Chronic Cough & Chronic Throat Clearing

What is Chronic Cough?

Chronic cough is persistently troublesome cough lasting four weeks or longer. Chronic cough is a cough that does not resolve. This type of cough usually is dry and not productive. In severe cases the ‘coughing fit’ can trigger laryngospasm, which results in difficulty breathing. Often chest x-rays, CT scan of the chest and other tests are normal in individuals with longstanding dry chronic cough. Chronic cough can cause considerable physical and psychological distress and impacts quality of life.

What are the Causes of Chronic Cough?

The most common causes of persisting cough in the absence of infection are: 

  • Laryngopharyngeal reflux 
  • Allergies (post nasal drip) 
  • Reduced hydration 
  • Smoking 
  • Asthma 
  • Chronic bronchitis 
  • Gastroesophageal reflux 
  • Chemical sensitivities 
  • Idiopathic

Other causes of persisting cough are: 

  • Postviral vagal neuropathy 
  • Respiratory infection 
  • Aspiration 
  • Heart conditions 
  • Lung cancer 
  • Sarcoidosis 
  • Side effect of medications, e.g.: ACE-inhibitors used to treat blood pressure

How is Chronic Cough Evaluated?

A thorough medical evaluation is necessary to determine the cause or the contributing factors for chronic cough. Often a battery of tests is necessary to determine the cause of the cough. These batteries of tests include but are not limited to the following

  • Allergy testing 
  • Sinus examination (CT Scan of the sinus) 
  • Chest X-Ray / Chest CT Scan 
  • Spirometry and other lung function tests 
  • Laryngeal endoscopy / stroboscopy 
  • Reflux testing (esophageal endoscopy, pH probe monitoring) 
  • Bronchoscopy

What is the Treatment for Chronic Cough?

Chronic cough is treated based on the underlying cause. However if the underlying cause of the cough is not established and if the cough is dry and non-productive, it is best treated with pharmacological agents and with behavior management strategies. The physician will determine the specific pharmacological treatments based on the specific triggers of the cough. The following drugs may be prescribed depending on the cause of the cough: proton pump inhibitors for reflux management, antihistamines, inhaled corticosteroids, amitriptyline, neurontin. Life style changes for reflux, smoking cessation, increasing water intake. The speech language pathologist assists in retraining and reducing the frequency of cough with behavioral management strategies. Eliminating and modifying triggering agents for cough is also necessary.