What is Chronic Cough?

Typically, the search for the cause of your chronic cough can involve several different systems in the body. A thorough history and physical examination will help decide which direction your physician will take as well as any diagnostic studies or consultations that may be necessary. Once lung infection such as pneumonia or tumors have been ruled out through x-ray examination, there are several other common causes that should be considered. These include:

Chronic bronchitis related to smoking—Chronic airway inflammation related to smoking is very common. If you smoke, quitting is the best thing you can do for your health. Smoking weakens your immune system and increases your risk of lung, throat, and other cancers.

Blood pressure medication—Some commonly prescribed blood pressure medications known as angiotensin-converting enzyme (ACE) inhibitors can cause a dry cough. Common medications in this category include enalapril (Vasotect®) and lisinopril (Prinivil®, Zestril®). If you have a dry, chronic cough and no other causes are found and you are taking one of these medications, speak to your primary care physician about finding an alternative blood pressure medicine.

Upper airway cough syndrome—Many nasal disorders cause rhinitis resulting in nasal drainage, which can cause cough and lead to a disorder called upper airway cough syndrome (UACS). These disorders can cause a persistent feeling of drainage in your throat, called post-nasal drip, which can cause frequent coughing and throat clearing. An evaluation for these disorders may include testing for allergies (such as to tree pollens or animals) and possible evaluation by an ENT specialist for chronic rhinosinusitis or other disorders.

Over-the-counter treatments for UACS may include nasal saline rinses (e.g., neti pot), steroid nasal sprays (e.g., Flonase®), or oral antihistamines and allergy medications (e.g., Allegra®, Zyertec®, or Claritin®). Prescription treatments and procedures for UACS can include nasal antihistamine sprays (e.g., Azelastine®) and allergy immunotherapy treatment. There are effective surgical procedures available for certain conditions that have failed medical management.

Asthma—Asthma refers to inflammation of the lower airways causing constriction and spasm that is often associated with allergy issues and aspirin sensitivity. Often there is a family history of asthma or allergies to the environment. You can speak to your primary care physician or pulmonologist about evaluation and treatment for asthma. Some ENT specialists also diagnose and treat asthma.

Gastroesophageal reflux disease and laryngopharyngeal reflux—When acid repeatedly “refluxes” from the stomach into the esophagus alone, it is known as gastroesophageal reflux disease (GERD). If contents in the stomach come up into the throat, this is called laryngopharyngeal reflux (LPR). One of the main symptoms of reflux is chronic cough, and LPR may also contribute to post-nasal drip.