An upper respiratory tract infection (URTI) cough lingering for more than 3 weeks is usually termed “post-viral cough”. The grey area between 3 and 8 weeks of cough is difficult to define aetiologically since all chronic cough will have started as an acute cough, but the clear diagnostic groups of chronic cough are diluted by those patients with post-viral cough. The members of the guideline group initially met to discuss content, format and purpose of the document and to consider the most appropriate methodology for the critical review of available literature and the generation of recommendations. Consensus was obtained on these points and members of the Guideline Group were allocated to one of three subgroups concerned with acute cough, chronic cough, or specialist cough clinics. These three clinical areas were further divided into sections and individuals were identified to conduct an independent literature search for each of these and to produce a discussion document based on their literature appraisal.
If you have a cough that you just can’t shake, see your doctor and explore the possibility of other sources of your misery. But among nonsmokers, the most common cause of a cough is that humdrum malady, the common cold. At least 200 viruses are capable of causing a cold, which is one reason why it’s so common.
The idiopathic (unexplained) cough remains a mystery. Patients with this cough-predominantly peri-menopausal women with a lower capsaicin threshold, many of whom have had an upper respiratory infection preceding symptom onset-may have been inadequately diagnosed.
RM The first step is to prospectively demonstrate whether or not there is a difference in response to gabapentin based on the presence or absence of GERD or an abnormal pH impedance study. It might turn out that GERD alone is not causing the cough; GERD may merely be one of the stimuli evoking cough in a patient with an abnormal cough reflex. Treating GERD without treating the abnormal reflex may not necessarily improve the cough; the abnormal reflex has to be treated as well.
These symptoms usually disappear within a few days, but the cough can persist for weeks. Various pollutants and irritants in the air can cause a persistent cough. Even short-term exposure to fumes (such as diesel exhaust) can result in cough, phlegm, and lung irritation, for instance. Fumes can also exacerbate the symptoms of allergies or asthma. A more serious respiratory tract infection is pneumonia, which can be caused by bacteria or viruses.
Acute cough is usually caused by a viral URTI but may arise from other aetiologies such as pneumonia or aspiration of a foreign body. The duration of a single episode of URTI associated cough varies but is rarely more than 2 weeks. A cut off of 2 months for chronic cough has been arbitrarily agreed in both American10 and European guidelines.6 The economic impact of acute cough may be usefully thought of in terms of a series of patient thresholds that trigger interventions such as the purchase of a cough medicine or consultation with a general practitioner (GP).
The second mechanism proposes that reflux moves above the food pipe and causes tiny droplets of stomach acid to land in the voice box or throat. This type of reflux is known as laryngeal pharyngeal reflux (LPR). LPR may lead to the development of a cough as a protective mechanism against the reflux. There are several ways to significantly reduce the occurrence of acid reflux symptoms, and in most cases prevent the acid reflux before it starts. With less acid reflux episodes, there is less chance of esophageal damage.
Foreign material obstructing the airways of the lungs, asthma, and allergies need to be evaluated by a pediatrician. Cigarette smoking is the most common cause of a constant, chronic cough. Treatment for chronic cough is to identify the cause and treat it. Chronic cough is a cough that persists over time.
Medications such as codeine are not recommended for the treatment of chronic cough given concerns for addiction. In children, codeine is specifically not recommended for acute or chronic cough due to safety concerns.
If you have had a persistent cough for some time, your GP may wish to consider referring you to the Cough Clinic at Castle Hill Hospital where a Consultant Chest Physician specialising in chronic cough accepts referrals from all over the UK. Seek advice from your GP regarding any medications that may be causing the cough or could be prescribed to improve it.
A cough may be caused by several different factors. If it is due to gastric acid or non-acid (‘silent’) reflux, then this condition will require treatment or further investigation. Acid or non-acid reflux from the stomach, especially at night. Research shows that some chronic conditions such as asthma and otitis media can be caused by gastric reflux.