Contents
Prolonged cough
exhausts, deprives sleep not only of the sick person himself, but also of his family members, and sharply worsens the quality of life. Every 7th patient consults a doctor with complaints of cough, and despite the apparent simplicity of the situation, finding the causes of chronic cough can sometimes be very difficult.
The first question the doctor needs to ask is whether the cough is acute or chronic. This depends on the duration of the symptoms: acute cough lasts no more than 3 weeks, subacute cough lasts up to 2 months, chronic cough is said to occur when symptoms persist for more than 8 weeks.
It is believed that the causes of acute and subacute cough are respiratory infectious diseases; such a cough can go away without treatment.
If the cough bothers the patient for more than 8 weeks, then most often it is caused by chronic diseases and cannot be avoided without medical help.
Prolonged cough is the main symptom of many chronic respiratory diseases, and in recent years many doctors have recognized that chronic cough is not only a serious symptom, but also an independent disease.
A prolonged cough is often complicated by very unpleasant conditions, such as:
- sleep disorders;
- reflux of acidic stomach contents into the esophagus – so-called reflux disease or gastroesophageal reflux (GER);
- urinary incontinence; and etc.
Causes of prolonged or chronic cough
Patients suffering from a long-term cough most often consult a general practitioner, who refers them to an allergist, pulmonologist or ENT doctor. All experts agree that the most common causes of chronic cough are:
- bronchial asthma (about 30% of chronic cough in non-smoking adults);
- chronic rhinitis or nasopharyngitis;
- reflux disease (GERD);
These 3 diseases are sometimes called “cough triad” But not only the “cough triad” can be the cause of a lingering cough; sometimes a patient comes for an appointment who has undergone the most thorough medical examination, which has not revealed any signs of illness.
The path for such patients usually lies through the hospital, where they undergo expensive and unnecessary procedures; They are looking for a malignant tumor, tuberculosis, exotic infections… Everything is in vain, they cannot find the cause, but the cough does not stop. Modern medicine believes that an annoying chronic cough does not always have a cause in the form of a disease of the nasopharynx, bronchi, lungs or pleura; sometimes a chronic cough itself is a separate disease. Old-school doctors said that such a cough was “idiopathic,” that is, “without an established cause,” and were treated with drugs that suppress the cough center in the brain.
Today, pulmonologists use the term “cough hypersensitivity syndrome” This condition has nothing to do with allergies; its nature lies in the fact that the cough receptors in the mucous membrane of the respiratory tract react to such weak stimuli that usually do not cause a cough reaction. Among the factors that provoke cough in cough hypersensitivity syndrome, it is necessary to list:
- pungent odors,
- car exhausts,
- tobacco smoke,
- culinary spices,
- excessively dry air,
- speech load,
- changes in inhaled air temperature,
- wind and other physical influences.
The main symptom of cough hypersensitivity syndrome is an unexplained cough in the absence of objective signs of pathology, hoarseness or a sudden change in the timbre of the voice, a sensation of “tickling” or irritation in the throat or behind the sternum.
As we all know, coughing is protective. In a healthy person, the trigger for coughing is the entry of foreign contents into the respiratory tract or infection. After the provoking factor is removed, the cough reflex subsides. Sometimes, after curing a respiratory tract disease, the altered sensitivity of cough receptors remains for a long time, which react to even the most insignificant stimuli, provoking a coughing attack.
Most often, cough hypersensitivity syndrome, which can occur in both children and adults, is formed against the background of a protracted inflammatory disease of the respiratory system and persists after recovery from this disease, leading to a pronounced decrease in the quality of life. The longer an inflammatory focus exists in the respiratory tract, the higher the risk of developing cough hypersensitivity syndrome. That is why doctors insist on timely treatment of respiratory infections. Preventing the development of cough hypersensitivity syndrome is much easier than treating an established chronic cough.
Treatment of persistent and chronic cough
Treatment of pathology of the respiratory system and, in particular, long-term cough can be carried out both by a therapist and, depending on the established causes, by specialized specialists: a pulmonologist, an allergist, an ENT doctor.
Before prescribing treatment, it is necessary to establish the cause of chronic cough. To do this, during the initial visit, a doctor of any specialty must perform a detailed clinical examination of the patient, collecting family, medical, professional and, oddly enough, “tourist” history. Sometimes the key to solving a clinical problem is the details of the patient’s life, his work, the places he has visited recently, so the doctor can ask the most unexpected questions. After a detailed conversation, a standard set of diagnostic tests and consultations with related specialists are usually prescribed. For chronic cough, a sample examination plan includes:
- X-ray of the lungs,
- general blood test, determination of the level of immunoglobulin E, which characterizes the allergic mood of the body;
- determination of pulmonary function using spirometry,
- consultation with an ENT doctor;
If at this stage of the examination it is possible to establish a diagnosis of bronchial asthma, disease of the nasopharynx or paranasal sinuses, or reflux disease (GERD), then the patient is indicated for further treatment by a specialized specialist.
If the diagnosis remains unclear, then, after a conversation with the patient, a so-called “trial therapy“, aimed at eliminating the most likely causes of chronic cough – the asmatic component, chronic inflammation of the nasopharynx and gastroesophageal reflux.
If a trial treatment does not produce an effect within 1,5-2 months, the doctor is forced to prescribe a more in-depth examination. At this stage, computed tomography of the chest organs, spirography with provocative tests, bronchoscopy and gastroscopy are performed.
Among doctors, it is believed that treating a persistent and chronic cough is a difficult task, so it is easier to prevent its development. Almost any chronic cough once began against the background of a banal acute viral respiratory tract infection. The transition of the inflammatory process into a chronic cough and the formation of cough hypersensitivity is facilitated by concomitant diseases – esophageal reflux, chronic rhinitis, pharyngitis, damage to the paranasal sinuses. If these diseases are treated in time, it is possible to prevent the formation of cough hypersensitivity and reduce the risk of developing chronic cough.