A cough can be a nuisance to your day or it can evolve into something more. Maybe you have a simple cold, bronchitis, or allergies? It usually goes away without having to worry too much about it or seek medical attention. But what if your symptoms last longer than a few weeks? We all understand that coughing serves an important purpose – a function of our body that is used to clear our airway of secretions and foreign bodies in order to prevent infections, obstruction, and inflammation. Most people have developed an occasional cough that can persist for a few days or even weeks, but it's important to recognize when it becomes classified as a chronic cough and when you should see your medical professional.
A chronic cough can significantly impact your day and make it hard to sleep at night. You may have other associated symptoms such as runny nose, watery eyes, heart burn, chest pain, coughing up blood, wheezing, or shortness of breath. It can lead to fatigue, frustration, and affect your ability to function. Physicians classify a cough as chronic when it lasts more than 8 weeks, meaning there may be an underlying condition that needs to be diagnosed and treated.
In people who smoke, the most common cause, not surprisingly, is smoking! The harmful smoking particles can irritate your airways, leading to cough and other much more harmful effects, such as recurrent infections and tumor.
In the non-smoker, there are three main diseases that can lead to a chronic cough. In fact, 90% of the time, one of these three diseases is responsible for that persistent cough. The first is asthma, which can start in childhood or adulthood. Asthma can be associated with allergy, exercise, non-allergy, or just manifest as cough with no other associated symptoms. One common scenario is the person who has had allergy for most of their life but never has been diagnosed with asthma. They can develop a pneumonia or bronchitis that leads to persistent coughing for weeks or months. They often have an underlying predisposition to asthma, known as reactive airways, that may require treatment with asthma medications to resolve the symptoms.
The second cause of chronic cough is post nasal drainage. Nasal drainage can lead to mucous running down the back of your throat, irritating the lining of the upper and lower airways vocal cords, and resulting in sore throat and cough. Chronic infections of the sinuses and sinus allergies are the major culprits here.
The final cause of chronic cough is one that we may not intuitively think of – gastroesophageal reflux disease (GERD), or heartburn. GERD occurs when stomach contents travel upwards into the esophagus and irritate the nerves of the esophagus that can trigger the cough reflex. This can be tricky to diagnose, as many times cough is the only symptom noticed, without the classic heartburn presentation.
Cough is one of the top five reasons that people see their doctor, and specifically, pulmonologists are lung physicians who specialize in the evaluation and treatment of chronic cough. Along with taking a thorough history and physical examination, they may order further workup such as pulmonary function testing, oxygen measurements, and a chest xray or chest ct scan. They can perform a bronchoscopy if indicated, which is a camera inspection of the upper and lower airways. You may need to be referred to other specialists such as an ENT, allergist, or a GI doctor in order to provide a multi-disciplinary approach to treating the cough. So if these symptoms apply to you, consider seeing your pulmonologist for evaluation of all the common, and the not so common, causes of a cough.
Sachin Lavania, MD, FCCP
North Fulton Pulmonary Specialists
Dr. Lavania has dedicated his career to the clinical and scientific understanding of pulmonary diseases and respiratory-related critical illnesses so that he can help his patients "breathe easier" and maintain a high quality of life. At North Fulton Pulmonary Specialists, he diagnoses and treats a range of medical issues, including shortness of breath, cough, COPD, asthma, lung nodules, lung cancer, obstructive sleep apnea, pulmonary hypertension, sarcoidosis, interstitial lung disease, and pulmonary embolism.
After earning his undergraduate degree from Duke University and his medical degree from the University of South Carolina School of Medicine, Dr. Lavania did his residency in internal medicine at the University of South Carolina/Palmetto Health Richland, also in Columbia. He then completed his fellowship training at the University of Maryland, in Baltimore, in pulmonary/critical care.
Dr. Lavania is board-certified in internal medicine, pulmonary disease, and critical care medicine.
He has published and presented on pulmonary hypertension in patients with advanced interstitial pneumonia, as well as on asthma, pulmonary fibrosis, emphysema, and other pulmonary diseases.
Dr. Lavania currently is the Medical Director of the Intensive Care Unit and Respiratory Therapy at North Fulton Hospital. He is a member of both the American Thoracic Society and the American College of Chest Physicians.
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