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INTRODUCTION

This pageexplains some of the reasons why people develop a chronic cough and outlines what can be done to help you.

WHAT CAUSES CHRONIC COUGH?

Coughing is a natural defence mechanism that your body uses to protect your trachea, or windpipe. If something, such as a particle of food, should accidentally enter your trachea it would trigger a violent cough which would hopefully propel the particle back into the mouth, where it would not cause any harm.

In most people, the airway can tolerate a certain amount of irritation before a cough is triggered, otherwise we would all be coughing all the time, simply due to triggers like breathing and swallowing. In some people, however, the sensitivity of the airway is increased, so that they cough with only minor irritation which would not bother other people.

Things that can sensitize the airway include:

·        Acid reflux

·        Infection

·        Problems with the vocal cords

In acid reflux the contents of the stomach can come back up into the back of the throat. People with this often have other symptoms such as indigestion and heartburn. They may also taste a vomit-like taste in the mouth, particularly at night.

Probably the most common cause of chronic cough is a cold or flu-like illness. When this happens, most people would not be surprised if they developed a cough. It becomes a problem when it takes longer than a couple of weeks to stop. It is not known why some people have a cough that won’t go away, but it seems that some viral infections in particular cause this. In the vast majority of cases the cough eventually stops, but this can take many weeks or months.

Vocal cord problems only very rarely cause a cough. People with this sort of problem will probably have other symptoms such as a feeling of a lump in their throat, or hoarseness.

Not everybody with a chronic cough has a sensitized airway though. Some people who have developed asthma can have a chronic dry cough. Asthma is often associated with wheeziness and shortness of breath, but this is not always the case, and some patients only have the cough. In this situation the cough is often brought on by triggers such as exercise, cold air or a specific allergy, such as cat fur. A lot of patients with this problem find that it is worse in the early morning.

ARE ANY SPECIAL TESTS NECESSARY?

Your specialist will have examined you thoroughly, to look for signs of acid reflux or vocal cord problems. Occasionally a chest X-Ray or an X-Ray of your swallowing (barium swallow) will have been arranged. If there is a visible problem with your vocal cords, you may need a small sample (biopsy) taken from them.

In most cases, however, special tests are not necessary or helpful.

WHAT TREATMENT IS AVAILABLE FOR CHRONIC COUGH?

The treatment you are offered will depend on the cause of your cough, but may include one or more of the following.

- Nothing: if there is no serious cause and it is likely to settle by itself, your specialist may feel that no further treatment is necessary.
- Anti-acid drugs: if it is possible that your problem is due to acid reflux, then you will be offered anti-acid drugs. The most        

     commonly-used one today is omeprazole (Losec ®). You will also be advised to make some changes to your lifestyle.
- Asthma treatment: your specialist may recommend that you have a trial of medication used to treat asthma. This would normally be

     supervised by your own GP.

WHAT IS THE OUTLOOK FOR THE FUTURE?

Most patients with chronic cough find that it settles with time. If a specific cause is identified then the targeted treatment listed above will usually clear it up fairly quickly.