What is Causing Your Chronic Cough?

Woman Coughing

It’s normal to develop a cough now and then. The common cold, the flu, and countless other mild respiratory concerns can cause you to have a cough. Even high levels of dust or particularly arid environments can create this condition. However, these coughs should come and go rather than be persistent. If you’d had a cough that has lasted in excess of eight weeks or four weeks in children, it’s classified as a chronic cough. This can indicate the presence of a severe lung infection, chronic bronchitis, or asthma.

If your chronic cough has yet to be diagnosed or explained, it’s important that you visit a primary care physician. It’s vital that you recall if there have been periods of coughing not directly related to your lungs. Based on your evaluation, they may refer you to see a specialist, such as an ENT specialist or otolaryngologist, for a comprehensive evaluation.  

What Are Common Causes of Chronic Cough?

Respiratory concerns may cause a chronic cough, but more often, they will involve multiple different bodily systems. This is why you must provide a thorough medical history and undergo a full examination by your physician. This can include consultations with specialists and diagnostic studies under their guidance. They will begin by eliminating concerns such as lung infections or tumors. This elimination process may involve the use of various imaging techniques, such as x-ray. 

If these have been ruled out, additional causes will be considered, including:

  • Tobacco-Related Chronic Bronchitis – Those who regularly smoke tobacco or other substances may experience chronic inflammation of the airway. Smoking in any form weakens the immune system. Tobacco, in particular, increases your risk of throat, lung, oral, and other cancers. If you are presently a smoker, it’s best that you begin a smoking cessation treatment as soon as possible.
  • Blood Pressure Medication – There are a number of medications typically prescribed for blood pressure that can cause a dry cough. Medications such as Vasotect®(Enalapril) and lisinopril (Prinivil® and Zestril®) are angiotensin-converting enzyme (ACE) inhibitors known to have this effect. If your chronic cough is dry and there are no other factors identified, check your medication list. If any ACE inhibitors are found on it, speak to your physician for potential alternatives.
  • Upper Airway Cough Syndrome – There are a number of nasal disorders known to cause rhinitis. This condition can cause nasal drainage that results in coughing and a disorder known as upper airway cough syndrome (UACS). Common symptoms of this disorder are post-nasal drip, persistent drainage sensations in the throat, frequent throat clearing, and coughing. Those experiencing these symptoms will often be evaluated for allergies and chronic rhinosinusitis under the guidance of an ENT specialist.
  • Asthma— This is a common respiratory condition presenting as inflammation of the airways in the lower lung. This inflammation can cause spasming and constriction in a manner similar to aspirin sensitivity and allergies. If you’re experiencing these symptoms and have a family history of asthma, it’s time to speak to your primary care physician. They may offer treatment or refer you to an ENT specialist who diagnoses and treats asthma patients.
  • Gastroesophageal reflux disease and laryngopharyngeal reflux—These conditions, also known as GERD and LPR, respectively, are known to cause a chronic cough. GERD involves the flowing of acid into the lower esophagus from the stomach. LPR occurs when stomach contents flow up into the throat. LPR is also known to contribute to symptoms of post-nasal drip.

These conditions represent the most common sources of chronic cough encountered. The list is by no means comprehensive, and other causes may be present. Another frequently seen cause of a chronic cough is neurogenic neuropathic cough.

Understanding Neurogenic or Neuropathic Cough

This form of chronic cough occurs due to the nerves in the larynx, upper respiratory system, or voice box being excessively sensitive. This condition is known to affect as many as one out of ten Americans. A diagnosis for neurogenic cough typically occurs once all other causes for a chronic cough have been ruled out. Talking, inhaling cold air, moving, and laughing are all known to be common triggers for those living with neurogenic cough. It most commonly affects women and those middle-aged and older.

The source of the condition is overly sensitive nerves responsible for controlling sensation in the cough. The nerves will respond to stimuli that are common and generally non-irritating. This can include swallowing, breathing, talking, laughing, and varying temperatures. It can occur in isolation, but it’s also common in the period after upper respiratory illnesses or colds. Some patients describe the experience as feeling like something is stuck in their throat. Sensations experienced include burning, tingling, pain, and constriction. This may lead some patients to engage in excessive throat clearing in an attempt to relieve the sensation.

Your ENT specialist may provide a variety of treatments for neurogenic cough. Speech-language therapy is one potential approach. The pathologist who works with you will instruct you in the form of therapy known as cough retraining. While undergoing this process, you’ll learn to control or suppress your cough. Some common techniques for doing so are sipping water, maintaining good hydration, and swallowing. If this doesn’t produce acceptable results, medications may be suggested. You’ll also be directed to avoid habits such as alcohol, caffeine, smoking, mouth breathing, and straining while speaking.

If medications are considered, there are a few different options you may be presented with. These medications for treating neurogenic cough include:

  • Gabapentin (Neurontin®)
  • Pregabalin (Lyrica®)
  • Amitriptyline (Elavil®)

These medications are known to produce some common side effects. These include fatigue, headache, confusion, dizziness, weight gain, and stomach upset.

Speak To Your ENT Specialist To Learn More

If you’re experiencing symptoms related to chronic cough and want to seek relief, reach out to your ENT specialist. They’ll have the knowledge and information to help you start taking real steps to ease or eliminate your symptoms. You don’t have to live with chronic cough; schedule your consultation today!

Lee A. Kleiman

Dr. Lee A. Kleiman is a double board certified ENT & plastic surgeon at Anne Arundel ENT in Annapolis, Maryland known for his superior clinical outcomes in all Surgical and Non-Surgical ENT, specializing in Sinus Care, Voice and Swallowing, Rhinoplasty and Revision Rhinoplasty, and Facelifts and Non-surgical Aesthetic. He also continues to attend conferences internationally and nationally to keep abreast of the latest treatments and technology. 

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