Cough is one of the most common and bothersome symptom for which people may seek medical attention. When its due to an acute infection it can be treated relatively easily with antibiotics and cough syrups/suppressants. But when it lingers beyond a week or two, and especially if its dry, symptomatic treatment or repeated courses of antibiotics are usually of no additional help in controlling it. Under these circumstances, we have to find the actual cause of the persistent cough and treat the cause rather than the cough itself if we want to succeed.

Some of the most common causes for a persistent cough are: 

  1. Mild asthma. Many mild asthmatic cough rather than wheeze and their chest may be perfectly clear. This is called “variant” asthma, that is a variation of the usual disease. This kind of asthma can develop at any age, especially after a cold or viral infection.
  2. Acid reflux disease. When a person lies down to sleep the stomach acid can reflux up to the throat, especially if there is a hiatal hernia present. Once in the throat the acid can be inhaled into the lungs irritating them and causing the cough. This can go on night after night after night
  3. Chronic drainage from the sinus that “tickles” the lungs from above.
  4. Very thick or very dry mucus in the bronchial tubes. This causes the cough to be ineffective in evacuating the phlegm and a person can cough for hours before anything comes up.
  5. Smoking can chronically irritate the airways, which produce more mucus than normal, and are more irritable than average, same as the asthmatic lungs may be.
  6. Chronic infection such as TB or fungus or bacteria that is not killed by the usual antibiotics.
  7. Most scary of all, a persistent cough may be the only sign of a developing lung cancer!

So this is why when you say “just give me something for the cough” we many times reply “come in and be seen, you need a CXR, I have to listen to your lungs, and we’ll take it from there!”
Authored by: Ana Roman, M.D.

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