Chronic dry cough: Diagnostic and management approaches

Introduction 

A chronic cough is a cough that doesn’t budge easily. It typically lasts more than eight weeks or more. It is very persistent and worse at night. Chronic cough is prevalent among children and adults. It is often a symptom of an underlying disease, not severe. But in a few instances, the disease might be severe. 

What is chronic cough?

It is infrequent that a cough persists for more than a month. Only a few people know that cough has a purpose. When people cough, they remove as much foreign material and mucus from the airways, averting it from the lungs. Chronic cough can significantly impact a person’s day-to-day life as it is persistent and annoying. A chronic cough might also be a symptom of a viral infection or mucus drip, so it can go away once that is treated. 

Causes 

Since chronic cough is a symptom, let’s have a look at the possible causes for it,

• Upper airway cough syndrome: 

Upper airway cough syndrome may be caused by one of the three reasons, i.e., postnasal drip or paranasal sinuses into the pharynx or swelling of cough receptors in the upper airway. This causes continuous cough. 

Upper airway cough syndrome is usually treated with antihistamines and decongestants.  

•  Nonasthmatic eosinophilic bronchitis:

Nonasthmatic eosinophilic bronchitis (NAEB) is the eosinophilic inflammation of the respiratory tract, almost identical to the one present in asthma. But, in contrast to asthma, nonasthmatic eosinophilic bronchitis is not related to irregular airflow limitation or airway hyperresponsiveness.

Chronic cough due to Nonasthmatic eosinophilic bronchitis is usually treated with inhaled corticosteroids. The dosage and length of treatment depend on the severity of the condition. 

•  Gastroesophageal Reflux Disease (GERD): 

Gastroesophageal Reflex Disease occurs when the contents in the stomach (stomach acid) move up in the tube, known as the oesophagus, connecting the mouth and stomach. This phenomenon is common among individuals, and it happens rarely. But when the reflux occurs frequently, then it is a cause to be worried. It can irritate the lining of the oesophagus and can cause damage to it. 

Treatment for Gastroesophageal Reflex Disease is generally over-the-counter medicines and lifestyle changes when it’s not frequent. When the case is severe, treatment options may vary from strength proton inhibitors to strength H-2 blockers and even surgery in some patients.

• Asthma: 

Asthma is a common disease, and it is not usually a serious condition. There are many variations of asthma, one of them being cough-variant asthma. Cough-variant asthma doesn’t usually have any other symptoms than cough. But this cough can be prolonged for months. It causes increased inflammation in the airway. 

• Allergy: 

A person may suffer from allergies due to allergens like pollen, dust, mites, mould, pet dander, and many more. A common symptom of these allergies is chronic cough. Sometimes, the cough might go away as soon as the allergen is removed from the environment.

Treatment for chronic cough due to allergies varies from using an air purifier, over-the-counter medicines, medication prescribed for the particular allergy, using a humidifier, etc.,

How to diagnose a chronic cough 

Typically, the physician might first enquire about the condition and details of the case and then order tests accordingly. Some of the standard tests are,

• X-ray 
• Computerised tomography (CT) scans
• Bronchoscopy
• Rhinoscopy 
• Spirometry
• Methacholine challenge test
• Throat swab
• Blood tests

Conclusion

Cough is one of the respiratory tract’s first and vital defence mechanisms. Chronic cough persisting over eight weeks can also be due to severe conditions. Chronic cough may cause an interruption in day-to-day activities, leading to exhaustion, disturbance of sleep, missing work, urinary stress incontinence, and, in extreme cases, rib fracture. 

However, it is more likely that once the underlying cause is treated, chronic cough may decline gradually. 

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