days since vaccines have been developed. It is more likely to occur in adults due to a decreased immunity. The condition can be treated by the use of antibiotics. 

7. Tuberculosis (TB)

Tuberculosis is an infectious disease caused by bacteria, which mainly affects the lungs. The disease is usually spread through exposure or inhalation of infected air droplets released via sneezes or coughs.

The common signs and symptoms of an active tuberculosis are:

• Persistent coughing that lasts for more than three weeks
• Hemoptysis (coughing up blood)
• Difficulty in breathing and chest pain
• Fever and chills
• Fatigue
• Weight loss
• Night sweat
• Decreased or loss of appetite

8. Gastroesophageal Reflux Disease (GERD)

In this condition, stomach acid travels back into the tube that connects the esophagus and stomach, which causes irritation, discomfort, and heartburn. If constant irritation is experienced, it may lead to chronic or persistent coughing.

9. Chronic Obstructive Pulmonary Disease (COPD)

Cigarette smoking is the major cause of COPD in the United States. However, secondhand smoke, fireplace smoke, chemical fumes, and exposure to air pollution can also cause COPD. This term is also used in describing other respiratory diseases such as emphysema and chronic bronchitis. Over a period of time, COPD becomes worse and tends to interfere with everyday life activities. 

The symptoms of COPD are:

• Chest pain or tightness 
• Shortness of breath
• Frequent respiratory infections
• Throat clearing upon waking up
• Wheezing
• Foot or leg swelling
• Lack of energy
• Cyanosis (blue lips, skin, or fingernails)

10. Pulmonary Fibrosis

Pulmonary fibrosis is respiratory disease wherein lung tissues become scarred or damaged. This condition is usually seen in people who have a long history of smoking.

The lung disease may or may not have a specific cause. Deep lung tissue scarring prevents the oxygen from moving into the bloodstream. Symptoms include:

• A hacking and dry cough
• Fatigue
• Fast shallow breathing
• Clubbing of the toes or fingertips
• Gradual weight loss without trying to lose weight
• Shortness of breath

Pulmonary fibrosis is common among middle-aged or older adults. It has a poor prognosis with most patients having a life expectancy of fewer than 5 years. 

11. Bronchiectasis

Bronchiectasis is a condition characterized by an abnormal widening and scarring of the airways. Individuals with a past lung infection such as pneumonia are at higher risk of developing the condition. The disease can be prevented by early treatment. Its symptoms include:

• Fatigue
• Fever and chills
• Coughing up yellowish or green mucus
• Wheezing
• Blood in mucus
• Shortness of breath

Treatment 

For effective treatment, it is important to determine the cause of an individual's chronic cough. A chronic cough may be caused by more than one underlying cause. Cough treatment is usually prescribed according to what causes a person's cough. The following medications are used to treat persistent coughing:

• Glucocorticoids and Bronchodilators - These drugs are the most effective medications for coughs related to asthma. They help open up the airways by reducing inflammation.

• Antihistamines, Glucocorticoids, and Decongestants - These medications are standard treatments for allergies and postnasal drip.

• Antibiotics - An antibiotic is prescribed when a chronic cough is caused by a bacterial infection.

• Cough Medicine - If a cough is causing serious problems and the exact cause cannot be determined, then a cough suppressant may be prescribed by a doctor. However, there is no evidence that shows the effectiveness of over-the-counter cough medications.

Allergies

Treatment for allergies includes avoiding triggers, prescribing antihistamines, allergen immunotherapy, nasal steroid sprays, and decongestants. 

• Older Antihistamines - Some people with sinus problems or non-allergic rhinitis may respond best to older antihistamines.

• Corticosteroids - For the treatment of asthma, a combination of corticosteroids is usually given daily along with inhaled albuterol (ProAir, Ventolin, or Proventil) as needed. Instead of steroids, sometimes, medications such as Singulair is used. If there are significant allergies, then allergen immunotherapy can be done and triggers should be avoided. Medications for asthma help widen the airway passage and reduce the swelling. To prevent or stop asthma attacks, these medications can be taken long-term. The standard treatment for asthma is inhaled gluococorticoids, which include budesonide (Pulmicort), fluticasone (Flovent), and beclomethasone (QVAR).

• Inhaled Steroids with Bronchodilators - For chronic bronchitis treatment, a combination of inhaled steroids with bronchodilators is used.

GERD

GERD can be treated by making certain lifestyle changes. These include avoiding spicy and fatty food, losing weight and not eating right before bedtime. Other treatment options are proton pump inhibitors such as:

• Omeprazole (Prilosec)
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)

For coughs due to reflux, it may take weeks or months for individuals to respond to reflux therapy. Reflux medications basically neutralize, block, or reduce acid production. They include antacids and H2 receptor blockers.

Pneumonia

To treat bacterial infections such as pneumonia antibiotics are used.

Postnasal Drip

In a postnasal drip, steroid nasal sprays, decongestants, and antihistamines help thin and remove mucus. These medications also help reduce inflammation in the nasal passages.

• Postnasal Drip from Colds - Antihistamines such as chlorpheniramine (Chlor-Trimeton) or clemastine (Tavist, Dayhist) can be given. Nasal congestion can be improved by decongestants such as pseudoephedrine. A runny nose can be relieved by nasal sprays such as ipratropium bromide (Atrovent), which is available without a prescription.

• Postnasal Drip from Allergies - Nasal glucocorticoids can be used to help reduce nasal inflammation. Oral antihistamines such as fexofenadine (Allegra), cetirizine (Zyrtec), or loratadine (Claritin) are usually prescribed. Postnasal drip can also be relieved by nasal antihistamine sprays such as azelastine (Astelin).

Management of Symptoms

Cough reflex can be relaxed by taking over-the-counter medications such as dextromethorphan. If over-the-counter medications do not work, doctors may prescribe stronger medications such as benzonatate. Some cough medications that contain narcotic codeine or hydrocodone can cause drowsiness and may be habit-forming. To treat a chronic cough, both are helpful but may have some side effects such as confusion, dizziness, difficulty concentrating, nausea, and fatigue. 

Natural Remedies for a Persistent Cough

• Honey - Coughs due to a bacterial infection can be relieved by honey since it has antibacterial properties. Honey is considered as a demulcent. Irritated mucous membranes can be coated and soothed with honey due to its high viscosity and stickiness.

• Licorice Root Tea - It eases congestion and soothes the airways by thinning the mucus. It is a demulcent and a natural expectorant.

• Tea Thyme - It relaxes the bronchi and trachea. It also has antimicrobial properties, which help reduce coughing and promote comfort by opening up the airways.

• Ginger Peppermint Syrup - It is a natural expectorant that helps loosen the mucus from the lungs. An irritating tickly cough can be relieved by this syrup.

• Pepper and Honey - A great remedy for a cough with a lot of mucus or chest congestion.

Outlook

The outlook depends on the cause and treatment of a persistent cough. A simple cough usually goes away with immediate treatment. Treat and manage a cough once you know what's causing it. Manage your cough with the following tips:

• Drink an adequate amount of water. Water can help loosen and thin the mucus. Warm liquids soothe the throat such as tea and broth.
• Avoid spicy foods, chocolate, caffeine, and citrus fruits if you have acid reflux.
• Suck a cough lozenge.
• Take a hot shower. To add moisture in the air, turn on the humidifier.
• Breathe in steam.
• Avoid smoking.
• Perform nasal irrigation or use a saline nose spray to loosen up the mucus.