Chronic Cough

Chronic cough is a problem Ear, Nose and Throat specialists see everyday. For practical purposes, lets talk about a chronic cough that’s been going on for more than a few months. Everyone occasionally gets a viral (not treatable by antibiotics) or even a bacterial (treatable with antibiotics) infection that may last several weeks. Some people however are plagued by a cough that either stays, or comes and goes for months or even years.

While there are a zillion different causes, there are a few causes so common that over 90% will fall into these categories.

In children, the three most common causes are allergy, sinusitis, and asthma which basically reflects an inherited gradation in severity of reaction to environmental exposure. Most kids with asthma have recurrent wheezing on breathing out usually associated with shortness of breath. Diagnosis is often made by listening with a stethoscope to the lungs. Asthma drugs usually control uncomplicated asthma. Allergy, however, is often associated with asthma and needs to be controlled to get satisfactory results. Sometimes a combination of nasal steroid inhalants and antihistamines is enough, but frequently allergy testing and treatment is required in addition to asthma medication.

Even when asthma is not present, allergies can cause enough drainage or irritation to cause coughing. Often with more severe nose and sinus allergies, infections further complicate the picture. Pure allergic drainage is usually thin and clear but when thicker, stickier and especially yellow or green colored drainage occurs, sinus infection is usually present. Often low grade chronic sinus infections drain only down the throat and are not obvious. Infected sinus drainage will not be helped by allergy medicine until the infection is cured. This requires antibiotics (sometimes for several weeks) and in severe cases sinus surgery. Chronic sinus infections are particularly bad about making asthma worse and more difficult to control. Curing a chronic sinus infection almost always makes asthma better and even without asthma usually cures the cough. Chronic cough in children with or without asthma, is almost always associated with allergy and some sinus infection.

In adults, all the things that occur with children can still occur. Adults however, have a few other causes which children usually do not have. Exposure to any tobacco smoke, in the environment is a major cause. It is not only a common cause of coughing to smokers, but a health risk to those around them, especially to children. Sometimes fumes and chemical exposure, especially at work, is a cause. Excepting these obvious causes, by far the most common cause in adults is GERD (gastroesophageal reflux disease). While heartburn is a frequent symptom, many older and especially overweight individuals have stomach acid leak upwards into the throat while lying down at night without obvious symptoms. Some of this is breathed into the lungs during sleep causing an acid irritation of the breathing passages leading to cough. Often there is a lot of phlegm and secretions in the throat upon awakening in the morning. Stomach acid blockers usually help but may require more than a month before improvement occurs.

Worse things, such as cancer, can also cause chronic cough. Chronic cough can almost always be helped and may be a sign of more serious problems, so if cough persists see your doctor for diagnosis and treatment.

Dr. Chuck Guice is a Hattiesburg Ear, Nose and Throat specialist and can be contacted by email at ceguice@netdoor.com