In contrast, a persistent cough is a major quality-of-life issue. Coughing is a physiologic response meant to clear the airway of mucus, infections, foreign bodies, or irritants. However, when a cough persists for many weeks or months, it becomes a disabling medical problem that can lead to loss of sleep, muscle pain, fractured ribs, syncope, stress incontinence, and vomiting. Not only do chronic cough sufferers lose sleep and miss work, but they endure exhaustion, frustration, embarrassment and frequent doctor’s visits. Therefore, chronic cough requires a closer look.
What the patient may not consider
A persistent cough may signal an underlying disease. The correct diagnosis requires a comprehensive investigation—including an in-depth history and physical examination, pulmonary function studies, x-rays, laboratory studies, endoscopy, and specialized studies (e.g. allergy testing, methacholine challenge, 24 hour pH probe).
The presence of multiple pathological processes (e.g. asthma, GE relux and sinusitis) can cause interactions that resist treatment until all are successfully managed. Identifying the precise cause of a chronic cough can save a patient years of unnecessary discomfort.
A respiratory defense mechanism
Coughing is mostly an involuntary automatic reflex action stemming from irritation of the bronchial mucosa or the mucosa of the upper airway. If it lasts just a few weeks, the condition is labeled as acute coughing, usually due to viral infections of the airway, sinusitis, bronchitis, pneumonia, flares of asthma, or nasal allergy. Sometimes, coughing results from irritation outside of the respiratory mucosa. For example—a persistent cough may signal inflammation of the pleura, a lung tumor, heart disease, or irritation of the external ear canal. Identifying the cause of a chronic cough—lasting longer than 6-8 weeks—can be difficult because of its atypical presentation.
However, only a correct diagnosis of the cough’s origin leads to successful therapy.
- Asthma. Chronic cough as the only sign of asthma is often referred to as cough variant asthma. It’s usually a dry, hacking cough that may worsen following exercise, talking, laughing or crying. Pulmonary function tests may be normal or reveal a mild obstructive pattern. When pulmonary function tests are normal, a positive methacholine challenge helps support the diagnosis of asthma. Such patients often have a dramatic response to asthma medications included beta agonists (albuterol), cromolyn sodium and or inhaled corticosteroids.
- Non-asthmatic eosinophilic bronchitis. These patients have evidence of eosionophils in their sputum and often respond to corticosteroids. Their methacholine challenge is negative and distinguishes these patients as non-asthmatics.
- Gastroesophageal reflux disease (GERD). It is thought that the gastric acid irritation of the respiratory mucosa stimulates the Vagus nerve, leading to a chronic cough. Treatment includes a proton pump inhibitor (PPI), inhibiting acid production and reflux by elevating the head of the bed, discontinuing smoking, losing weight and following a diet that doesn’t stimulate acid production. All of these treatments can decrease this cough.
- Upper airway allergy (allergic rhinitis and/or sinusitis). This may lead to chronic post-nasal drip.
- Post infectious cough. This may follow a viral infection of the respiratory tract and coughing can last up to 6 months.
- Chronic sinusitis.
- Laryngeal reflux. Specific irritation of the upper airway from acid reflux.
- Use of ACE inhibitors.
- Chronic bronchitis.
- Cigarette smoking.
- Bronchiectasis. This is caused by damaged bronchial tubes
- Psychological causes. Cough diminishes during sleep.
How coughing works
Chronic cough may be a sign of the airways’ response to:
- Altered mucus quality or quantity (bronchitis, sinusitis)
- Increased sensitivity of cough receptors (asthma, cigarette smoking)
- Inhalation of an irritant (GE reflux, neurological disease)
- Direct stimulation of cough receptors (e.g. tumors, thyroid enlargement, inhaled foreign body)
- Indirect stimulation of cough receptors (lung disease, heart failure)
- Psychological causes (e.g. cough tic syndrome)
Investigative work for most adults & children
A comprehensive evaluation may include:
- Chest X-ray
- Allergy testing
- Pulmonary function testing
- Methacholine challenge CT of chest and sinus
- Lab work: CBC, total eosinophil count , IgG’s, Sweat test, sputum analysis: gram stain, eosinophil count, and culture
- Upper GI, pH probe, esophageal endoscopy
Each 500mg Capsule contains :
Ingredients Qty Inula racemosa 100mg Bambusa arundinacea 50mg Piper longum 50mg Piper nigrum 50mg Glycyrrhiza Glabra 50mg Zingiber Officinale 50mg Ocimum sanctum 50mg Pistacia integerrima 50mg Abies webbiana 30mg Amomum subulatum 20mg
1 - 2 capsules twice a day with honey/warm water.