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respiratory health

Persistent Cough by I.Randi

Generality

A persistent cough is defined as having a duration of more than three weeks.

Like any other type of cough, even the persistent cough is a defense mechanism implemented by the body in an attempt to protect the airways from foreign and / or irritating substances, from the attack of pathogens, etc. More precisely, it is a symptom that can be triggered by a wide variety of causes and that should never be underestimated, in particular when it assumes the character of a persistent cough - or worse, of chronic cough - as it could be an indication of pathologies more or less serious not yet diagnosed.

What is that

What is Persistent Cough?

Persistent cough is defined as such when it lasts more than three weeks. To be more precise, this particular symptom is considered persistent when it continues to manifest itself for between three and eight weeks.

When the duration is less than three weeks, one speaks of acute cough; on the contrary, when the symptom in question persists for more than eight weeks, it is called chronic cough. If not treated properly, the persistent cough can easily develop into a chronic form, significantly affecting the patient's quality of life.

Types of Cough

Types of Persistent Cough

A persistent cough can be substantially of two types:

  • Fat : also known as persistent productive cough, it is characterized by the presence of phlegm (sputum) whose characteristics can vary depending on the cause that triggered it.
  • Dried : it is a very annoying type of cough in which there is no production of phlegm, so there is no kind of expectoration.

Depending on the time of day in which the symptom occurs, it is also possible to distinguish:

  • Persistent daytime cough : it occurs mainly or exclusively during the day.
  • Persistent nocturnal cough : tends to occur almost exclusively during night rest.

The onset of one type of persistent cough rather than another substantially depends on the causes that give rise to the symptom. Naturally, in order to establish an appropriate therapy, it is absolutely necessary to identify which type of persistent cough affects the patient.

Causes

What are the causes of Persistent Cough?

As mentioned, the causes that lead to the appearance of a persistent cough can be multiple and have different origins and nature. Below, the most common and widespread ones will be listed.

  • Infectious diseases such as:
    • Influenza: disease typically caused by viral infections that can give rise to a self-limiting cough (tends to resolve within two weeks), or to a persistent cough, usually - but not exclusively - of a dry type;
    • Tuberculosis: is a disease caused by beating Mycobacterium tuberculosis ; it is characterized by the appearance of a persistent cough both diurnal and nocturnal associated with hemoptysis (emission of blood with cough).
    • Pneumonia and pleurisy: they are inflammatory diseases that affect the lungs and pleura and can be caused by various types of microorganisms. Generally they cause a persistent dry cough which, over time, evolves towards a fatty form with the production of phlegm.
    • Bronchiectasis: these are pathological conditions characterized by excessive dilation of the airways caused by the formation of mucus plugs, in turn, due to the presence of infections. They can cause persistent fat type cough.
  • Chronic Obstructive Pulmonary Disease (COPD): mainly caused by smoking, COPD is characterized by a chronic inflammatory state of the bronchial tree which is associated with the appearance of various symptoms, including a persistent fat type cough that tends to occur especially in the morning, after waking up.
  • Asthma : it is a chronic inflammatory disease that affects the bronchi. It causes a persistent and generally persistent cough, which tends to occur mainly during the night or when you wake up.
  • Cystic fibrosis : it is an autosomal recessive disease characterized by the obstruction of the respiratory tract by a thick and viscous mucus. Causes a persistent cough with sputum production.
  • Gastroesophageal reflux : gastroesophageal reflux consists of the rise of acidic fluids contained in the stomach towards the esophagus. The presence of this condition can lead to the appearance of a persistent nocturnal cough which tends to become chronic if the disorder is not treated (reflux cough). The symptom is triggered by the irritating action exerted by the gastric fluids during their ascent from the stomach.
  • Heart failure : this is a condition in which the heart cannot pump the right amount of blood needed by the body to perform normal physiological activities. It can cause several symptoms, including persistent cough.
  • Lung and airway tumors : are malignant diseases of a malignant nature that affect the respiratory system. They can cause a persistent cough that tends to become chronic and to vary its characteristics (intensity, presence of sputum, etc.) as the tumor grows and expands.
  • Continuous exposure to irritants, such as, for example, cigarette smoke or other substances present in particular workplaces (gas, aerosol, dust, etc.).

Associated symptoms

What Symptoms Can Occur in Association with Persistent Cough?

The symptomatology that accompanies the persistent cough varies depending on the cause that originated it. However, among the symptoms that most frequently may be associated with coughs lasting more than three weeks, we recall:

  • Fever (typical, but not exclusive, of infectious diseases);
  • Nasal congestion and rhinorrhea (these are symptoms that can occur both in the presence of flu illnesses and in the presence of allergies);
  • Muscular and osteoarticular pains (typical of the flu);
  • Sore throat (typical symptom of airway infections);
  • Hoarseness (can derive from the continuous tussigenous reflex that lasts for weeks);
  • Enlarged lymph nodes in the neck;
  • Swollen ankles and legs (typical symptom of heart failure);
  • Tachycardia and heart disease;
  • Involuntary weight loss;
  • Gastrointestinal symptoms, such as, for example, acidity and stomach pain (may be due to the presence of gastroesophageal reflux);
  • In the case of persistent cough with phlegm, the presence of blood - in traces or in large quantities - in the sputum (it is a rather severe symptom that can indicate various diseases, such as serious infections - tuberculosis - and lung or airway tumors) .

