Chronic Cough

GENERAL INFORMATION:

What is a chronic cough? A chronic cough is a cough that lasts longer than three or four weeks. When nerves in the airways of the respiratory system are stirred, we cough. A cough is a blast of air that removes things that do not belong in the airways. The respiratory system is made up of the nose, larynx (voice box), trachea, bronchi, and lungs. This system manages our breathing. A chronic cough is more common among people who smoke at least one pack of cigarettes every day.

What is a chronic post-infective cough? A post-infective cough is a cough that appears after getting an infection in your airways. With this condition, your chest x-ray is normal. It is called a chronic post-infective cough when it lasts longer than eight weeks.

What causes a chronic cough? Chronic cough can be caused by one or more conditions. After a respiratory tract infection, many people develop a chronic post-infective cough. Other common causes of chronic cough in people who do not smoke are the following:

• Postnasal drip: This is when fluid from the nasal cavity drips down your throat, and is called upper airway cough syndrome.
  
  
• Cough variant asthma: In asthma, there is inflammation (swelling) and tightening of the airways. Swelling is a response to things that you are allergic to or find bothersome.
  
  
• Gastroesophageal reflux disease: This is also known as GERD. This is a condition where fluids from the stomach flow back to the esophagus and up your throat.

• Lung diseases such as lung cancer, chronic obstructive pulmonary disease (COPD), and bronchiectasis. These also include asthma, bronchitis, pneumonia, and pulmonary edema.
  
  
• Smoking, or being around tobacco smoke and harmful substances such as asbestos.
  
  
• Taking certain medicine, such as angiotensin converting enzyme (ACE) inhibitors and beta-blockers. These medicines are often used to treat heart conditions and high blood pressure.
  
  
• Other conditions such as heart disease, AIDS, cystic fibrosis, and allergies.

What causes a chronic post-infective cough? Most cases of chronic post-infective cough are caused by germs such as viruses and bacteria. The airways become inflamed and very sensitive to changes in temperature or substances called allergens. If you usually have a cough after having an infection in your airways, this may be caused by asthma.

How can I tell caregivers about my cough? Tell caregivers when your cough started. If your cough comes and goes, tell caregivers when it started and how much time passes between attacks. Tell them about any other signs and symptoms. If you find it hard to eat or have lost weight without trying, tell your caregiver. Tell them if you recently had a cold. Caregivers also need to know if you are taking medicines such as angiotensin converting enzyme (ACE) inhibitors or beta blockers. Tell them about any medicine, street drugs, herbs, or supplements that you use. Caregivers need to know if you smoke, or if you breathe in chemicals or tobacco smoke at your work or your home. Tell caregivers if you have other health conditions such as bronchitis, lung cancer, COPD, congestive heart failure or AIDS.

What signs and symptoms may be related to my chronic cough?

• Clubbed (larger than normal) fingertips.
  
  
• Itchiness, redness, and rash on your skin which may come and go for a long time.
  
  
• Masses or lumps felt inside your nose or on your neck.
  
  
• Pain and itching in your throat, or a feeling that some phlegm (mucus) is sticking to the back of your throat.
  
  
• Red, swollen, or watery eyes, or increased sensitivity to light.
  
  
• Swelling in your arms, hands, legs or feet.
  
  
• Whistling sounds when you breathe.

How may my chronic cough be treated? If your chest x-ray is normal and you are not at risk for cancer, you may not need any treatment. Elderly people with a new cough, confusion, and fast breathing may need a chest x-ray to check for pneumonia. If caregivers find a condition causing your cough, that condition will be treated. You may need to stop taking a certain medicine if that is causing your cough. If caregivers cannot find out why you have a cough, you may be treated for upper airway cough syndrome, asthma, or GERD. The following may be used to treat a chronic cough:

• Medicines:
  
  
  • Allergy medicines: This medicine includes antihistamines and decongestants. These prevent or decrease the symptoms of allergies, such as itching, redness, and rash. This medicine may help if upper airway cough syndrome is causing your cough.
    
    
  • Antibiotics: These medicines kill germs causing infection and are used to treat airway infections such as bronchitis.
    
    
  • Bronchodilators: This medicine helps decrease trouble breathing by widening your airways.
    
    
  • Cough medicine: This medicine may soothe your throat and decrease your urge to cough. It may help you sleep if coughing keeps you awake.
    
    
  • Gastric acid secretion inhibitors: This medicine may help if your cough is caused by GERD. This medicine treats GERD by decreasing the amount of acid in your stomach.
    
    
  • Steroids: This medicine can treat conditions such as asthma by decreasing airway swelling. This medicine may be taken for 6 to 8 weeks. Caregivers will have you take less over time.
  
  
• Surgery: Surgery may be needed to treat conditions that do not improve with medicine. A surgery called fundoplication may be used to treat GERD. Ask your caregiver for more information about this surgery.

What can I do to prevent my chronic cough?

• Avoid exposure to smoke and irritants. Wear a mask if you work around smoke and chemicals. Avoid places where there is tobacco smoke or pollutants. Avoid being around things that you are allergic to.
  
  
• Change your diet. Avoid caffeine, which is found in coffee, tea, and soda. Avoid eating during the four hours before you go to sleep. Ask your caregiver if you need to lose weight, and make a plan to lose it.
  
  
• Place your head and upper body on a pillow when you sleep. When your head is placed higher than the rest of the body, you may not cough as much.
  
  
• Stop smoking. Smoking may give you a dry mouth and irritate your throat.
  
  
• Talk to your caregiver about using alternative medicine for your cough. These may include herbal medicines, vitamins, and food supplements.

Will I need appointments with other caregivers? You may need to see a pulmonologist if your symptoms do not improve after eight weeks of treatment. He may do a bronchoscopy to find the cause of your cough. Ask your caregiver for more information about bronchoscopy. You may need to see an otolaryngologist if you still have a cough after using medicine to treat sinusitis or upper airway cough syndrome. He may test you for allergies or give medicines for your immune system. You may need to see a gastroenterologist to diagnose and treat GERD. You may need to see a cardiologist to find out if heart disease or pulmonary hypertension is causing your cough. He may do tests such as echocardiography to check your heart for problems. You may need to see a caregiver that works with conditions that are caused by being around harmful chemicals.

What should I expect with time or treatment? Relief from chronic cough depends on the cause of the symptoms, your treatment and other factors. If you are generally healthy with a normal chest x-ray, your cough will likely go away. You may need to visit your caregiver every few weeks until your cough goes away. A chronic post-infective cough usually goes away without treatment. If a condition causing your chronic cough is found and treated, your cough may go away. It may take some time for medicine to decrease your cough. If you have GERD, it may take six months of treatment before it gets better. You may need to have surgery if medicines used to treat GERD do not work.

Call your caregiver if you have any of the following:

• You become very tired after coughing.
  
  
• You have a hoarse voice.
  
  
• Your coughing keeps you awake, and you have trouble sleeping.

Seek immediate help by calling 911 if you have any of the following:

• You have pain with deep breathing, or sharp pain when twisting your body.
  
  
• You cannot control when and where you urinate.
  
  
• You cough up blood, or find blood in your phlegm.
  
  
• You faint when you cough.
  
  
• You have trouble breathing.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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