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A lingering cough or chronic cough is a symptom that affects a significant number of people yearly. It is the second most common complaint for which patients see the doctor for a general examination. (1)
It is a symptom that can significantly interfere with the quality of life.
Types of Cough
Cough is usually classified into three categories according to its duration:
- An acute cough is one that lasts less than 3 weeks.
- A subacute cough is defined as a cough with a duration of 3-8 weeks.
- Lastly, a chronic cough is one that has been present for more than 8 weeks.
The duration of the cough can help guide diagnosis and avoid unnecessary and invasive testing.
Probable Causes of a Lingering Cough
Cough can be caused by many factors. Usually, a history of the duration and symptoms can help narrow down the etiology.
It has been reported that causes of cough cannot be identified in up to 42% of the patients presenting at a specialized clinic. (2)
An acute and subacute cough is usually due to an upper airway infection (URI). Even after most symptoms of a URI resolve, the cough can linger for several weeks. This is thought to be due to multiple mechanisms, including postnasal drip, increased sensitivity of airway nerves after the infection, and airway inflammation. (1)
Some studies have shown that in over 50% of patients, the cause of subacute cough was post-infectious cough, and the condition usually resolved without any intervention. (3)
Other causes of acute cough include:
- Pulmonary embolism
- Chronic pulmonary disease
All these conditions are considered serious and typically manifest other symptoms such as fever and shortness of breath along with the cough.
The most common causes of chronic cough are:
Chronic cough can also be the result of:
- Underlying lung disease
- Chronic bronchitis
- Lung infections
- Environmental irritants
- Heart failure
- Lung cancer
Symptoms of a Lingering Cough
The symptoms of a lingering cough vary depending on the underlying pathology but can include:
Recommended Treatments for a Lingering Cough
The medical treatment for a lingering cough depends on the underlying cause.
However, some medications can be taken to control the cough while undergoing testing. These include:
- Codeine (6)
- Inhaled glucocorticoids
Lifestyle Changes and Home Remedies for Lingering Cough
Depending on the cause of the cough, some lifestyle changes that can be made for relief:
- Quit smoking and avoid secondhand smoke.
- Use a humidifier, take steamy showers, and drink plenty of water to thin out secretions.
- Use a neti pot to help with postnasal drip.
- An air purifier might help if allergies are contributing to the cough.
- If you have heartburn, avoid acidic and spicy foods, do not eat late at night, and elevate the head of the bed.
- Take honey as it is a natural remedy for cough.
- Use cough drops/lozenges.
Also Read: 7 Natural Expectorants to Relieve a Cough
Diagnosing a Lingering Cough
Diagnosing chronic cough usually involves the following steps:
1. Medical history
The first step to diagnosing a chronic cough is to review the patient’s medical history, which typically includes the following information:
- Recent cold or allergy symptoms
- History of lung disease such as asthma
- Smoking history, or exposure to smoke or other noxious fumes
A good history can help direct the next step.
2. Physical examination
The doctor will physically evaluate the patient to find clues about the cause of the cough:
- If there is mucus at the back of the throat, UACS is possible.
- If significant wheezing is detected, asthma might be the culprit.
3. Imaging tests
If the patient is older, is a smoker, or has COPD, it would not be unreasonable to obtain an X-ray on presentation.
This will usually help rule out some obvious causes of cough, such as pneumonia, fluid in the lungs, or a malignancy.
However, a negative X-ray does not rule out a lung issue. If a pulmonary etiology is suspected, a CT scan would be the next test.
4. Diagnosis by exclusion
If these preliminary steps prove inconclusive, the doctor will adopt a stepwise approach that eliminates the most common etiologies of chronic cough one by one to reach the true culprit:
- Because UACS is the most common cause, the patient can be started on a trial of an intranasal glucocorticoid, such as Flonase, or an antihistamine-decongestant if they have a history of allergies.If there is no improvement in a few weeks, the next step would be to rule out asthma and heartburn, and so forth.
- If asthma is suspected, the patient can be started on a trial of an inhaler and monitored for resolution of the cough. In addition, a test called spirometry can be done to see if the patient responds to the inhalers.
- If heartburn is an issue, either an acid reducer or a proton pump inhibitor, such as omeprazole, can be started. Alternatively, the patient can be referred for further testing, such as esophageal pH monitoring.
Risk Factors of a Lingering Cough
People at risk for chronic cough include those with a history of: (5)
- Underlying lung disease such as asthma
Complications of a Lingering Cough
The complications of chronic cough include but are not limited to:
When to See a Doctor
You should see a doctor if your cough lasts more than 3 weeks or if you experience alarming symptoms such as:
- Shortness of breath
- Unintentional weight loss
- Prolonged fever
- Blood in your sputum
A lingering cough is common and usually benign, so you need not worry unnecessarily. However, you should not have to deal with this annoying symptom for longer than needed.
To manage the cough, you need to be proactive. Follow your doctor’s advice. Take the necessary steps at home to alleviate your symptoms, and do not hesitate to follow up when necessary.