Chronic Cough

Mechanism of Cough

Cough is reflex initiated by stimulation of afferent airway receptors (specially of pharynx, larynx, trachea and bifurcation of trachea) of Vth, IXth and XIth nerves,– which goes to cough center in mid brain–from mid brain efferent emanate– to produce coordinated contraction of intercostal muscles, abdominal wall, diaphragm and pelvic floor to produce cough.

Causes of Chronic Cough

In children, bacterial bronchitis and asthma are most common causes for chronic cough.

Most common causes in nonsmoker are:

Post nasal discharge syndrome (PNDS) or upper airway cough syndrome (UACS), Asthma, GERD or gastro esophageal reflux disease.

Other causes:

Tuberculosis, Foreign body of nose or bronchus, Pertussis, some medications like ACE inhibitors and b-blockers for high blood pressure,

Other less common causes are bronchogenic carcinoma, congestive cardiac failure, cystic fibrosis, interstitial lung disease and psychogenic.

“Chronic cough in smokers is most commonly because of allergy, post nasal discharge, GERD, bronchitis and cancer.”

Conditions Causing Cough

UACS (Upper Airway Cough Syndrome):- it includes post nasal discharge, allergic rhinitis, vasomotor rhinitis, non allergic eosinophilia syndrome (NARES), sinusitis, occupational, medicine, fungal and pregnancy induced rhinitis.

PND (Upper Airway Cough Syndrome)(Post Nasal Drip):- Secretion of mucus in the back of nose and throat and repeated clearing of throat. Most common cause is allergy and sinusitis. Underlying cause should be treated; decongestant or mucolytics, and steroid nasal spray are helpful. Saline irrigation is safe and very effective.

Asthma: – second common cause of chronic cough, it is leading cause in children. Usually it is associated with shortness of breath or wheezing but sometimes asthmatic patients may only have cough. It is aggravated by cold air, strong fumes and exertion.

GERD (Gastro-Esophageal Reflux):- Acid from stomach flow back to esophagus. Patient may have heart burn/sour taste/regurgitation of food material but there may be clinically silent GERD.

It is treated by life styleand food habit changes read more GER H2 blockers and proton pump inhibitors (PPI) also given for 3 months along with cough medicines.

Lung cancer or bronchogenic carcinoma is rare cause but in a smoker when nature of cough changes suddenly with blood in mucus, it should raise suspicion to rule out the cancer.

General Measures During Cough at Home

Though it does not replace proper diagnosis and medical management but it helps as supportive treatment in faster recovery and reduces sleepless nights.

Proper Rest

Take balanced diet with plenty of vitamin and minerals to boost defense mechanism.

Vitamin c and zinc supplements.

  • Keep hydration adequate.

  • Hot soups like tomato soup, chicken soup works wonder in thinning of secretions.

  • Black pepper, basil leaves, cloves and ginger boil with water and drink at night time; it’s soothing and helps in mucus coming out.

  • Honey is age old miraculous natural cure from cough.

  • One pinch of turmeric with 1 cup warm milk helps in easy expulsion of mucus.

  • Researches show ginger, garlic and onion has medicinal properties and helps in cold and cough.

  • Gargles with warm saline (salt in warm water)

  • Saline irrigation or nasal wash (1/4 teaspoonful of salt in lukewarm water)

  • Humidification.

  • Steam inhalation.

  • Avoid smoking; active and passive.

  • Avoid alcohol as it increases swelling of mucus membrane.

  • Avoid dust, pollen, pets, deodorants, chemical irritants.

  • Do deep breathing exercises.

  • Get flu vaccine before season starts, it works.

Management of Chronic Cough

Thorough evaluation and history of patient is very important on this aspect.With super specialization focus is becoming narrower and clinicians are more focused on specific organs, approach should be integrated on patient as a whole.

Causes may be obscure and numerous anything from nose to distal bronchioles, thus a coordinated team approach is vital in treatment of chronic cough.

It involves testing for all three leading causes of cough namely upper respiratory cough syndrome (PND), asthma and GERD (gastro-esophageal-reflux disease) and treating them simultaneously.


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