Heal Chronic Cough

Coughing helps to clear foreign substances from your lungs and keep your upper air passages clear. A chronic cough is defined as a cough that lasts more than 8 weeks (or 4 weeks for children) and is one of the most common complaints addressed in family medicine. Typically chronic coughs are symptoms of other disorders, including asthma, allergies, acid reflux or sinus problems. A chronic cough may also be the result of smoking, exposure to secondhand smoke or an infectious disease. If left untreated, a chronic cough can lead to complications such as headaches, dizziness, urinary incontinence, fractured ribs, sore abdominal muscles, excessive sweating, and even conditions such as COPD or emphysema. Healing a chronic cough depends largely on identifying and treating the underlying cause of the cough. If you have a chronic cough, see your doctor: while it's usually not a serious symptom, it can be a sign of serious diseases including lung cancer.

Steps

Getting Relief

1. Keep hydrated. Drink plenty of water. In general, it's recommended that men drink about 13 cups (3 liters) of water a day, and women drink about 9 cups (2.2 liters) of water a day. Not only will the fluids help soothe your throat, calming irritation that is causing you to cough, but they can also help thin the secretions in the throat.
2. Gargle with salt water. This is an age-old remedy for coughs and sore throats. Though it won't treat the chronic cough, it can help reduce any swelling and provide some relief.
   • Mix 1 teaspoon of salt into 8 ounces of warm water. Gargle with this mixture every few hours.
3. Take a cough suppressant. A cough suppressant works to block the cough reflex. It's important to note that a suppressant will not treat the main cause of the cough but may provide some relief, particularly if your cough is interfering with your sleep.
   • For a long time, codeine was seen as the "gold standard" cough suppressant drug because it decreased activity in the part of the brain that brings about coughing. However, recent studies have suggested that codeine is not effective in suppressing coughs. Furthermore, there is an addictive potential to codeine and not all providers or patients are comfortable with this.
   • A common cough suppressant is dextromethorphan (e.g., Triaminic Cold and Cough, Robitussin Cough, Delsym, Vicks 44 Cough and Cold). Be cautious with using over-the-counter cough medicines. Always talk to your doctor before using, and only use the dosage and follow the directions as specified.
   • Do not give cough medicines to children under the age of four.
   • If your cough is productive, meaning it brings up mucus or phlegm, don't use a cough suppressant.
4. Use cough lozenges. Most throat lozenges, such as Halls or Fisherman's Friend, have medicine in them that works to numb the throat to provide a soothing effect.
   • You can purchase lozenges or "cough drops" (as they are commonly known) with eucalyptus or mint, which can further help clear out and sooth your airways.
   • Do not give any lozenges to children under the age of 4, as they pose a choking hazard.
5. Eat fruit. Scientific research suggests that incorporating more fruit can help prevent a chronic cough thank to its high amounts of fiber and flavonoids.
   • Research has shown success with apples, pears, and grapes, but you can also try other brightly colored fruits including blueberries, cherries, oranges, and strawberries.
6. Avoid allergens. If you suspect your cough is caused by allergies, make an effort to avoid those allergens. Common allergens include pollen, dust, grass, scented soaps or perfumes, and animal dander.
   • You can also take an antihistamine or decongestant to provide relief from an allergy-related cough.
7. Use a humidifier. Using a humidifier overnight may assist you in keeping a moist environment which can alleviate dry air and help your airways stay clear. Warm or cool damp, misty air can help sooth a swollen throat and also provide some relief from a scratchy, hoarse throat.
   • If you don't have a humidifier, you can also try putting a shallow pan of water in your bedroom overnight. This will add moisture to the air.
   • You could also take a hot shower. Following the same idea as the humidifier, the steam from the shower assists in clearing secretions from the nasal passages.
8. Use honey. Honey is a well known treatment for long-standing coughs. Studies have shown that honey is as effective at battling night-time cough as the cough suppressant dextromethorphan, with none of the side-effects. You can add a teaspoon of honey to hot tea to help soothe a throat that is sore from constant coughing.
   • Do not give honey to children younger than 1 year old.
9. Use benzonatate (Tessalon Perles, Zonatuss). A non-narcotic cough suppressant, benzonatate is believed to help alleviate cough symptoms by reducing the cough reflex in the lungs, thus relieving the chronic cough. Commonly prescribed forms of benzonatate include Tessalon Perles and Zonatuss.
   • Tessalon Perles are non-habit forming capsules, and should be taken as directed by your doctor. This medication must be swallowed as a whole. Do not take more than is directed, as it could cause serious side effects.
   • You may want to discuss using Tessalon Perles with your provider since it can interact with other medical conditions, including pregnancy and the taking of other medications.

