Chronic Cough

Do you have a lingering cough that won't go away? Cough is a common symptom of allergies such as allergic rhinitis (hayfever).  Allergic triggers are often common, usually harmless substances such as pollen, mold spores, animal dander, dust, foods, and medications.

Cough is a way that the body protects itself from these allergens. It helps by removing mucus, fluids, and infections from the airways.

Coughing does not always mean there is a problem, however coughing at night after going to sleep is almost always abnormal and needs medical attention.

Causes of cough
In children, cough is divided into acute cough (usually lasting one to two weeks) and chronic cough (lasting greater than four weeks).

  • Acute cough - Most children with brief periods of coughing are coughing because of viral upper respiratory tract infections. Many different viruses cause these infections in children. Healthy preschool children in day care can have up to six to eight viral respiratory infections with cough every year. This acute cough is usually due to postnasal drip and direct airway irritation by the virus. Postnasal drip is a condition in which mucus drips slowly from the nose and sinuses to the back of the throat. Medications may or may not be necessary or helpful. It is best to check with your doctor.
  • Nasal and sinus disease causing cough - Postnasal drip due to rhinitis (inflammation in the nasal passages) or sinusitis (inflammation in the sinus cavities) is another common cause of cough that can become chronic. Usually, other symptoms such as nasal congestion and runny nose are present, but sometimes the only symptom noticed is the cough. Allergic rhinitis, either seasonal or year-round, is often the cause, and tests for allergies may be necessary. Sinus infections can persist for weeks to months causing cough, sometimes with minimal nasal symptoms. Occasionally, your doctor may advice you to do a sinus X-ray or limited CT scan of the sinuses.
  • Stomach and esophageal causes of cough - In some children, the cause of chronic cough is due to problems with the stomach and esophagus (food tube). Most commonly, this is due to gastroesophageal reflux disease (GERD). This is often associated with a feeling of heartburn. But young children often don't complain of heartburn because they may not know it is abnormal or may not be able to describe the feeling. In some children, heartburn does not seem to occur even with GERD. Other children may develop a hoarse voice and/or choking as a symptom of GERD. This may need to be investigated by your doctor which includes a trial of medicines for GERD.  In young infants, reflux and swallowing problems are a common cause of persistent cough, particularly when it occurs after eating.

Other causes of cough include:

  • Post-viral cough - Children without asthma, allergies or sinusitis can have a cough after viral respiratory infections lasting for weeks. There is no specific therapy for this cough and it does eventually resolve. It is often due to increased sensitivity at the cough trigger points and is suspected when the cough does not respond well to asthma medications. Cough suppressant medications can be tried but they are not always helpful.
  • Inhaled foreign body - Although small foreign bodies, such as a piece of a plastic toy or part of a peanut, hot dog or a hard candy can be accidentally inhaled at any age, it most commonly occurs in boys, ages two to four years. The foreign body may or may not appear on an x-ray. It can cause a cough to persist for many weeks to months until it is discovered.
  • "Habit" cough - This is a persistent cough that has no physical cause. It occurs most commonly in children, adolescents and young adults. It occasionally persists after a simple viral respiratory infection. The cough typically is dry and repetitive or is a "honking" cough that usually worries parents and teachers much more than the child. Habit cough is absent at night after the child goes to sleep.
  • Irritant cough - Exposure to environmental tobacco smoke and other pollutants (smoke and exhaust from wood burning, air pollution and exhaust from vehicles) is associated with increased cough in healthy children and may worsen the cough associated with asthma or rhinitis. These substances should be avoided, particularly in children with asthma or rhinitis.

Treatment
Often, simple daytime cough after viral respiratory infections requires no specific treatment, particularly if it resolves in one or two weeks.

The primary treatment for chronic cough should be aimed at the underlying cause-asthma, GERD, rhinitis or sinusitis. Treating cough symptoms with mucus thinning agents such as guaiafenesin has limited benefit in most patients. Cough suppressing medications such as over-the-counter medications that contain dextromethorphan are also of limited value, but can be tried. Stronger cough suppressing agents such as codeine-containing medications are more effective, but have more side effects and should only be used for short periods of time.

If you have been experiencing a cough, make an appointment with Dr Gomez Dinger for an evaluation today.