Chronic Cough in Older Adults: Causes and Treatment Options

General Internal Medicine

Hello, Dr.
Tseng: I am a 60-year-old male with a long-standing cough issue.
I have seen both traditional Chinese medicine and Western medicine, but there has been little effect.
My cough is dry and very severe, especially before going to bed and often wakes me up in the middle of the night.
Traditional Chinese medicine suggests that it is due to excessive liver fire, and I have been taking loquat syrup for many years, which provides slight relief while taking it, but the cough returns after stopping.
Western medicine diagnosed it as bronchitis, but the medication only works for a short time.
I would like to ask the doctor what the problem might be and how it should be treated.
Thank you.

Yang, 60~69 year old female. Ask Date: 2002/09/17

Dr. Zeng Guosen reply Internal Medicine

Hello Mr.
Yang! After reviewing your complaints, your symptoms may resemble chronic cough.
Generally, a cough that persists for more than two months can be diagnosed as such.
In terms of differential diagnosis, there are several possibilities.
First, we need to consider whether you are taking any specific antihypertensive medications.
Secondly, we should assess if there is any post-nasal drip or gastroesophageal reflux.
If neither of these conditions is present, we may need to consider asthma or chronic bronchitis caused by long-term smoking.
Ultimately, we hope you will visit a pulmonology clinic for further examination and treatment.
Wishing you and your family peace and happiness.
This response is provided on behalf of Dr.
Li Shih-Wei, Chief of Pulmonology at Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2002/09/17

More Info

Chronic cough in older adults can be a complex issue, often resulting from a variety of underlying causes. Given your age and the history of persistent cough, it is essential to consider several potential factors that could contribute to your symptoms.
Firstly, chronic cough can be classified into two main categories: productive (with phlegm) and non-productive (dry). Since you mentioned that your cough is non-productive and particularly severe at night, this could suggest several possibilities. One common cause of chronic cough in older adults is post-nasal drip, where mucus from the nasal passages drips down the back of the throat, triggering a cough reflex. This condition can be exacerbated by allergies, sinus infections, or even gastroesophageal reflux disease (GERD), where stomach acid irritates the esophagus and throat, leading to coughing, especially when lying down.

Another potential cause could be asthma or chronic obstructive pulmonary disease (COPD), particularly if you have a history of respiratory issues. These conditions can cause inflammation and narrowing of the airways, leading to coughing, wheezing, and difficulty breathing. Given that you have seen both traditional Chinese medicine practitioners and Western doctors without significant improvement, it may be worthwhile to revisit the possibility of asthma or COPD, as these conditions can sometimes be overlooked, especially if the cough is not accompanied by typical symptoms like wheezing or shortness of breath.

Additionally, medications can also play a role in chronic cough. Certain medications, particularly ACE inhibitors used for hypertension, are known to cause a persistent dry cough in some individuals. If you are taking any medications, it would be prudent to discuss this with your healthcare provider to determine if they could be contributing to your symptoms.

In terms of treatment options, it is crucial to identify the underlying cause of your chronic cough. If post-nasal drip is suspected, antihistamines or nasal corticosteroids may help alleviate symptoms. For GERD, lifestyle modifications such as dietary changes, weight management, and medications to reduce stomach acid can be effective. If asthma or COPD is diagnosed, bronchodilators and inhaled corticosteroids may be prescribed to help manage symptoms.

Given your history of trying various treatments without success, it may be beneficial to undergo further diagnostic testing. This could include pulmonary function tests to assess lung function, a chest X-ray to rule out any structural issues, or even a referral to a specialist such as a pulmonologist for a more comprehensive evaluation.

Lastly, it is essential to maintain open communication with your healthcare provider about your symptoms and treatment responses. Chronic cough can significantly impact quality of life, and a tailored approach to treatment based on a thorough understanding of your medical history and current symptoms is vital for effective management. If you feel your concerns are not being adequately addressed, seeking a second opinion may also be a valuable step in finding relief from your chronic cough.

Similar Q&A

Persistent Coughing: Understanding Chronic Cough in Older Adults

Hello, my father is in his fifties and has been a teacher for over twenty years. Recently, he caught a cold and has been coughing continuously since then. He has seen both traditional Chinese medicine and Western medicine; the traditional doctor advised against consuming tonics, ...

Dr. Jiang Zhenyuan reply Pulmonology
A persistent cough definitely requires further evaluation by a specialist. I recommend starting with a pulmonologist. There are many potential causes for a chronic cough, including asthma, chronic obstructive pulmonary disease (COPD), lung infections (such as pneumonia and tuberc...

Persistent Cough in a 63-Year-Old: Possible Causes and Concerns

Hello, my father is 63 years old and has a history of hypertension and diabetes. Since he caught a cold last December, he has been coughing continuously with phlegm. Even after recovering from the cold, he still coughs, and it has gotten worse when lying down compared to sitting....

Dr. Qu Changke reply Pulmonology
Hello Magic: For the issue of persistent cough that does not improve, it is advisable to visit a pulmonology clinic for a thorough examination.

Struggling to Clear Phlegm: Managing Chronic Cough in Bronchiectasis

Hello Dr. Yang: My mother has bronchiectasis and a chronic cough. She is 58 years old and has recently reported that her symptoms have worsened. She feels that she has phlegm that she cannot seem to cough up, and her coughing has become more severe. She was previously taking trad...

Dr. Yang Wenda reply Pulmonology
Hello Ms. Yang: Chronic cough is an inevitable symptom of bronchiectasis, and significant improvement in a short period is difficult to achieve. Additionally, due to unstable weather conditions, the cough symptoms may worsen. It is recommended to return for a follow-up visit with...

Chronic Cough: Causes, Symptoms, and Treatment Options

Hello Doctor, I would like to ask you about my mother's persistent cough. I can hear her coughing during the day and especially at night when it becomes more severe (with phlegm, and sometimes she coughs continuously for a long time). This condition seems to have lasted for ...

Dr. Zhou Ziguang reply Pulmonology
Hello, there are many causes of chronic cough, such as bronchiectasis, tuberculosis, chronic bronchitis, psychogenic factors, and asthma, among others. I recommend that you visit a pulmonology department for further evaluation, including a chest X-ray. Thank you for your understa...