When is a cough considered chronic?
Coughing is a protective reflex that clears the airways. After a cold, it can persist for several weeks while the bronchial mucosa is restored, and this is normal. Doctors divide coughs by duration: acute - up to 3 weeks, subacute - from 3 to 8 weeks, chronic - more than 8 weeks. In children, a cough lasting longer than 4 weeks is considered chronic, and the approach to it is different - the child is examined by a pediatrician. Character also matters: a wet cough often indicates bronchial disease, a dry cough more often indicates asthma, reflux or the effects of medications.
- Acute cough - up to 3 weeks
- Subacute, post-infectious - 3–8 weeks
- Chronic in adults - more than 8 weeks
- Chronic in children - more than 4 weeks
- Dry and wet, with phlegm
Common reasons
In most nonsmoking adults with normal x-rays, the cause can be found among several common conditions. The cough variant of asthma is manifested only by coughing, often at night, after exercise or in cold air. With rhinitis and sinusitis, mucus flows down the back of the throat and irritates the cough receptors. Reflux causes coughing even without heartburn. ACE inhibitors, which are prescribed for hypertension, cause a dry cough in some people, which goes away after changing the drug. Often one person has several reasons combined at once.
- Bronchial asthma and eosinophilic bronchitis
- Postnasal drip syndrome with rhinitis and sinusitis
- Gastroesophageal reflux disease
- Taking ACE inhibitors
- Chronic bronchitis and COPD in smokers
- Bronchiectasis
- Less commonly - tuberculosis, tumor, interstitial lung disease, heart failure
Associated symptoms
The nature of the cough and the accompanying symptoms prompt the doctor in the direction of the search. Nasal congestion, coughing up mucus in the morning and a frequent desire to clear your throat indicate diseases of the nose and sinuses. Wheezing, coughing at night, when laughing or in the cold are characteristic of asthma. A sour taste in the mouth, heartburn, cough after eating and when lying down speak in favor of reflux. Copious purulent sputum occurs every day with bronchiectasis. Weight loss, sweating and fever require the exclusion of tuberculosis and tumor.
- Drip of mucus down the back of the throat
- Wheezing, coughing attacks at night
- Heartburn, belching, hoarseness in the morning
- Large amount of sputum
- Shortness of breath on exertion
- Swelling of the legs and shortness of breath while lying down - possible cardiac cause
What examinations are needed
The examination begins with a detailed questioning and examination: the doctor is interested in smoking, profession, pets, medications taken. All patients with chronic cough are advised to undergo chest x-ray and spirometry with a bronchodilation test. If spirometry is normal but asthma is suspected, challenge tests or exhaled nitric oxide are measured. The ENT doctor examines the nose and sinuses and, if necessary, prescribes endoscopy and CT scanning of the sinuses. If reflux is suspected, a trial treatment or gastroscopy is performed. Chest CT and bronchoscopy are performed as indicated.
- Chest X-ray
- Spirometry with bronchodilation test
- Complete blood count with eosinophil count
- Sputum analysis, including for Mycobacterium tuberculosis
- Examination by an otolaryngologist, nasal endoscopy
- CT scan of the chest and bronchoscopy - according to indications
- Consultation with a gastroenterologist if reflux is suspected
Treatment
Effective treatment of chronic cough is treatment of its cause, and not endless use of antitussive syrups. For asthma, inhaled glucocorticosteroids are prescribed, for rhinitis - nasal sprays with glucocorticosteroids and nasal lavage, for reflux - nutritional correction and proton pump inhibitors. If the cough is caused by an ACE inhibitor, the doctor replaces the drug with a medicine from another group. The most important thing for smokers is to quit smoking. When the cause cannot be found, they speak of a refractory cough: in this case, special breathing exercises and medications that affect the cough reflex, as prescribed by a doctor, help.
- Quitting smoking and vaping
- Treatment of asthma with inhaled drugs
- Treatment of rhinitis and sinusitis
- Nutrition and regimen for reflux, proton pump inhibitors
- Replacing ACE inhibitors according to the doctor's decision
- Breathing and speech therapy for refractory cough