Chronic Cough

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

Another common cause of chronic coughing is reflux, when acid from the stomach is regurgitated into the throat and irritates the throat lining. This kind of cough is typically exacerbated after the patient has been lying down for some time as the position makes it easier for the acid to work its way up during reflux, causing the patient to cough up foamy phlegm. Sometimes, the coughing can even be so bad that the patient is awoken from sleep by the cough.

Many doctors often miss acid reflux as a cause for the cough as the relationship between gastric problems and coughing is not immediately obvious. As such, no matter how much cough suppressant the patient takes, as long as the reflux is not cured - by adopting a good diet, avoiding overly acidic food or fruits, elevating one’s head slightly higher above the level of the stomach during sleep and maybe taking some anti-acid medicine - the cough will persist.

Of course, another very common type of chronic cough is smoker’s cough. As might be expected, inhaling smoke of any kind will cause one to cough persistently as one’s lungs try to expel the smoke. Fortunately, quitting will tend to make the cough go away within a few days, as will the chances of one developing lung cancer. For this reason, no matter how long one has been smoking, quitting immediately will always be in one’s best interests.

Certain drugs may also cause chronic coughing in some patients, especially a class of drugs known as ACE inhibitors. Often prescribed for hypertension, ACE inhibitors have the unfortunate side effect of increasing the sensitivity of the throat, thus causing some patients to develop chronic coughing. If this is the case for you, speak to your doctor, that he may prescribe a different type of drug for the management of your hypertension.

Certain kinds of heart failure may also result in chronic coughing. As the heart becomes increasingly congested, it starts to exert pressure on the lungs, thus making the patient feel that they need to cough. Other reasons include neurological problems - in particular, when the nerve that controls the airway or throat is affected - or cancer of the throat. For this reason, it is highly recommended that you see a doctor if you have a cough that simply will not go away.

Dr Lau Chee Chong Senior Consultant,
Ear Nose Throat, Head & Neck Surgery

Dr Lau Chee Chong at Mount Elizabeth Centre treats both adults and children. His practice covers all areas diagnostic, surgical and medical of ENT, head and neck practice. The clinic is well-equipped for almost all ENT procedures to be done in-clinic, including NBI (Narrow Band Imaging) video rhinolaryngoscopy, which gives very clear images and is particularly effective in identifying early-stage nose, head and neck cancers.

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