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Many ailments can lead to chronic cough

Dr. Jonathan Matz, an internal medicine and allergy and immunology specialist at Sinai Hospital.
Dr. Jonathan Matz, an internal medicine and allergy and immunology specialist at Sinai Hospital. (Steve Longley, Baltimore Sun)

Chronic coughs are one of life's little annoyances. Coughing fits make it hard to sleep, make breathing difficult when exercising and can sneak up when you least expect it, like during an important phone call. The causes of chronic cough are many, said Dr. Jonathan Matz, an internal medicine and allergy & immunology specialist at Sinai Hospital of Baltimore and a partner with Dr. Golden & Matz LLC. He talks about the causes and treatments for chronic cough.

What is considered a chronic cough and how often does it occur?

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Cough is considered chronic when it has lasted six to eight weeks in adults and more than four weeks in a child. Chronic cough is quite common. One report from 2006 found 10 to 20 percent of adults may develop chronic cough; it is less common in children.

What are the most common causes of a persistent cough?

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Post nasal drip from allergies and/or sinus problems and asthma are the most common causes. Gastroesophageal reflux (GERD) is the next most common cause. In the winter months it is not uncommon to see cough lasting six to ten weeks after certain viral and bacterial respiratory infections, sometimes referred to as "post-infectious" cough. Other frequent causes include: chronic bronchitis and emphysema (COPD) that occurs after years of smoking

What are some causes of chronic coughs that people don't always think about?

Sometimes cough can be caused by medicines such as the ACE inhibitors used to treat high blood pressure, such as lisinopril and enalapril. Uncommon pulmonary problems such as sarcoidosis, tuberculosis, pulmonary fibrosis, and cancers often cause chronic cough. In children, foreign objects such as inhaled pieces of food are not uncommon. In recent years, there has also been a recurrence of whooping cough (pertussis), which is highly contagious and more commonly affects non-vaccinated infants and children, but may cause chronic cough in adults.

How do you know when a chronic cough is a major health problem and not just an annoyance?

Anyone that develops chronic cough should be evaluated to look for the cause. That is the only way to know if it is a serious health problem or a symptom of a less serious problem.

What are some of the symptoms that come along with a chronic cough?

Depending on the underlying condition causing the cough, one can have a variety of other symptoms. If there is wheezing, shortness of breath and chest tightness associated with your cough, asthma is most likely. Should you feel post nasal drip and head congestion, allergies and sinusitis may be at fault. The symptoms of burning in your chest or heartburn may suggest GERD. The appearance of discolored phlegm or fever suggests an infection of some sort. If there is blood expectorated during cough, it should be immediately evaluated to rule out a pulmonary problem.

The act of coughing on a regular basis can cause problems in itself. Coughing will temporarily increase in intracranial pressure; this can lead to headaches and popped blood vessels on the surface of the eye. Coughing also causes brief increases in thoracic and abdominal pressure leading to painful rib fractures and leaking of urine in susceptible people.

How are chronic coughs treated?

Treatment for chronic cough is directed at the underlying cause. Find the cause, treat the cause, cure the cough.

Diagnostic tests such as chest and sinus x-rays are often the first step. CT scans of the sinus and chest may be needed to get a more detailed look. In some instances direct visualization of the chest (bronchoscopy) or sinus (rhinoscopy) may be required. When an abnormality is found on a diagnostic test, in rare instances a biopsy will be performed to identify the cause.

Once the underlying cause is found, we turn to treatment. For allergies and sinus problems, the use of antihistamines and nasal steroids are initial therapies, allergy immunotherapy (allergy shots, sublingual tablets or drops) may be appropriate for long term management. For asthma, we use inhalers with bronchodilator and anti-inflammatory properties along with some tablets and immunotherapies. When GERD is implicated, appropriate dietary changes and medications can be quite effective. If infection is thought to be the cause, antibiotics may be necessary along with some cough suppressants until the infection resolves.

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When initial therapies are unsuccessful, evaluation by specialists are helpful. These would include physicians that have done special training in treating this common problem; such as allergists, pulmonologist and otolaryngologists.

In most cases the cause is found and treatments are successful.

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