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Chronic cough

Everyone experiences cough at some point in their lives. Healthy people will cough for protection, in order to clear the airways of substances that irritate the lungs such as smoke or something going down the wrong way. It can also be a symptom of some conditions, such as chronic obstructive pulmonary disease (COPD) or flu. However, some people experience a cough that can last for months or years. Experts believe that 1 in 10 people may live with this type of cough. In this factsheet you will find information on the symptoms of chronic cough, its causes and triggers, and some of the ways you can manage the condition. Chronic cough can be defined as lasting longer than eight weeks, and occurring without the following symptoms: coughing up blood, wheeze you cannot shift, significant shortness of breath, weight loss, weakness, lethargy and pain.

Last Update 03/04/2021
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Who does chronic cough affect?


The condition tends to affect people later in life, with a peak age of around 50 years. Women are two times more likely to experience chronic cough than men.

What are the main causes and triggers of chronic cough?


You may have chronic cough as part of another condition, including asthma, rhinitis (a blocked, itchy, or runny nose), COPD or an interstitial lung disease (ILD). Although this may explain the reason you have a cough, healthcare professionals from around the world are suggesting that even when cough coincides with another condition it should be treated separately. Some of the main causes include:

  • Reflux from the stomach, where contents from the stomach come up the food pipe (oesophagus) into the throat
  • Nerve damage
  • Inflammation in the airways
  • Disorders of the upper airways, such as rhinosinusitis, in which the sinus is inflamed

In people with chronic cough, there are certain things that can trigger a coughing fit. Below is a list of common triggers:

  • Irritants, such as tobacco smoke, perfumed products and pollution
  • Changes in physical activity
  • Hot or cold environments, or moving into a different environment, such as leaving your home on a cold day
  • Speaking or singing
  • Lying down
  • Getting up in the morning
  • Eating

What are the symptoms of chronic cough?


The main symptom of chronic cough is the cough itself, but it can affect people in very different ways including how often you cough and how long each coughing fit lasts. Other symptoms include:

  • Persistent tickling in your chest and throat
  • Irritating, or itching, sensation in your chest and throat
  • Hoarseness of your voice, or other types of vocal issues
  • A feeling that your throat is blocked
  • A funny taste in the mouth
  • Passing out (cough syncope)
  • Incontinence (problems with controlling the bladder and bowel)

Chronic cough can have a huge impact on your quality of life. You may find that the things that can trigger a coughing fit, including eating and speaking, cause you to limit your social life and make you feel isolated. People with chronic cough often worry about the impact of their cough on their spouses, families and friends, and that their cough will be disruptive during every day social activities, such as going to the cinema or a restaurant.

“I was always really conscious of coughing around other people. I worked as a clinical director for a large organisation, which involved lots of meetings. “If I needed to talk, I used to drink gallons of water to lubricate my throat and would avoid eating during the day, which meant I was very hungry at night.”

Sue Nelson, UK, who has experienced chronic cough for 17 years

How is chronic cough diagnosed?


Despite the fact that it is very common, many people with chronic cough may experience difficulty getting a diagnosis from their healthcare professional, due to a lack of understanding or awareness of the condition.

To give a diagnosis of chronic cough, your doctor will normally need to ask you questions about your cough, such as when do you first cough in the morning? Do you experience any other symptoms?

The Hull Airway Reflux Questionnaire (HARQ) is a widely recognised survey used for the diagnosis of chronic cough. It will ask you to rate how often you’ve experienced issues including hoarseness or problems with your voice, coughing when eating, and coughing brought on by speaking.

How is chronic cough treated?


A number of treatments are available for chronic cough. Different treatments work for different people so you may need to try a few options to find the best one for you. The main drug groups include:

  • Motility agents: drugs that help to get some movement into the oesophagus and tighten up the valve between the oesophagus and the stomach
  • Drugs to suppress the cough such as antihistamines and low-dose morphine

Your healthcare professional may suggest you try one of these drugs depending on the type of cough you have.

More research into the effectiveness of these existing treatments is needed, as well as more research to find further treatments to successfully tackle chronic cough.

Several trials of new drugs are currently underway drugs specifically targeting the nerves which cause the sensation of irritation. Early results of these trials are encouraging, but further research is needed before the drugs can be made available.

Are there any other ways I can manage my symptoms?


As cough varies from person to person, individuals tend to find different ways of managing their cough that work for them. If you are overweight, losing even a small amount of weight can help to reduce the severity of coughing symptoms. Studies have shown that specialised speech therapy sessions can also be effective in managing cough.

Below are some techniques that people with chronic cough use to manage their symptoms.

“To manage my asthma and cough, I try to keep moving as much as possible. I walk a lot, as well as cycling and swimming, which are effective for me.”

Betty Frankemölle, The Netherlands, who has chronic cough and asthma.

“I make sure that I always carry water with me, because if I start talking my voice weakens and triggers my cough. I avoid really hot places and make sure that I wrap up warm and cover my mouth if I’m going out in the cold. I also make sure that I take my medication exactly as instructed.”

Sue Nelson, UK, who has experienced chronic cough for 17 years.

“I have been learning to focus on my breathing to try to gain some control, and I think that this is successful to some extent.”

Ing-Marie Osterlund, UK, who has experienced chronic cough for 10 years.

What are the medical experts doing about chronic cough?


Healthcare professionals from around the world recently produced a new statement on chronic cough, which suggests for the first time that chronic cough should be managed as a separate condition. This statement will be shared with healthcare professionals in Europe to raise awareness of chronic cough and help them diagnose and treat the condition.

Now that chronic cough has been defined in this way, experts hope that more people will receive a targeted approach to managing their cough. It will also enable further research into the syndrome and its causes, leading to improved treatment, care and support for people living with chronic cough.

You can access the abstract to the expert statement on chronic cough at: http://erj.ersjournals.com/content/44/5/1132.abstract

This material was compiled with the help of Professor Alyn Morice, Sue Nelson, Betty Frankemölle, Jill Adams and Ing-Marie Osterlund.
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