Of course, those listed above are just some of the many symptoms that can arise in association with or following the onset of a persistent cough. The symptoms can be much wider and may vary from patient to patient.

When to worry

When to worry and when to go to the doctor?

Generally speaking, in the presence of a persistent cough it is always necessary to consult a doctor to identify which disorder has caused it.

In fact, when the symptom persists for several weeks, it means that there is a basic cause not yet identified or inadequately treated that persists - or worse, becomes complicated - with the passage of time.

The moment you go to the doctor, in addition to providing information on the type of cough manifested, it is very important to report any other symptom present. Only in this way, in fact, the doctor will be able to make an accurate diagnosis.

Diagnosis

How do you make a persistent cough diagnosis?

The diagnosis of persistent cough is relatively simple, since this symptom is considered as such when its duration exceeds three weeks. The determination of the cause that gave rise to the cough in question may be more difficult. In this sense, it can be particularly useful to know:

  • What type of persistent cough affects the patient (fat or dry);
  • When the symptom manifests itself (persistent day or night cough);
  • If the symptom manifests itself when one is in a certain position (for example, lying position in the case of reflux cough) or when one performs a certain action or activity (for example, when one smokes, when one stands up, etc.);
  • What other symptoms appear in association with a persistent cough (for example, fever, sore throat, green or yellow catarrh, catarrh with blood, etc.);
  • In the presence of phlegm, color and consistency of the phlegm (for example, the dense, yellow-green catarrh is typical of infections, the frothy white catarrh is typical of COPD, and so on).

In addition to the collection of anamnestic data, the doctor can carry out more in-depth investigations to investigate the cause of the persistent cough using means such as blood tests, CT scans, MRI scans, electrocardiograms, gastroscopy or specialist visits (for example, gastroenterological examination, otorhinolaryngology visit, cardiological examination, etc.).

Obviously, the choice to carry out a certain type of analysis, diagnostic examination or specialist examination rather than another is up to the doctor alone and depends on the diagnostic suspicion formulated on the basis of the anamnesis and the medical examination carried out on the patient.

Care

Treatment and Treatment of Persistent Cough

Since persistent cough is a symptom to all intents and purposes, its complete resolution depends on the cure of the disease or disorder that caused it (for example, administration of asthma sufferers in the presence of asthma; administration of gastroprotectors and antacids in case of cough reflux, administration of antibiotics in the presence of bacterial infections, surgical therapy, radiation therapy and / or chemotherapy in the presence of tumors, etc.).

Once the triggering factor is eliminated, in fact, the persistent cough should disappear.

However, in some cases - in addition to the therapy aimed at eliminating the triggering cause - the doctor may decide to prescribe drugs for the symptomatic treatment of persistent cough, in order to give relief to the patient from this annoying and insistent symptom.

Clearly, the treatment varies according to the type of cough shown by the patient.

Dry Persistent Cough

To treat dry persistent cough, it is possible to use so - called antitussive or cough suppressants, if you prefer. These are active ingredients capable of "extinguishing" the tussogenic reflex directly at the central level where it originates (nervous center of cough). Among these, we recall:

  • Codeine (Paracodina®);
  • Dextromethorphan (Aricodil Tosse®).

Persistent Fat Cough

For the treatment of persistent fatty cough it is necessary to resort to drugs that are able to facilitate the expulsion of the phlegm. For this reason, in similar situations we resort to the use of active ingredients with an expectorant, mucolytic and mucoregulating action, among which we recall:

  • N-acetylcysteine ​​(FLuimucil®);
  • Bromexine (Bisolvon Linctus®);
  • Ambroxol (Mucosolvan®);
  • Guaifenesin (Sedative and Fluidifying Bronchenol®).

The phlegm that characterizes the persistent fat type cough must necessarily be expelled; in no case, therefore, can the use of sedative drugs be used as in the case of a persistent dry cough.

However, for more in-depth information on possible cough treatments, we recommend reading the dedicated article: Calm the Cough.

Please note

Although many of the aforementioned drugs are classified as prescription-free (SOP) or over-the-counter (OTC) drugs - therefore, like drugs that can be bought freely in pharmacies or parapharmacy - before using them, it is always good to ask your doctor for advice confidence. In fact, even if it is not necessary to present the medical prescription for dispensing such medicines, this does not mean that they are free of contraindications or side effects. Furthermore, their use is not always indicated and the possibility of resorting or not to symptomatic therapy depends on the cause that gave rise to the symptom (for example, in case of reflux cough, the symptomatic treatment is completely useless).

Finally, let us recall again that, in any case, the consultation of the doctor is always necessary in the presence of a persistent cough, since - as seen above - it could be a sign of different types of pathologies, some of which are also very serious.

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