How should a persistent cough be managed?

There are many reasons why a persistent cough can occur, this can often be confusing when trying to determine what the cause is and it is why seeing a pulmonologist is often fundamental.

We recently spoke with Dr Bryan Sheinman who is a highly established Consultant Chest Physician. In this article, we discussed with him how a persistent cough should be managed and got the answers to some of your FAQs about this concerning symptom.
 

How long does a cough need to last to medically be considered 'persistent'?

By definition, 8 weeks. It’s slightly arbitrary but that’s the international agreement.
 

What conditions can a persistent cough indicate if it's dry?

In the absence of x-ray or CT scan findings, a persistent cough may indicate one of a number of hidden conditions such as, gastrointestinal reflux, asthma, upper airways diseases leading to post-nasal drip or eosinophilic bronchitis. Additionally, we are now learning rather more about hypersensitivity of the larynx.

However, some patients do not have any of these conditions and we now term this category Chronic Refractory Cough.
 

What may cough with sputum indicate?

Here we have a different spectrum of diseases, most of which do have associated pathological findings which can be determined relatively easily. However, these conditions are quite separate from the more puzzling situation where the cough is dry (see above).

When should you consult a doctor?

The current recommendations are, if it’s an acute cough that has lasted longer than three weeks, you should consider seeing a doctor and if it lasts for longer than eight weeks, your doctor should consider referring you to a chest specialist who has a special interest in persistent cough.

What is the treatment for a chronic cough?

The treatment depends entirely on the underlying cause, it may be quite simple if the cough relates to, for example, gastric reflux, or asthma but if the underlying cause is not detected by an appropriate qualified specialist, it is then labelled Chronic Refractory Cough.

In this situation, various forms of treatment have been found useful in many cases, including, speech and language therapy, neuromodulators such as gabapentin, pregabalin, amitriptyline and sometimes opioids such as morphine.

If you’re currently experiencing a chronic cough, or any of the conditions mentioned in this article, we recommend booking an appointment with a leading pulmonologist such as Dr Bryan Sheinman . Visit his Top Doctors profile today for information on appointment availability.