I’ve had a cough for years. Why???

One of the most common complaints we see in our practice is a chronic cough. A chronic cough is defined as a cough that has been consistently present over the course of at least 8 weeks. While the following possibilities are numerous, most coughs are not a sign of a serious issue and can be dealt with. The key is investigating it thoroughly and making sure to check all the boxes along the way.

Common Causes:

• Postnasal Drip (Upper Airway Cough Syndrome): Mucus dripping down the back of your throat from your nose or sinuses can irritate the throat and trigger a cough. This is one of the most frequent causes of chronic cough. You might not always feel the drip itself.

• Asthma (particularly Cough-Variant Asthma): In this type of asthma, a dry, persistent cough is the main symptom, rather than the more commonly known wheezing and shortness of breath. The cough can be triggered by cold air, allergens, or respiratory infections.

• Gastroesophageal Reflux Disease (GERD): Stomach acid backing up into the esophagus (the tube connecting your throat to your stomach) can irritate the esophagus and trigger a cough reflex. This can happen even without noticeable heartburn.

• ACE Inhibitors: These medications are commonly used to treat high blood pressure and heart failure. A dry cough is a well-known side effect for a significant percentage of people who take them.

• Chronic Bronchitis: While often associated with a productive (mucus-producing) cough, chronic bronchitis, especially in its early stages or in milder forms, can sometimes manifest as a dry cough. This is more common in current or former smokers.

• Environmental Irritants: Ongoing exposure to irritants like smoke (tobacco or other), dust, fumes, pollution, or even very dry air can lead to a chronic cough.

Less Common Causes:

• Non-Asthmatic Eosinophilic Bronchitis (NAEB): This condition involves inflammation in the airways with an accumulation of white blood cells called eosinophils, similar to asthma, but without the variable airflow obstruction seen in asthma. A chronic dry cough is the primary symptom.

• Lung Diseases:

  • Interstitial Lung Diseases (ILD): This is a broad group of disorders that cause scarring (fibrosis) of the lungs. A dry cough is a common symptom.

  • Bronchiectasis: In this condition, the airways in the lungs become widened and damaged, leading to a chronic cough, though this often becomes productive over time.

  • Lung Cancer: NO… THIS IS NOT THE FIRST THING YOU SHOULD THINK! While often accompanied by other symptoms, a new or changing chronic cough can, in some instances, be a sign of lung cancer, especially in individuals with a history of smoking or other risk factors.

• Infections: While most coughs from acute infections like colds or flu resolve within a few weeks, some infections (like pertussis/whooping cough or atypical pneumonia) can lead to a prolonged cough.

• Medications (other than ACE inhibitors): Some other medications can occasionally cause a dry cough as a side effect.

• Psychogenic Cough (Habit Cough): This is a cough that has no underlying physical cause and is thought to be a learned behavior or related to stress or psychological factors. It's usually a diagnosis of exclusion after all other potential causes have been ruled out.

• Heart Failure: In some cases, fluid buildup in the lungs due to heart failure can cause a chronic cough, which can sometimes be dry. This is usually accompanied by other symptoms like shortness of breath (especially with exertion or when lying down), fatigue, and swelling in the legs.

• Obstructive Sleep Apnea (OSA): Some research suggests a link between OSA and chronic cough, possibly due to airway irritation or reflux.

• Foreign Body Aspiration: Though less likely to go unnoticed for years, if a small object was unknowingly inhaled, it could cause a persistent cough.

How to Investigate:

When you see us, here is what we will do:

• Take a detailed medical history, including information about your cough (when it started, what makes it better or worse, any associated symptoms), your lifestyle, medications, and any other health conditions.

• Perform a physical examination, including listening to your lungs and heart.

• Recommend tests, which might include:

  • Chest X-ray or CT scan: To look at the structure of your lungs.

  • Spirometry: A breathing test to assess lung function, often used to diagnose asthma or COPD.

  • Tests for GERD: Such as an endoscopy or a trial of acid-suppressing medication.

  • Allergy testing: If allergies or postnasal drip are suspected.

  • Sputum culture: If an infection or inflammation is suspected (though less likely with a persistently dry cough).

  • Bronchoscopy: Most of the time, it does not get to this point. Bronchoscopy is a procedure where a thin tube with a camera is inserted into your airways to look for abnormalities, if other tests are inconclusive.

  • Trial of medications: For example, trying an inhaler for possible cough-variant asthma or medication for postnasal drip or GERD to see if the cough improves.

Yes, the list is exhausting, the possibilities numerous. However, with a systematic approach, it’s quite possible that that nagging cough that your friends keep telling you “you should get checked out” can be cured.