Treating the Underlying Condition

1. Visit your doctor. If your cough does not go away, you should make an appointment with your doctor. She will be able to determine the source of the cough and treat it accordingly.
   • Although it can be difficult to pinpoint the underlying cause of the cough, it is essential to do since in most cases, a chronic cough disappears once the underlying condition is addressed and treated. The three most common causes of a chronic cough are asthma, postnasal drip, and gastroesophageal reflux disease (GERD). These three causes are the reasons for 90% of all cases of chronic coughs.
   • Most doctors will begin by taking your full medical history and conducting a physical examination. In general, physicians will try treating one of the common underlying conditions of coughs and only if those treatments are unsuccessful will they conduct additional testing, including X-rays, CT (Computerized tomography) scans, bacterial tests, lung function (spirometry) tests, etc.
   • Your doctor will also ask you what medicines you're taking. Sometimes, prescription medications can cause a cough. ACE inhibitors, used to treat high blood pressure, are common culprits behind chronic coughs.
   • In the case of a child, the doctor may initiate testing, including a chest X-ray and spirometry test, if the history and physical exam don't reveal a clear cause.
2. Treat asthma. A cough that is caused by asthma may come and go depending on the time of year, but can also develop if you've recently had an upper respiratory infection, also known as the common cold. An asthma-related cough can also worsen if you're out in the cold or are exposed to certain chemicals or fragrances. In addition there is also a type of asthma known as "cough-variant asthma" that is typified by the hyperactivity of the airways due to pollutants and often in conjunction with seasonal allergies.
   • Most physicians will recommend that you use an inhaler with corticosteroids to treat asthma, such as Flovent and Pulmicort. These inhalers reduce inflammation and expand your airways. Inhalers are only available by prescription so you'll need to talk with your doctor directly. Generally, these inhalers are taken twice daily. The user must follow a certain procedure for the inhalers to be effective: take a deep breath out, then take a deep inhale while squeezing the pump of the inhaler. Rinse your mouth out after use to avoid potential thrush from the steroids remaining in your oral cavity.
   • If you have asthma, your doctor will prescribe bronchodilator medications such as Albuterol that relax muscles in the airway (thus averting a coughing spasm) and help increase air flow to the lungs. These are generally inhaled every 4 to 6 hours, as needed. However, inhaled steroids remain the foremost treatment for asthma that causes a predominant coughing pattern.
   • If you have a cough due to asthma, your doctor may also prescribe montelukast (Singulair), which can help treat coughing and other symptoms.
3. Treat acid reflux. This is a very common condition in which stomach acid leaks back into your esophagus, the tube that connects your stomach and throat, and irritates your esophageal lining. This irritation can eventually result in a chronic cough. The cough in turn worsens GERD, so a vicious cycle eventually develops if you do not seek treatment for GERD. If you are also experiencing indigestion or heartburn frequently, then GERD is a likely cause of your cough.
   • To treat GERD, you can take either acid blockers or Proton Pump Inhibitors (PPIs). Acid blockers (also known as H2 blockers) reduce the production of stomach acid. The most widely recommended H2 blocker is ranitidine, or Zantac, which can be obtained OTC or with a prescription. Ranitidine can be taken orally in tablet form. In general, most H2 blockers are to be taken 30 to 60 minutes before eating (but only twice per day maximum).
   • PPIs work by blocking a chemical system called the hydrogen-potassium adenosine triphosphatase enzyme system, which produces stomach acids. They reduce the production of acid and also increase the tone of the lower esophageal sphincter, thus preventing the acid from traveling into your upper airway and triggering a cough. One PPI, Prilosec, is available over the counter, whereas others, including Aciphex, Nexium, Prevacid, Protonix, and stronger Prilosec, require prescription. PPIs should not be used for longer than 8 weeks, unless directed by your doctor.
