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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.
Probable Causes of a Lingering Cough
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 the airway nerves after the infection, and airway inflammation. (1)
The most common causes of chronic cough are:
- Upper airway cough syndrome (UACS)
- Asthma
- Gastroesophageal reflux disease (GERD) (2)
Chronic cough can also be a result of:
- Smoking
- Medications
- Chronic bronchitis
- Bronchiectasis
- Lung infections
- Environmental irritants
- Aspiration
- Heart failure
- Lung cancer
Symptoms Accompanying a Lingering Cough
The symptoms that may accompany a lingering cough vary depending on the underlying pathology but can include:
- Runny nose/nasal congestion
- Postnasal drip
- Throat clearing
- Hoarseness
- Heartburn
- Sour taste
- Wheezing
- Shortness of breath
Medical Treatment 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:
- Dextromethorphan
- Codeine (3)
- Benzonatate
- Gabapentin/pregabalin
- Inhaled glucocorticoids
Diagnosing a Lingering Cough
Diagnosing chronic cough usually involves the following steps:
1. Medical history
The doctor will 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.
Lifestyle Changes and Management of a Lingering Cough
Depending upon the cause of the cough, you can try the following home intervention to get quicker 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.
- Elevate the head of the bed.
- Take honey as it is a natural remedy for cough. (4)
- Use cough drops/lozenges.
Risk Factors of a Lingering Cough
People at risk for chronic cough include those with a history of: (5)
- Smoking
- Heartburn
- Underlying lung disease such as asthma
Complications of a Lingering Cough
The complications of chronic cough include but are not limited to:
- Decreased quality of life
- Self-consciousness
- Anxiety
- Insomnia
- Exhaustion
- Dizziness and passing out
- Musculoskeletal pain
- Hoarseness
- Urinary incontinence
- Rib fracture
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
- Night sweats
Final Word
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 have a follow-up checkup when necessary.
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