Cough is a common symptom. It can be caused by a cold but also by more severe diseases. Therefore, it should not be underestimated, especially if it does not stop. It is necessary to rely on a specialist to investigate its possible origin and manage it appropriately.
What Are the Causes of Cough and What to Do When It Doesn’t Stop?
Acute Cough and Chronic Cough
Coughing is a rapid and vigorous defense mechanism, a physiological reflex involving the entire respiratory system, modulated by the nervous system.
Coughing allows bronchial secretions to be managed to remove foreign bodies from the upper airways and keep them clean.
Following a physical stimulus, the respiratory muscles “contract,” generating a violent and rapid spasm. This is a protective reflex but can also be a symptom of an underlying, perhaps more serious, illness in some situations.
A cough is defined as chronic when it lasts more than 8 weeks; if its duration is shorter, it is considered an acute cough.
If the cough persists, seeing a pulmonary specialist is essential to identify the causes and allow for better therapeutic management, reducing complications.
Cough: The Causes
It is not always easy to identify a direct cause of cough, as it is a common nonspecific symptom of several diseases, and several processes often generate it. It is common for patients to report an acute or chronic cough as their primary symptom, which also often impacts their daily life significantly.
Suppose you are faced with an acute cough. In that case, it is essential to define how and when the symptomatology started, as this allows the specialist to rule out a possible foreign body inhalation or an underlying infectious process.
In cases of chronic cough, patient study is essential, as investigating first the most common causes and then the rarer ones.
Among the most common causes of cough of pulmonary origin:
- Respiratory tract infections;
- Viral in nature, such as influenza and COVID-19
- Bacterial in nature
- Bronchial asthma;
- Chronic bronchitis, such as chronic obstructive pulmonary disease – CPD;
- Bronchiectasis.
Common causes not directly related to the lungs include:
- Disorders affecting the upper airways (nose and throat);
- Gastroesophageal reflux;
- Heart disease;
- Allergies;
- Drugs, such as some antihypertensives (ACE inhibitors).
The first approach is to rule out infectious or common diseases through appropriate tests.
As a second step, if the tests have yielded a negative result or the patient has not responded to treatment appropriately, rarer pathologies are investigated, such as interstitial lung diseases, accumulation pathologies, autoimmune diseases, lung anatomical changes, or neoplasms.
In even rarer situations, where the cough is not linked to organic or inflammatory changes of any kind, physicians can define the symptom as an idiopathic cough, that is, without a clear explanation or somatic.
What Are the Complications of Cough?
Cough can also cause physical and psychological complications – ranging from mild to severe – depending on the duration of the symptom. Many of these are associated with the increased pressure (abdominal, thoracic, and cranial) caused by coughing itself.
Mild complications can be:
- Pain (often localized in the chest muscles);
- Changes in mood and sleep (such as depression, fatigue, and insomnia);
- Headaches;
- Gastroesophageal reflux;
- Vomiting.
More severe complications include:
- Rib fractures;
- Pneumothorax;
- Syncope;
- Cardiac arrhythmias;
- Urinary incontinence;
- Abdominal wall hernias.
Cough: A Pulmonary Examination and Tests for Diagnosis
First, the patient and the specialist will have a thorough interview, during which the pulmonologist will collect all the data to recreate their physiological, pathological, and pharmacological history, which will then be supplemented with a clinical examination and chest X-ray to look for signs that can help the diagnosis.
The spirometry examination will provide the pulmonologist with a variety of information about the lungs’ health status and then allow for the direction of the diagnosis.
The interview will also define the times when the cough stimulus occurs most frequently – perhaps in the morning, after meals, or in the evening in bed – and the type of cough, whether dry, of the wheezing or irritative type.
The information obtained up to this point will allow the diagnostic process to be directed toward pulmonary or extrapulmonary causes.
When we talk about pulmonary causes, it is crucial to mention the second-level functional or radiological investigations such as global spirometry, alveolar-capillary diffusion CO (DLCO), i.e., a bronchodilator test to rule out possible bronchial asthma, or a chest CT scan to rule out the possible presence of pulmonary changes such as pulmonary fibrosis, neoplasms, or bacterial, mycobacterial, viral, or fungal infections.
Should all prove negative, other second- and third-level tests will be prescribed, such as bronchial provocation test, fibrobronchoscopy, polysomnography, and echocardiogram.
Where extrapulmonary causes are involved, an evaluation of the upper airway – to rule out conditions such as allergic rhinitis or chronic rhinosinusitis – and the gastroesophageal tract will be performed to rule out gastroesophageal reflux disease. Tests are appropriate to evaluate the cardiovascular system, especially if in the presence of signs of decompensation as well. If an allergy is suspected, an allergologic evaluation is carried out.
How to Soothe a Cough?
Cough treatment is closely related to identifying the causes and paying attention to the associated symptoms. The discomfort that often accompanies it can be reduced by taking mucolytics or sedatives in case of a dry, hacking cough.
It should be specified, however, that these medications treat the discomfort but do not resolve the cause of the cough, and often, the coughing urge remains.
Once the cause is identified, a personalized treatment can resolve the cough or reduce its impact on the patient’s quality of life.
