Chronic Cough
By Sanaz Majd, MD
There’s nothing more awkward than having to cough in public places during the aftermath of the COVID era. However, not all coughs are COVID-related. In fact, most are not even infectious. And most people with a lingering cough are not coughing because they are carrying a deadly disease—it is typically just something that is irritating the upper airway or throat.
Here are the three top causes of a chronic cough:
POST-NASAL DRIP
It may seem too simple of an explanation to some patients, but it is actually one of the most common causes of a persistent cough. Our ears, nose, and throat are all connected, and post-nasal drip is simply the dripping of the fluid and phlegm from your nasal and sinus passages down to the back of your throat. It may sound gross, but it happens to all of us to some extent. This drip, when significant enough, irritates and inflames the throat and causes a cough, sometimes along with a hoarse voice and/or a persistent sore throat.
There are two main underlying reasons for a chronic post-nasal drip—environmental allergies and upper respiratory infections. For those with allergies, pay attention to see if there is a seasonal pattern. Allergies can cause runny, stuffy nose, sneezing, watery eyes, and this buildup of fluid in the face needs to drain somewhere, so it drips down the throat and you end up swallowing it. And upper respiratory infections, which are by far most often caused by viruses, also cause stuffy/runny nose. This drip after a cold can linger for weeks after catching a virus. It can be especially worse in those people who already have allergies as their baseline and then they catch a cold on top of it all.
Post-nasal drip is typically worse at nighttime during sleep, thanks to gravity that pools the phlegm into the throat, and people often awaken coughing. The treatment is a prescription intranasal steroid spray, such as generic fluticasone that is available over the counter (OTC), and sometimes with an addition of an OTC daily non-drowsy antihistamine (such as loratidine or cetirizine). Note that the nasal sprays require a specific technique in order to produce full efficacy; if not used properly, they do not work as well. I have created a YouTube video showing how to use them properly, but the products typically come with an insert that shows you how to use them as well, so make sure to follow the instructions.
ACID REFLUX
Not everyone with acid reflux—the regurgitation of the acidic contents of the stomach upward into the throat—may actually sense it. And not everyone with acid reflux will have heartburn. Some people will just have a chronic cough. That’s because the acidic contents of the stomach irritate the throat and cause a cough. Some even have a sensation of “something stuck” in their throat due to all that inflammation, or even a chronic sore throat. It also can be worse at nighttime while lying flat.
A trial of an acid reducer such as OTC omeprazole, along with some dietary changes, can help relieve acid reflux. These food triggers often include spicy food, caffeine, alcohol, tomatoes/tomato sauce, mint, blueberries, citrus, and greasy/fatty foods. OTC anti-inflammatories, such as ibuprofen, can also cause/worsen acid reflux, as can nicotine.
ASTHMA AND/OR BRONCHITIS
Most people think that asthmatics wheeze, but some will experience a nasty cough instead. That’s because pollutants or irritants in the air will irritate the upper airways in the lungs. Most people with asthma develop it in childhood, but it can less frequently begin in adulthood as well, especially in smokers and those with fumes/chemical occupational exposure. Asthma is diagnosed with a special breathing test and the treatment is typically a prescription inhaler.
On the same token, besides asthma, viruses can also inflame the upper airways. This is most often seen after a viral syndrome or upper respiratory infection. Sometimes people wheeze with acute bronchitis, but often they have significant coughing spasms.
OTC treatments are often insufficient to treat upper bronchial inflammation, such as in asthmatics and those with acute bronchitis, and very often require a visit to the doctor. Treatment is typically an inhaler and/or a short course of steroids.
RED FLAGS
Now that you’ve learned the top 3 causes of a persistent cough, it’s important to realize that there are numerous other possibilities, including medications, lung disease, tuberculosis, walking pneumonia, etc. So if you are experiencing a chronic cough, it’s important to seek your doctor, most especially if you also experience any of these more concerning symptoms as well:
• Unintended weight loss
• Coughing up blood
• Difficulty breathing
• Night sweats
• Fever or malaise
• Fatigue
• You’re a smoker
• You have a history of cancer
With all that said, it’s important to note that the educational materials in my articles are for general, informational purposes only. You should always seek your doctor’s input on your own personal health.
Sanaz Majd, MD is a board-certified Family Medicine physician and host of the Majd MD YouTube channel (@Majd MD), reviewing the latest medical topics and headlines. You can also follow her on Facebook or Instagram: @SMajdMD.
