Persistent Cough Clinic
Persistent Cough Clinic // February 25th, 2020
Coughs are a natural reflexive action of the body in an attempt to clear your airways of mucus or an external irritant. It is normal for everyone to cough from time to time. These minor obstructions to your airway can lead to short term coughing until your airways are cleared. Coughs can persist for longer if there is an underlying cause such as a cold or flu.
Some people however find that their cough becomes chronic, even at times continuing long after the initial cause of the cough has been removed or treated. There are many possible precipitants of a long term, chronic cough. These include but are not limited to certain medications, chronic health conditions such as asthma and lifestyle habits or environmental exposure such as smoking.
Our chronic and persistent cough clinic is built around this knowledge that many factors are involved in any one person’s cough. Led by expert respiratory consultants, the clinic provides a comprehensive assessment and diagnostic service.
Your Respiratory and Cough Assessment
Full investigation of your persistent cough starts with a focused chest examination and a review of your personal medical history. Understanding the progression of your cough and its character will allow your consultant to direct you to the most appropriate investigations and treatment.
Aside from listening to your chest and ordering a basic chest X ray, there are further tests such as CT scans and allergy testing that are offered based on the consultant’s initial findings.
What could be causing my cough?
The origins of each cough vary from person to person but below are listed some of the most common causes we find in our patients.
Smoking This is a major lung irritant so naturally a cough resulting from smoking will persist and get worse with time. Passive smoking is also a factor to consider. Those who continue to smoke at their current level are unlikely to find satisfactory resolution of their symptoms even with medication and other medical care.
Medication Blood pressure medication called Angiotensin-converting enzyme (ACE) inhibitors are widely known to produce a tickly cough in patients. Our consultants have years of experience with this and liaise closely with any existing care providers to prescribe an appropriate and equally effective alternative.
Lung disease Includes conditions such as that caused by smoking which is known as chronic obstructive pulmonary disease or COPD. In the past this was known as emphysema or chronic bronchitis. Note this cough is independent of the ‘irritant cough’ caused by the smoke itself. Asthma that is undiagnosed or insufficiently treated can also present as a cough.
Post nasal drip A source of irritation for many, a post nasal drip is a result of mucus from your nose hitting your throat when lying down. The real culprit here of course is the cause of the excess mucus – this could range from various allergies to nasal polyps or infections.
Acid Reflux Often missed as a diagnosis, acid reflux can be a cause of coughing even if there are no other symptoms such as regurgitation or heartburn. Acid or acidic gas from the stomach can burn the lining of the throat and the airways as it rises from the stomach contents.
Rarer causes include a blood clot on the lung known as a pulmonary embolus or other sources such as bronchiectasis (excess airway widening and mucus production) or lung cancer (most likely in smokers). These causes of chronic cough are much less common but are fully investigated by our team if there is any cause for concern.
What investigations are required?
After discussing your symptoms and performing an examination, your doctor will want to perform lung functions tests. A ‘blowing test’ called peak flow gives an initial impression of your lung fitness. Or a more advanced but similar test called spirometry can be booked. An X ray is usually ordered to provide a snapshot of your lung health but further imaging may be requested by your consultant.
When should I see a doctor?
Anyone with a cough lasting longer than 3-4 weeks should see a doctor, especially in the absence of any obvious underlying condition or chest infection. Presenting with any ‘red flag’ symptoms such as coughing up blood, night sweats or unintentional weight loss are signs for concern. Your consultant will want to have an urgent scan booked along with blood tests after your initial chest examination.
If you have minor but persistent symptoms it is still a good idea to come in for a consultation sooner rather than later. Many conditions are simpler and faster to both treat and manage when they are caught in the early stages, the same holds true for coughs and respiratory medicine in general.
What treatment can I expect?
Your consultant will work closely with you to provide the bespoke treatment plan which will most effectively treat your cough. As this article shows, the causes of coughs are many and as a result there are numerous treatment options available.
First and foremost, smokers need to at least reduce, if not stop, their smoking habit. If the cough is medical in nature you may be prescribed some antibiotic treatment, a steroid spray or an inhaler. Remember that most causes of chronic cough are more likely to affect smokers than non-smokers.
Generally, for those who stop smoking and adhere to their treatment regimen, the outlook for those with chronic cough is positive and can be cured with the proper care and time. Our consultants often look beyond standard medical interventions to offer cutting edge treatments of even the most persistent coughs. New medication alongside speech therapist training is giving new ways of tackling this common and troublesome condition.