Chronic cough should not be categorised as a disease condition rather it is a symptom of different disorders. It is reported by 10-20% of adults, commoner in women and obese individuals.
The most common causes of chronic cough in adults include smoking, postnasal drip, asthma, and gastro-oesophageal reflux disease (GERD). And in children, respiratory tract infections, asthma, and gastro-oesophageal reflux disease are most commonly responsible for chronic cough. Persistent prolonged cough due to infections is more likely in patients with pre-existing airway disorders.
Management of chronic cough
Management of chronic cough poses various challenges as cause for cough may be vague, so a multidisciplinary approach is often needed.
Homemade remedies for cough
A tea made from 3 parts thyme leaf, 2 parts plantain, and 1 part mullein leaf has also been reported as being one of the most beneficial dry cough remedies, especially for chronic cough.
The bark of bay berry, when consumed in powder form, is very useful in curing throat congestions that cause the coughs. It also cures coughs caused due to chronic bronchitis.
For severe and chronic cough, make a mix with crushed 2-3 garlic and some cloves. Add this mix to a glass of milk or water. Boil the mixture till it reduces to half the original content. Filter and add some sugar to improve the taste. Drink it twice a day and continue this treatment for at least a week to experience improvement in chronic cough.
Codonopsis root used as a decoction, tincture or powder can be useful for chronic coughs.
It is known that drinking hot carrot juice can naturally ease chronic coughing.
Eat the mix of some heated jaggery and clarified butter. You can also massage the chest with a mixture of clarified butter and rock salt. It helps to cure chronic cough.
OTCs and prescription medicines for chronic cough
To effectively control chronic cough, there is need to identify and manage the underlying cause, and also to desensitise cough pathways. Patients with chronic cough should avoid exposure to irritants that can trigger cough and should also stop smoking. Patients should be offered symptomatic relief while awaiting the results of specific therapy. P
atients may be suggested over-the-counter cough medicines containing iodides, guaifenesin and/or dextromethorphan, and promoting habits such as drinking enough water, inhaling steam, and using cough lozenges and hard candies. Dextromethorphan tends to be less effective but may be helpful for minor coughs. Codeine may be prescribed in severe cases, and is an effective cough suppressant.
If a cough remains symptomatic for more than a few weeks, you should see an allergist, otolaryngologist, or a pulmonologist (lung specialist). Referral to a lung specialist may be recommended for evaluation, therapy and specific testing such as fiberoptic bronchoscopy and MIC in complicated cases. To rule out reflux disease as a cause of chronic cough, referral for upper gastrointestinal endoscopy and 24-hour pH monitoring may be indicated. Allergy testing may be done by an allergist. Immunotherapy may even be advised if the patient is sensitive to an unavoidable antigen.
Depending on the cause for the cough, you may be prescribed:
- If asthma is the associated cause, inhaled bronchodilators and steroids are given to decrease inflammation of the airways. In some cases, short-term oral steroids are prescribed.
- Treatment of GERD involves lifestyle modifications such as maintaining a healthy weight; eating smaller, more frequent meals; avoiding heartburn triggers such as alcohol, chocolate, mint and fried foods; avoiding meals before lying down and elevating the head while sleeping. If these don’t work, then you may be treated with medications such as famotidine, cimetidine, or ranitidine to decrease stomach acidity
- Antihistamines and decongestants, usually given in combination are the standard treatment for sinus problems and postnasal drip. Older, sedating antihistamines may be more effective in treating cough than the newer non-sedating drugs. Other treatments for allergies and postnasal drip include nasal corticosteroids and nasal antihistamines. Inhaled nasal steroids are very effective in treating allergic rhinitis, a common cause of cough. Additionally, other nasal inhalers like ipratropium bromide can relieve post nasal drip. Antibiotics may be prescribed if sinusitis is responsible for chronic cough.
- Infections such as bacterial pneumonia and bronchitis are typically treated with antibiotics such as cephalosporins and azithromycin. If pneumonia infection is close to the chest wall, inflammation of the surface of the lung causes pain and analgesics are advised in such a situation. Cough suppressants are used with caution in these situations because getting rid of phlegm by coughing helps clear the infection faster.
- If cough is caused by blood pressure medicines such as ACE inhibitors or beta blockers, it is wise to switch to another medication under the guidance of your doctor. Patients should not stop their medication on their own because a considerable elevation in blood pressure can result from discontinuation. Angiotensin receptor blockers can be suitable alternatives that have less potential to cause chronic coughing.
- In case the reason for chronic cough is unknown, you may be prescribed a cough suppressant or possibly ipratropium bromide, a bronchodilator that relaxes the air passages in the lungs.