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 | Persistent Cough
By Michael Spilane, MD
A cough associated with a common respiratory infection is understandable, and typically is gone in a couple of weeks. If a cough persists for more than a few weeks, something is wrong and an explanation is needed. For a person who smokes cigarette or cigars, the explanation is usually obvious--the chemicals in tobacco smoke inflame the bronchial tubes, leading to the cough and the stuff that is honked up. Worsening of a chronic cough in a smoker is usually caused by a viral or bacterial infection of the impaired and susceptible bronchial linings. Any smoker experiencing a new cough, a worsening cough that doesn't resolve with simple treatments, or coughing-up blood, has reason to worry about the possibility of lung cancer.
A persisting cough is sometimes present in those with allergic or perennial asthma. An asthmatic cough may be more troublesome for a person than shortness of breath or wheezing, and it may be the first symptom of the ailment. Yes, asthma can come on at any age. Chronic sinusitis is one of the most common causes of a continuing cough in the elderly. Secretions produced by inflamed sinus membranes drain down the back of the throat and enter the passage to the lungs. The resulting irritation of the bronchial tubes leads to the typical irritative cough. The cough is usually dry, but secretions may be brought up after awakening in the morning. It abates only after successful treatment of the sinus condition.
Regurgitation of stomach fluids during sleep can be the cause of a cough that won't go away. If the value at the top of the stomach does not function properly, stomach contractions can propel acidic secretions up the esophagus (swallowing tube). Bronchitis and cough develops when this fluid overflows into the airway tubes. The reflux of stomach contents into the esophagus often occurs silently at night when the sleeping position has eliminated the defense of gravity. If a correct diagnosis is made, treatment is highly effective. A cough can also be the result of swallowed food or drink going down the wrong tube." If this occurs on a regular basis, the cough will persist. Aspiration of swallowed food into the lung is unusual in healthy persons, but is common among the chronically ill and in those who are bedridden. Persons with impairment of the swallowing mechanism, such as those with strokes or Parkinsons disease, are most susceptible.
An annoying and persisting dry cough is a potential side effect of a class of drugs called ACE inhibitors (for example, lisinopril, Prinivil, and Accupril). These agents are commonly prescribed by physicians to treat hypertension, heart and kidney disease, and about 10 percent of users develop the cough. The cough resolves when the medication is stopped. Some people cough for the same reason they bite their fingernails. It's a habit. The characteristic throat-clearing cough is repetitive during the day but is not present during sleep. Recognition of the cause, and reassurance that disease is absent, is the foundation of a treatment plan. Other causes of a persisting cough include heart failure, an enlarged thyroid gland, tuberculosis, and scars from previous pneumonia. Sometimes the best of doctors may not find a cause and reluctantly attribute the cough to simple degeneration of airway tissues.
Anyone suffering from a persisting cough should see a physician. A correct diagnosis of the cause will usually allow planning for effective treatment. And if you are a smoker, be prepared to accept and follow the obvious advice.
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