Chronic Cough

What is cough?

Coughing is the body’s protective reflex that removes foreign bodies away from the lungs and upper airway passages.

Coughs can be categorised by the length of time they have occurred for.

• Acute cough – lasts less than three weeks and is commonly due to upper or lower respiratory tract infections, asthma or if you have breathed in irritants such as smoke or chemical fumes. 
• Chronic cough – a persistent cough that lasts longer than eight weeks.

Chronic cough affects between 8-10% of the adult population

What causes a chronic cough?

• Postnasal drip (mucus drips down from the back of your nose into your throat) as a result of hay fever, allergies, nasal polyps or infections stimulating cough.
• Laryngopharyngeal reflux (LPR) is stomach contents coming up and spraying into the airway can cause redness and swelling and triggers a cough.
• Asthma and asthma related airways diseases can also present with cough.
• Smoking.
• Side-effects of certain medications, for example angiotensin-converting enzyme (ACE) inhibitors commonly prescribed for high blood pressure and heart failure are known to cause chronic cough in some people.
• Aspiration- Food and/or drink entering the airway into the lungs over time can cause pneumonia. If you notice that you are coughing when eating and drinking then contact your doctor immediately.

Your doctor will often ask you questions and perform tests to further investigate if any of these causes relates to your cough and trial treatments such as antacids, nasal sprays or inhalers to see if this improves your cough. If you smoke it is key to stop and we or your GP can assist with this.

Sometimes there is no obvious cause found for the cough and trials of treatment are unsuccessful. In this case we call this Chronic Refractory Cough (CRC). Chronic refractory cough is where either no treatments have improved the cough or despite a likely cause being found and treated the cough remains.

If there is no obvious cause why am I still coughing?

Coughing is usually a normal response to a stimulus, however repeated coughing has a number of negative side effects such as:

• Increasing thickened secretions around the voice box.
• Redness and swelling around the voice box and upper airway.

Chronic coughing can become a vicous cycle. Once you have coughed, you will often feel the need to take a big breath and cough again. By doing this you are effectively “feeding” the cough as each big breath further irritates the lungs and throat and stimulates a cough.

Cough hypersensitivity

As a result of repeated coughing and irritation, the cough reflex can become hypersensitive (Cough Hypersensitivity syndrome) and stimuli that would not usually cause cough such as steam, strong smells, raising your voice or food often then trigger a cough.

One way to manage this is with cough prevention.

How can I prevent coughing?

To reduce cough, we need to manage the irritation and then introduce cough distraction techniques to help reduce your over-sensitive cough reflex.

Reduce irritation:

• Keep well hydrated sipping water every 15 minutes throughout the day and aim to drink approximately 1.5 to 2 litres of water a day.
• Avoid caffeine and alcohol which can dry the throat out.
• Avoid known triggers. If cold air is your trigger, loosely wrap a light scarf around your mouth when you go outside and use nasal breathing to warm and filter the air.
• Manage symptoms of reflux.
• Try inhaling steam

Use a facial steamer or a bowl of boiled water with a towel over your head.
Exercise caution with hot water and also gradually build your tolerance for steam e.g. initially start further away from the bowl building up to be nearer to the steam. Do not add anything to the water as this may irritate the lining of the throat.

Cough Distractions

• Pursed lip breathing.
• Instead of coughing, take a sip of water and/or a dry swallow.

Try a ‘super sip’.  If normal sips don’t clear the throat of irritation, try:

• Taking a sip of water
• Hold the water in your mouth
• Put your chin down to your chest
• Swallowing hard.

Please use the following QR code or website link to access the video that accompanies this leaflet: https://youtu.be/vdaMz0lGA70

Further information

Useful websites

If you would like further information about health conditions and treatment options, you may wish to have a look at the NHS website at www.nhs.uk.

www.blf.org.uk has further health information on coughing and breathlessness.

Disclaimer: This publication is designed for the information of patients. Whilst every effort has been made to ensure accuracy, the information contained may not be comprehensive and patients should not act upon it without seeking professional advice.

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