   • For more ways to treat GERD, including dietary tips, see Treat Acid Reflux Naturally. Common suggestions include avoiding "trigger" foods like fatty or fried foods, drinking more water, and eating smaller meals throughout the day.
4. Treat the occurrence of postnasal drip. Postnasal drip occurs when the mucus from your nasal passages and sinuses drips down the back of your throat. This can trigger your cough reflex. This condition is also called upper airway cough syndrome.
   • The standard treatment for postnasal drip are antihistamines, such as Claritin, Zyrtec Xyzal, Clarinex, and decongestants (such as Sudafed tablets or liquid and Neo-Synephrine and Afrin nasal sprays). They can be found over-the-counter in your local pharmacy. Follow any directions on the label and do not use more than the recommended dosage because these medications can have side effects, including dizziness and dry mouth. You may want to consult your doctor before use, especially if you have medical problems such as high blood pressure or take other medications.
   • More recently, Flonase and Nasacort, which are inhaled corticosteroids, were released for over-the-counter use. They are not addictive and should not be confused with a nasal decongestant spray.
5. Stop smoking. Smoking is the most common cause of chronic bronchitis, which can cause a chronic cough. Chronic bronchitis results in the long-term inflammation of your bronchial tubes, which are your major breathing airways. These changes can become permanent if you do not seek treatment or stop smoking. In addition to a chronic cough, chronic bronchitis can also cause wheezing and an inability to breath deeply and clearly.
   • Smoking also irritates coughs from other sources, and can cause serious issues such as lung cancer.
   • Most people with chronic bronchitis either smoke or used to be smokers.
   • It's also important to avoid second-hand smoke, as this can trigger a chronic cough even if you aren't a smoker.
6. Take an anti-allergy medication. If environmental allergens are causing your chronic cough, an over-the-counter allergy medicine can greatly help relieve your symptoms. Antihistamines (e.g., Claritin, Zyrtec, Tavist, Clarinex, and Xyzal), decongestants (Sudafed, Neo-Synephrine, Afrin, and Visine) and combination decongestant and antihistamine medications (Allegra-D or Zyrtec-D) are standard treatment for allergies.
   • Antihistamines work to block the substance histamine in your cells, the production of which is your body's response to an "attack" by an allergen on your immune system. Histamine is what causes redness, itching, and swelling. Note that although some antihistamines may cause drowsiness, there are newer ones the market that are explicitly labelled as non-drowsy. Take as directed.
   • Decongestants help to alleviate congestion and are usually recommended for use alongside antihistamines. Nasal spray and eye drop decongestants should be used only for a couple of days at a time because can worsen symptoms. Tablets and liquids can be used for longer. Follow the dosage and directions as specified on the bottle or box.
   • Nasal corticosteroid sprays, such as Flonase and Nasacort, can be very effective in reducing nasal allergy symptoms and reducing allergy-related cough.
7. Take antibiotics if you have an infection. If you are suffering from bacterial pneumonia, bacterial sinusitis, bronchitis, tuberculosis, or pertussis (whooping cough), your doctor will prescribe the correct kind and dosage of antibiotics according to your particular needs.
   • Be sure to complete the full course of antibiotic treatment. For example, if your doctor prescribes a 10-day treatment, make sure to take the antibiotics as specified for the full 10 days even if you feel like your symptoms have been improving.

Warnings

• If your chronic cough produces blood or vomiting, see your doctor immediately.
• See your doctor right away if your cough is associated with high or persistent fevers, weight loss, or chest pain or trouble breathing.
• It is imperative that you treat the underlying cause of your chronic cough. If untreated, it could cause irreparable damage.

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Sources and Citations

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