Struggling with Chronic Cough? This Might Be Why.

Updated July 2020

[This article was written with Dr. Mia Finkelston and Dr. Pardeep Shori, Medical Directors and family physicians on Amwell]

Most people have had an annoying cough at some point in their lives. Coughs can come in many forms – dry, whooping, or phlegmy – but on a broader scale, coughs can be categorized into two types: acute and chronic. An acute cough typically lasts for a couple of weeks, while chronic cough is defined as a cough that persists after eight weeks. Chronic cough is estimated to occur in up to 40% of the population, reported by Medscape.

Recent studies have shown that there are three conditions that directly influence the length and severity of a cough and which account for the cause of chronic cough in 92 to 100% of nonsmoking patients with normal chest X-rays:

• Postnasal drip syndrome (PNDS) also referred to as upper airway cough syndrome (UACS)
• Asthma
• Gastroesophageal reflux disease (GERD)

If one of these conditions is not properly managed, the other two conditions will worsen, ultimately making your cough more severe. To successfully treat one’s chronic cough, all three conditions – the coughing triad – should be considered in diagnosis and treatment.*

Postnasal Drip Syndrome (PNDS)

When a cough is present, this syndrome should be one of the first conditions considered. The sensation of post-nasal drip is trickling, phlegmy wetness cascading down the back of your throat that persists even after you think you’ve coughed away the buildup. PNDS can keep you from falling asleep at night, which is why it’s a dreaded condition for any light sleeper. PNDS is the most common cause of chronic cough in nonsmoking adults who have a normal chest X-ray. You might have PNDS if a cough is present with a constant need to clear the throat, a tickle in the throat, nasal congestion, or history of recent upper respiratory illness. 

Asthma

Asthma is best understood as a chronic inflammatory disease of the airway. Because asthma affects a person’s airway in such a drastic way, it is likely you could be wheezing, which makes a whistling or squeaky sound. When lying down, it may feel as though something is sitting on your chest. Asthma causes chest tightness and shortness of breath, which can result in pressure build-up. Not all people who have asthma have these symptoms and likewise, having these symptoms does not always mean one has asthma. The best way to diagnose asthma is with a lung function test, a medical history and a physical exam.

Gastroesophageal Reflux Disease (GERD)

The main causes of chronic cough in patients with GERD are most likely due to aspiration and irritation. Patients with GERD commonly have a sour or bitter taste in their mouth, which is very likely from a reflux mechanism consisting of your stomach contents. For those that have experienced heartburn before, we know it’s never pleasant and unfortunately, it is a common symptom of GERD. If heartburn, regurgitation, and a cough are present, it can suggest GERD-induced chronic cough. Treatment of GERD-induced chronic cough can be a combination of things, but eating a high-protein, low-fat diet is a great place to start.

If you are struggling with chronic cough, there is hope – treatment of the coughing triad. The physician who focuses on diagnosing and treating all three conditions can be very successful at treating chronic cough. So let’s say good-bye to that irritating cough – log on to Amwell today, get a treatment plan personalized for you and get rid of that pesky thing. We’re here to help you get back to living your best life.

*Nonasthmatic Eosinophilic Bronchitis (NAEB) is another condition that can come into play with chronic cough and is very similar to classical asthma. According to recent studies, NAEB has been reported in about 10% to 30% of chronic cough cases. Although less common, when treating the coughing triad, NAEB could be a present condition and should be considered during diagnosis.