Persistent Cough: Causes, Symptoms, and Treatments

Q: Persistent Cough: Causes, Symptoms, and Treatments

Hello： Based on what has been described, it is more likely to be caused by a sensitive trachea or post-nasal drip. <br>However, since this is not an in-person consultation, please visit a pulmonologist for evaluation and treatment.

Coughing symptoms

Since January of this year, I have been experiencing recurrent colds due to taking care of children, resulting in two to three episodes of illness.
Although the colds have resolved, I have been suffering from a persistent cough.
Before the Lunar New Year, I took antibiotics prescribed by an otolaryngologist, which improved my condition.
However, in late February, I attended a relative's funeral during a cold and rainy spell, where I was exposed to a strong smell of smoke and burning paper, leading to difficulty breathing.
After that, my cough worsened, and I felt like my airways were tightly congested with phlegm.

In early March, I could no longer tolerate the cough and went to Tainan City Hospital's pulmonology department for a chest X-ray.
Dr.
Zhong Guomou stated that my lungs appeared clear with no abnormalities or signs of inflammation, concluding that it was likely an allergic cough or unresolved bronchitis.
Despite taking medication, I still cough, although not as severely as before.
I have visited the clinic several times, and the diagnosis has consistently been allergic cough, with prescriptions for cough suppressants, expectorants, and bronchodilators.
I feel that the frequency and intensity of my cough have improved, but I am not completely well.
Currently, my symptoms include an itchy sensation in my chest when exhaling, but I do not experience this when inhaling.
When I speak loudly, I am unsure if it is due to prolonged coughing or phlegm, but my voice feels slightly muffled and low.
Coughing forcefully sometimes helps clear a small amount of phlegm, and exhaling slowly provides some relief.
I feel phlegm in the oropharynx (the soft area below the throat) that is difficult to expel and tends to be swallowed.
When I do manage to cough it out, it is a fine, slightly sticky white phlegm.

When my chest or throat itches, I cough forcefully a few times, with intervals ranging from one to ten minutes.
It is not the kind of cough that causes continuous choking; rather, it is more about clearing phlegm from my chest and throat.
If I try not to cough, I can hold my breath and breathe slowly, which alleviates the urge to cough.
I do not smoke or drink alcohol, but I do experience post-nasal drip and mild gastroesophageal reflux.
Eating sweets tends to trigger more frequent coughing, which subsides after a while.

At night, I do not cough while asleep, and I also do not cough much upon waking; it primarily occurs during the day.
I do not cough when engaging in physical activity or breathing deeply.
Most of the coughing occurs while sitting or when my body is relatively still, leading to an itchy sensation in my chest.
In the past, I often had dry coughs to clear my throat, but this time the cough has lasted longer and is deeper.

After researching online, I have become increasingly alarmed (thinking it might be lung cancer), so I would like to consult a doctor about what this situation might be.
Thank you.

Mr. Zhang, 40~49 year old female. Ask Date: 2018/04/13

Dr. Zhou Ziguang reply Pulmonology

Hello: Based on what has been described, it is more likely to be caused by a sensitive trachea or post-nasal drip.
However, since this is not an in-person consultation, please visit a pulmonologist for evaluation and treatment.

Reply Date: 2018/04/13

More Info

Persistent cough can be a frustrating and concerning symptom, especially when it lingers after other respiratory infections have resolved. Based on your description, it seems that your cough has been exacerbated by a series of colds, exposure to irritants, and possibly underlying conditions such as allergies or gastroesophageal reflux disease (GERD). Let's break down the potential causes, symptoms, and treatment options for your situation.

Causes of Persistent Cough
1. Post-Infectious Cough: After a respiratory infection, it is common for a cough to persist for several weeks. This is often due to residual inflammation in the airways, which can take time to heal.

2. Allergic Rhinitis: Allergies can lead to post-nasal drip, where mucus drips down the back of the throat, triggering a cough. This could explain your symptoms of throat irritation and the feeling of mucus in your throat.

3. Asthma or Reactive Airways: Exposure to irritants like smoke or strong odors can trigger bronchospasm in sensitive individuals, leading to coughing and wheezing. Your description of feeling tightness in your chest and having difficulty breathing after exposure to smoke supports this possibility.

4. Gastroesophageal Reflux Disease (GERD): The sensation of mucus in your throat and increased coughing after eating certain foods (like sweets) could indicate that stomach acid is irritating your esophagus and throat, leading to a cough.

5. Chronic Bronchitis: If you have a history of smoking or exposure to pollutants, chronic bronchitis could be a consideration. This condition is characterized by a persistent cough with mucus production.

Symptoms to Monitor
- Cough Characteristics: The presence of thick, white, or bubbly phlegm suggests that your cough is productive. The fact that it worsens with certain foods or after exposure to irritants is also significant.

- Timing of Cough: Noticing that your cough is worse during the day and improves at night can indicate that it is related to environmental triggers or post-nasal drip rather than a more serious condition.

- Associated Symptoms: Pay attention to any additional symptoms such as shortness of breath, wheezing, or chest pain, as these can provide important clues to your healthcare provider.

Treatment Options
1. Medications: Since you have already been prescribed bronchodilators and cough suppressants, it may be beneficial to continue these as directed. If your symptoms are related to allergies, antihistamines or nasal corticosteroids may help reduce inflammation and mucus production.

2. Avoid Irritants: Try to minimize exposure to smoke, strong odors, and other environmental irritants. If you are in a situation where you cannot avoid these triggers, consider wearing a mask to reduce inhalation of irritants.

3. Manage GERD: If you suspect that GERD is contributing to your cough, lifestyle modifications such as avoiding trigger foods, eating smaller meals, and not lying down immediately after eating can be beneficial. Over-the-counter antacids or medications may also help.

4. Hydration and Humidification: Staying well-hydrated can thin mucus, making it easier to expel. Using a humidifier in your home can also help keep airways moist and reduce irritation.

5. Follow-Up Care: Since your cough has persisted despite treatment, it may be wise to follow up with a healthcare provider. They may recommend further testing, such as allergy testing or pulmonary function tests, to better understand your symptoms.

When to Seek Immediate Care
If you experience any of the following, seek medical attention promptly:
- Difficulty breathing or wheezing
- Chest pain that is severe or persistent
- Coughing up blood or large amounts of mucus
- Symptoms that worsen or do not improve with treatment
In conclusion, while persistent cough can be alarming, it is often manageable with the right approach. Understanding the underlying causes and working closely with your healthcare provider will be key to finding relief. Don't hesitate to reach out for further evaluation and support as needed.

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