Understanding Chronic Cough: Causes, Symptoms & Diagnosis

Coughing can be a mere annoyance or a symptom of something more profound. But when a cough persists for more than 8 weeks, it’s time to explore the realm of chronic cough.

Chronic cough is a complex condition that poses challenges for healthcare professionals in accurately diagnosing and effectively managing patients.

As healthcare professionals, understanding the causes, symptoms, and diagnostic approaches associated with chronic cough is vital to provide optimal care and improve patient outcomes.

In this blog post, we will uncover the underlying causes, prevalence, and diagnostic approaches. From understanding its definition to the common triggers. You will gain valuable insights that will help you identify and manage chronic cough effectively, ultimately improving the well-being of your patients affected.

Table of Contents

What is Chronic Cough?

Cough is the most common presenting symptom in primary care in patients of all ages. In fact, prior reports have demonstrated up to 40% of primary care visits (depending on practice setting) can be attributed to cough presentation, workup and management.

A cause is ultimately identified in most patients presenting with undifferentiated chronic cough.

Finding the cause though needs a lot of work and attention to detail. Having a systematic evaluation to get to that diagnosis is really important.

In our free course, we will give you tools on how to do that.

Definition and Classification of Chronic Cough

According to a report published in the CHEST Journal, cough is arbitrarily classified by duration of symptoms:

  • Acute cough: less than 3 weeks
  • Sub-acute cough: 3-8 weeks
  • Chronic cough: more than 8 weeks.

Therefore, a chronic cough is a cough that lasts eight weeks or longer.

Chronic cough is more than just an annoyance. There is a prevalent myth in the medical community that chronic coughing is a minor issue which patients must learn to live with.

But that’s far from the truth.

A chronic cough can interrupt your sleep and leave you feeling exhausted. Severe cases of chronic cough can cause vomiting, lightheadedness, rib fractures Mayo Clinic, urinary incontinence, anxiety and depression.

Prevalence of Chronic Cough in Canada

Chronic cough is a prevalent condition affecting a significant portion of the population in Canada.

Dr. Imran Satia has studied Canadian data from patient surveys and found that:

“Chronic cough prevalence and incidence in the general population demonstrate that amongst individuals with chronic cough, 8.5% were current smokers at baseline, while amongst all current smokers, chronic cough had a prevalence of 34%.”

For that reason, it can be assumed that:

  • 16% of patients overall will have chronic cough.
  • It gets more common as you get older
  • It’s much more common if you are a smoker and even if you stop smoking it is more common than in non-smokers.
graphic: chronic cough in canada
Graphic by Imran Satia et al. ERJ Open Res 2021.

These statistics underline the need for a deeper understanding of chronic cough and highlight the importance of effective management strategies to ease the burden it poses on individuals and the healthcare system in Canada.

Common causes of Chronic Cough

Chronic cough is a complicated disease. It can have multiple underlying causes and can be a symptom of a variety of underlying conditions, making it difficult to diagnose and treat effectively.

The most common causes of chronic cough are:

  • Upper Airway Cough Syndrome
  • Asthma
  • Gastroesophageal reflux disease (GERD)

These play significant roles in the manifestation of this persistent condition.

Upper Airway Cough Syndrome, often associated with postnasal drip and nasal congestion, contributes to chronic cough through irritation and inflammation of the upper airway.

Asthma, a chronic respiratory condition, can trigger coughing episodes due to airway inflammation and hypersensitivity.

Gastroesophageal reflux disease (GERD), characterized by stomach acid reflux into the esophagus, can lead to chronic cough as acid irritates the sensitive lining of the throat.

Understanding these key contributors is crucial for healthcare professionals in formulating targeted diagnostic and treatment strategies for patients with chronic cough.

Other causes for chronic cough

There are other important causes of chronic cough that need to be investigated.

These include:

  • Non-asthmatic eosinophilic bronchitis
  • Post infectious causes- bacterial, viral, other
  • Medications
  • Airways disorders- chronic bronchitis, bronchiectasis, neoplasms and foreign boc
  • Parenchymal lung disorders- interstitial lung diseases, lung abscess, chronic infections, CHG
  • Aspiration due to glottic insufficiency
  • Zenker’s diverticulum
  • Neurogenic cough (post-viral vagal neuropathy)

Patient Story: a Doctor’s Approach to Chronic Cough

Because of the many possible underlying causes of chronic cough, it is sometimes confused with asthma, reflux or other lung conditions, often leading to patients being misdiagnosed.

Making the right diagnosis requires ruling out underlying causes and conditions and raising awareness among health care professionals.

Take Sara for example, a respiratory therapist who was working in the asthma field while suffering from undiagnosed chronic cough herself for years.

Read her case (or listen to our podcast) and learn about a doctor’s multidisciplinary approach to chronic cough.

Symptoms and complications of Chronic Cough

According to Mayo Clinic, a chronic cough can occur with other signs and symptoms, which may include:

  • A runny or stuffy nose
  • A feeling of liquid running down the back of your throat (postnasal drip)
  • Frequent throat clearing and sore throat
  • Hoarseness
  • Wheezing and shortness of breath
  • Heartburn or a sour taste in your mouth
  • In rare cases, coughing up blood

See your doctor if you have a cough that lingers for more than 8 weeks, and especially one that brings up sputum or blood, disturbs your sleep, or affects school or work.

The Chronic Cough Patient Journey (FREE course)

Understanding the causes, symptoms, and diagnostic approaches of chronic cough is essential for healthcare professionals. By recognizing the significance of this condition, we can provide better care and support for patients.

Interested in learning more about chronic cough? This content is part of our free CME for healthcare professionals: “The Chronic Cough Patient Journey”.

Gain access to the latest information regarding chronic cough and practical tips that can help you support your patients in their diagnosis and treatment journey.

You will also earn 2 hours of Continuing Education Credits by the CFPC and Royal College.

Learn more about Chronic Cough

Unravel the complexities of chronic cough in our blog section. Discover causes, treatments, and practical tips to manage this persistent condition.

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