In this post I would like to outline 4 major causes of a chronic cough (coughing that doesn’t seem to go away for more than 2 months). At the end of the page I have included a video in which I discuss causes of cough in more detail.
1. Gastroesophageal reflux disease (GERD)
When stomach contents move back up into the esophagus (the tube connecting it to the mouth), this is called gastroesophageal reflux. It can happen to most people without causing any issues, however if it leads to heartburn or other problems, then we talk about gastroesophageal reflux disease (or GERD). Some people may also suffer with something called a hiatus, or hiatal hernia – when the upper opening of the stomach passes through the diaphragm into the chest cavity. This opening is then unable to close properly and acid reflux occurs.
Gastroesophageal reflux is actually a very common cause of chronic coughing, and one of the first things that needs to be ruled out when considering treatments.
Most often, the reflux fluid is highly acidic in nature and when sucked into the airways will cause irritation and coughing. In these cases, treatment aimed at reducing the acidity of the stomach can help with symptoms. However, in some instances the reflux in non-acidic, and anti-acid medication would not help. Non-pharmacological measures are likely to help in all circumstances and may include:
- Adjusting your diet, by avoiding certain foods which cause more reflux – can be very spicy foods, dairy etc. This can differ from person to person and it’s important to know your own body to understand which foods are best for you.
- Avoiding late night meals before going to bed. Going to bed with a full stomach is bound to induce acid reflux when you lie flat as gravity helps bring up food contents. It is generally recommended to avoid eating for 2-3 hours before going to bed. In addition, this is likely to help promote a better sleep quality, as your body would not be busy digesting a large meal.
- Aiming to have a healthy weight. People who are overweight will have a lot of weight on their belly and when lying flat, it will push down on the stomach, forcing its contents up into the esophagus. Losing weight in these circumstances can help improve acid reflux
- Raising the torso during sleep. Some people find it helpful to slightly raise the top end of the mattress (by placing something under it) or using a triangular pillow. A slight tilt in the torso can help keep the stomach contents down.
2. Post-nasal drip
Post-nasal drip refers to nasal secretions that stream down the back of the throat. People who suffer with chronic rhinitis (inflammation of the nasal passages) generally have a lot of mucus which can actually irritate the back of the throat, causing a chronic cough.
Again, this is one of the main causes of cough and needs to be ruled out when considering other treatments.
Treating chronic rhinitis, usually with low doses of a corticosteroid nasal spray, generally helps to dry out secretions, reducing post-nasal drip. After a few weeks of treatment, the cough also tends to improve.
Asthma is normally thought of as a lung airway disease characterized by attacks of breathlessness, chest tightness and wheeze. However, there can be instances when cough may be the only symptom (cough-variant asthma). Most often however there is an overlap between coughing and other respiratory symptoms.
Asthma is an inflammatory condition of the airways and treatment generally involves inhalers containing low doses of corticosteroids. These do a great job controlling the airway inflammation and reducing the symptoms to the point where asthmatics can actually have nearly-normal lives.
4. Treatment with ACE inhibitors
Angiotensin-converting enzyme (ACE) inhibitors are a class of high blood pressure or heart failure medication which is very commonly prescribed. You can recognize these medications as their drug names always end in -pril (e.g. enalapril, ramipril, perindopril, quinapril etc.). They may also have other brand names, but if you look at the pharmacological name, it would end in -pril.
In up to 10% of cases, these treatments may be induce chronic coughing. As they are very commonly used, a lot of people may be having a cough for this reason (and a long time may pass until this is identified). The good news is that it is generally not a dangerous situation, but the cough can be bothersome.
In most instances, if suspected to be the cause of the coughing, ACE inhibitors can be replaced with an alternative class of medication called angiotensin receptor blockers (ARBs). These can also be identified by the ending of their pharmacological name, which is always -sartan (e.g. losartan, candesartan etc.). Please discuss with your doctor before making any medication changes.
In most cases, after changing to an alternative medication, the cough improves within a few months.