Chronic Cough
Manchester's Premier Respiratory Clinic
What is Chronic Cough?
Coughing is a normal protective process to clear particulates, liquids and mucus from the throat and lungs.
Anyone who develops new cough which lasts more than 3 weeks should access their local primary care physician to ensure it is investigated as there is an association with new persistent cough and a diagnosis of lung cancer.
Chronic cough is defined by a persistence of coughing for over 8 weeks. The cough can be dry or productive. Some coughs occur only during the day, some are related to exposure to irritants or allergens and others can are present through the day and night.
Symptoms
Apart from the cough, individuals can struggle with headaches, lethargy, chest pain or discomfort. Severe coughing spasms can lead to dizziness and even blackouts. Urinary incontinence is reported by some patients and nocturnal symptoms leads to sleep deprivation. Impact on mood is common.
Chronic productive coughs often lead to recurrent chest infections and need for recurrent treatment via the GP or admission in to hospitals during severe flare ups.
Causes
The most common causes of chronic cough include:
- Rhinitis (including hayfever) and sinus disease which leads to post nasal drip of mucus in to the throat causing upper airway irritation and coughing.
- Asthma including a variant where coughing is the predominant symptom, whilst breathlessness, wheeze and chest tightness is often be absent.
- Gastroeosphageal reflux disease where stomach contents tracks back up the gullet to the upper airways.
- Chronic Obstructive Pulmonary Disease (COPD), which is caused by smoking and certain occupational exposures.
- There are a group of medications used to treat blood pressure and heart disease called ACE Inhibitors which can cause coughing in susceptible individuals.
- Productive Coughs most commonly occur in COPD, asthma and bronchiectasis. The latter is a disease of the lung airways which are damaged leading dilatation and increased mucus production.
There are many other causes of chronic cough and an effective investigation process is required to support the correct diagnosis leading to the best treatment for the individual.
Idiopathic Chronic Cough (ICC): is an uncommon and is defined by the lack of a clear cause of the cough. Despite an absence of a causative agent ICC is still amenable to treatment, with therapies and medication.
Diagnosis
Relies on:
- Subjective assessment which occurs during the consultation with your doctor, this allows the identification of the disease causing your symptoms.
- Objective investigations support understanding of the cause and severity of the disease.
- Chest radiology: This includes a basic chest X-ray which will inform about any gross abnormalities causing symptoms. However, it is often necessary to proceed to chest CTs to define better the architecture of the lungs.
- Lung function testing (LFTs): LFTs are blowing test which define the type and extent of respiratory disease present.
- Exhaled Nitric Oxide (FeNO) analysis, again is a simple blowing test taking a few minutes to undertake with near instantaneous results, which demonstrates the severity of inflammation in certain types of asthma.
- Bronchoscopy is a day case procedure which allows the assessment of the lungs via fibrotic endoscopy. It is regularly preformed by Respiratory consultants to support diagnosis of many lung conditions, as it allows close inspection of the airways (endobronchial tree) and collection of samples to aid diagnosis and treatment. The procedure is usually preformed in a day case theatre with sedation and local anaesthetic. Most procedures take between 10 and 20 minutes to perform.
Treatments
Are dependent on the cause of the cough. Occasionally a treatment trial is given for a short period to understand if a likely diagnosis will respond to medication. Most chronic coughs respond very well to treatment. Medications do not need to be long term, though in cohort of patients long term medication is essential to keep symptoms controlled.
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