An expert guide to chronic cough

There are various reasons for a chronic cough, ranging from acid reflux, allergies to more serious conditions like lung cancer. Regardless of the cause, they can have significant impact on people’s quality of life.

Here to offer a detailed explanation is Professor Owen Judd, leading consultant ENT surgeon in Derby. He discusses why a chronic cough can perpetuate itself, how they are treated and more, in this informative article.                

What are the main causes of chronic cough? 

The main causes of chronic cough can be divided into three main areas. They're either in:

• The upper airways, so the nose and back of the throat;
• The throat itself, or the area of the larynx and voice box, or;
• The chest. 

Cause perspective, the most common cause that we get concerned about, with chronic cough or any problems with the lungs themselves, are things like lung cancer. So, any patient who has a chronic cough, that is one of the potential causes, which is why of course we have advertising campaigns that if you've had an unexplained cough for three weeks or more, you should visit your GP. That's primarily to rule out potential for lung cancer or chest problem. 

We, in ENT, see a lot of patients with chronic cough that have problems at throat level. So, either in the voice box itself, and there are many different causes for chronic cough in the voice box. Probably one of the most common is chronic irritation from reflux from the stomach, and then other issues can be in the upper airways themselves. Things like allergies, hay fever, for example, can often be particularly chronic cough. Issues with infection of the nose and sinuses, which can sometime give excess mucus production, which again, result in chronic cough. 

Actually, a cough itself can often be the cause of the cough. Every time we cough, we cause a degree of inflammation and trauma to the back of our voice box, when our vocal cords bang together very violently during a cough. We can then feel that irritation and tickling sensation, which will then make us cough again. It can often become a vicious cycle. For patients that have been coughing for a long period of time, repeatedly, it's often the cough itself that keeps itself going.

Why might I keep having to clear my throat?

That's actually very common as well, and in a very similar way to a chronic cough, chronic throat clearing is quite an aggressive action. Every time we clear our throats, we make the sound [coughs], for example, the back end of the vocal cords bangs together quite violently. This causes a degree of inflammation between the vocal cords at the very back which can then be felt as an irritation, which makes us feel like we need to clear our throat again. It can often set up a repetitive cycle. 

What's really common in causing inflammation at the back of the throat in the first instance, which gives us that sensation that there's something there that we need to clear, is often something known as silent reflux. This is a really common problem. The stomach contains both acid and enzymes. If we have too much acid in our stomach contents, and we reflux, that's what gives us heartburn and indigestion. 

If we have normal levels of acid in our stomachs, and are still refluxing, we may not necessarily feel it. We don't get that heartburn and indigestion, but it often will cause problems at the level of the throat. That's because the enzymes that sit in the stomach are designed to digest protein, and when they reflux into the back of the throat which is made up of very delicate, soft tissue, which of course are made of protein, it will cause lots of inflammation.

You then feel that inflammation and it feels like a ball of mucus stuck in the back of the throat, and the natural reaction is to try and clear your throat to try and get rid of that sensation. Of course, you can't cough up your own throat and therefore you can't get rid of that sensation completely. Every time you repeatedly clear your throat, you cause more inflammation, which makes you want to clear your throat again. A vicious cycle is really common with chronic throat clearing, in a similar way to chronic coughing. 

What can happen if a chronic cough is left untreated?

If a chronic cough is left untreated, as I've just mentioned it will just perpetuate itself. Each time we cough, we cause more inflammation and trauma at the back of the vocal cords, at the back of the larynx, which will make us cough again. It just keeps perpetuating itself. 

We don't get overly concerned by chronic cough being untreated, that's of course a worry for the patients. What we get concerned about is a chronic cough that isn't diagnosed. So, diagnosing the cause for the chronic cough is extremely important, at which point we can then instigate treatment. 

How can my chronic cough be managed?

If you have a chronic cough, and you're thinking how it's going to be managed, it depends on entirely the diagnosis. 

For patients who have upper airway generated cough, so problems with the sinuses, for example, allergic rhinitis, or hay fever, which is very common. This can obviously be treated. Most commonly, allergy and inflammation in the upper airways will be treated with topical steroids in the form of nasal sprays, or antihistamine medication. Typical treatment for things like hay fever and chronic sinusitis.

If you have a problem with allergy affecting the level of the throat, then again, antihistamines are very, very effective. Sometimes if we can diagnose this as a silent reflux problem, which is extremely common and leads to chronic habitual throat clearing and coughing, then treating that silent reflux with anti-reflux medication can be very, very helpful.

For patients who have chronic habitual throat clearing and coughing, and find it very difficult to break that habit, there are techniques and exercises that we can teach patients which helps them break that habit, and help them with a chronic cough and throat clearing, and essentially settle it down altogether. 

Ultimately, anyone who has a chronic cough, particularly if you have a cough that's lasting for three weeks or more, and it's unexplained, you need to see your GP to rule out any serious causes.

If you experience chronic coughing and require expert treatment, arrange an appointment with Professor Judd via his Top Doctors profile.