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Help! I Can’t Stop Coughing!

Ashley O'Rourke M.D.

MUSC ENT will take the time to explore all possible causes and find the solution right for you.

A chronic cough is a persistent cough that lasts for two or more months and it is more common than you would think.

When to Seek Medical Care

A person should seek medical attention for a cough that lasts more than four weeks. Medical care should be sought sooner for any cough that brings up blood, is associated with shortness of breath or caused by eating. Oftentimes, a person can be seen by their primary care physician who can then help guide them to the right specialist if needed.

What Causes Chronic Cough?

Sometimes the reason for the cough is easily identified, but oftentimes the root of the problem is not readily apparent. Chronic cough can be caused by a variety of medical problems, such as:

  • Infection
  • Asthma and other inflammatory conditions of the lungs
  • Allergy and/or irritant exposure
  • Sinus problems and/or postnasal drip
  • Acid reflux
  • Smoking and smoking related problems (such as COPD or emphysema)
  • Certain medications (such as ACE-inhibitors)
  • Swallowing problems
  • Airway and lung tumors (both non-cancer and cancerous growths)
  • Nerve sensitivity
  • Habitual coughing

How is Chronic Cough Evaluated?

To identify the cause of chronic cough, first a thorough history and physical examination is completed. After that, one or more diagnostic tests may be ordered to try and find the cause of your cough. These may include:

  • A Chest X-ray is usually the first test ordered if your physician is concerned that the cough has a lung (pulmonary) cause.

  • Pulmonary function tests (PFTs) are outpatient tests that evaluate the ability of the lungs to inhale and exhale air and can check for asthma or other lung diseases.

  • Allergy Tests are ordered if the cough may be allergy related. This is likely if the cough seems to be brought on by exposure to different environment surroundings (e.g. coughing occurs when exposed to dust) or with seasonal timing. A trial of antihistamines or nasal sprays is often prescribed if this is thought to be a cause for your cough.

  • Nasal Endoscopy and Laryngoscopy – your doctor will perform a laryngoscopy, where a small flexible endoscope is used to look at the nasal passages, upper airway and voice box. This exam is especially important if you have a long history of smoking. During the exam, your physician can also investigate a swallowing problem that causes coughing if food or liquid enters the windpipe (trachea) while eating.

  • Modified Barium Swallow (MBS), an x-ray test, may be completed with a speech-language pathologist to evaluate the function of swallowing.

  • Acid Reflux Work Up – When your stomach contents flow backwards from the stomach and into the food pipe (esophagus) or throat, it could cause chronic cough. Signs of acid damage can sometimes be seen with a laryngoscopy but many times acid reflux is diagnosed based on the patient’s symptoms. If this is the case, the first line of treatment is diet and lifestyle changes and a trial of antacid medication. If the cough does not resolve, then an endoscopy to look at the esophagus and stomach, an X-ray test called an esophagram, and/or a pH probe test may be ordered by your physician.

“Since it isn’t practical for a person to undergo every single type of testing in the evaluation for chronic cough, the tests ordered by the treating physician are guided by their careful review of the patient’s history and physical examination,” shares Ashli K. O’Rourke, M.D. of the MUSC Health Ear, Nose and Throat Department. Unfortunately, because of the wide range of causes of cough, patients typically undergo many diagnostic tests that may come back negative.

What can I do if no cause is found?

In some cases, when all other causes of cough have been sufficiently ruled out, specialized cough therapy, certain medications, and/or procedures can be tried to reduce nerve stimulation in the throat to quell the cough response.

About the Author

MUSC Health Ear, Nose & Throat

Keywords: ENT