Chronic Cough

Coughing occasionally is not harmful!

All of us cough for few days following upper respiratory infections, bronchitis or exposure to irritants such as smoke, paint, perfumes, etc.. In such cases a cough is transient and is not harmful. Have you ever wondered what makes us cough? A cough is a built in reflex to protect airways from foreign bodies and excess mucus build up. The cough reflex starts following irritation of nerve endings in the throat, voice box or bronchial tubes. The nerve endings transmit the irritation to the brain. The brain sends a counter impulse that makes the chest muscles and diaphragm (the muscle that partitions chest from the stomach) contract forcefully against closed vocal cords. When the pressure is built up sufficiently, the vocal cords relax and open suddenly, resulting in the explosive release of increased pressure. This clears the airways of mucus and foreign body that caused the irritation in the first place.

Coughing frequently and far too long could be hurtful!

It is not uncommon for a cough to linger for 3-4 weeks following a viral illness. However, if a cough persists for more than eight weeks in adults and 12 weeks in children, then it is considered chronic. A chronic cough has many reasons, and they differ in adults from children. Postnasal drip from allergies, irritation or chronic sinus infections, asthma and gastroesophageal reflux disease (GERD) account for nearly 85% of all cases of a chronic cough in adults! You may wonder how the GERD could make you cough! Both lungs and esophagus are supplied by Vagus nerve from the brain. Irritation of the Vagus nerve endings in the esophagus by acidic stomach contents causes reflex bronchospasm and cough. Often the GERD could be silent and may not be obvious until further investigations are carried out. ACE inhibitors, a group of medications used for the control of high blood pressure, could cause a chronic cough in 25% of patients who take them. Chronic bronchitis and rarely, lung cancer should be considered in smokers.

Children a cough for reasons different from adults

Less than 10% of children with a chronic cough have one of the etiologies above. Protracted bacterial bronchitis accounted for 40% of cases in one series. Exposure to cigarette smoke, foreign body aspiration, anatomical abnormalities of the airways, whooping cough (particularly in unimmunized children), cystic fibrosis, tuberculosis and recurrent aspiration of stomach contents into lungs are some of the other etiologies to be considered. If extensive investigations do not reveal a definitive diagnosis, habit or a psychological cause may be considered.

Some simple techniques you can follow

Since most chronic coughs in adults are caused by asthma, postnasal drainage, and/or acid reflux, our aim is to treat these causes, once other causes have been ruled out. Controlling the cough, however, can sometimes be very difficult and very frustrating. Some patients may develop pain or vomiting from coughing so hard. While cough suppressants can be helpful in some cases, there are some relatively simple techniques that can be used to control the symptoms and prevent coughing fits.
Chin tuck swallow- You’ve probably heard that you should carry water or lozenges with you if you have a cough. The trick to suppressing the cough, however, is how you swallow the water or saliva. You will get much better results if you tuck your chin into your chest before you swallow. This can be repeated as many times as is necessary to prevent a coughing fit. Breathe warm air- Breathing cold air can aggravate a cough. The best way to avoid this is by breathing through your nose. If your nose is too stuffy to breathe through, you can try cupping your hands over your mouth while you breathe to help warm the air. If you are unable to breathe through your nose, you should also work with your doctor to see if nasal sprays or other treatments are needed to relieve your nasal symptoms. Sleep on an incline- Some patients are unable to lie flat because postnasal drainage collects in their throats. Acid reflux can also be worsened when lying flat. While efforts should be made to treat these causes at their root, you may find it helpful to sleep on an incline. For patients with reflux, it is best for the whole mattress to be at an incline, rather than just using extra pillows. This can be done using bricks or phone books placed under the head end of the bed to raise it by about six inches.

Please make sure that you consult your doctor to find out if allergy and asthma evaluation is appropriate if a cough is not amenable to the above strategies.

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