Chronic cough
A cough lasting more than eight weeks. The cause is often in the nose or throat, or an oversensitive cough reflex, rather than the lungs.
A cough is called chronic when it has lasted more than eight weeks. It is common, exhausting and socially limiting, and in most cases a cause, or a combination of causes, can be identified and treated. A cough with blood, breathlessness, weight loss, swallowing difficulty, or a new cough in a smoker over 45 needs prompt review and a chest X-ray.
Common causes
- Postnasal drip from the nose and sinuses (rhinitis, chronic rhinosinusitis)
- Reflux reaching the throat, often without heartburn; see the reflux page
- Asthma and related airway inflammation, sometimes with cough as the only symptom
- ACE inhibitor blood pressure tablets (names ending in -pril), smoking and vaping
When the reflex itself is the problem
In many long-standing cases the cough reflex has become sensitised and fires at things that should not provoke a cough: talking, laughing, cold air, perfume. This is called cough hypersensitivity, and once the standard causes have been treated the focus shifts from hunting for one more cause to settling the reflex itself.
Assessment and treatment
Assessment includes a careful history, examination of the nose, throat and voice box with a small endoscope, and a chest X-ray if not already done. Treatment targets the causes found; for cough that persists, options include behavioural cough suppression therapy with a specialist speech and language therapist, low-dose nerve-settling medication, nerve block injections via laryngology colleagues, and the new P2X3 receptor blockers, which Mr Gane can prescribe where appropriate.
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This page is general information and not a substitute for individual medical advice.