Cough is a normal protective process which helps to remove unwanted contents from the lungs, trachea, and throat. Coughing is necessary to protect the airway from aspiration and is present at the time of birth. It is necessary to prevent many things, from choking to infections. Chronic cough can be debilitating, however, when it is unable to be controlled. It may cause disruption of normal activities such as breathing, talking, and even eating. Uncontrolled cough can lead to chest pain, incontinence and even broken ribs. Chronic cough may be very exhausting socially. Patients state that leaving the house is embarrassing and avoidance of others and public places result in feelings of isolation and frustration.
Causes of chronic cough include:
Asthma – This may be associated with shortness of breath and wheezing.
Allergies – Certain seasons, fragrances or foods may cause and allergic reaction which results in cough.
Post nasal drip – Secretions from the nose normally collect in the throat and individuals swallow these without realizing. However when the secretions increase in quantity or change to become thicker the throat may become irritated causing a chronic cough.
Acid reflux from the stomach also may contribute. Acidic contents from the stomach may reflux, or travel backwards into the esophagus and throat. Acid from the stomach may be very irritating to individuals, causing an uncontrolled cough. This may occur even without typical reflux symptoms such as heartburn.
Medications, including certain blood pressure medications are well known to have side effects including cough.
Vocal fold paralysis, in which one vocal fold does not move may cause secretions to pass by the vocal folds into the airway and cause coughing episodes.
Granuloma of the vocal fold can cause cough as a presenting sign.
Evaluation includes a through head and neck examination, including laryngoscopy and stroboscopy if necessary. To eliminate all the causes of cough, many tests may be indicated including
Chest X-ray or CT
Bronchoscopy and esophagoscopy
pH probe study
Treating a chronic cough depends on the cause. Unfortunately determining the cause may take some time and requires some patience.
Medications to treat the specific condition are often started and surgery is employed when necessary.