Cough: what to do if it does not go away

By Cristiano Antonino On Dec 22, 2022

Coughing is a fairly common symptom; it can be caused by a cold, but also by more serious illnesses. For this reason, especially if it does not pass, it should not be underestimated and it is necessary to refer to a pulmonary specialist who will investigate the possible origin and manage it in the most appropriate manner

What causes a cough and what to do when it does not pass?

Coughing is a rapid and vigorous defence mechanism, a physiological reflex involving the entire respiratory system, modulated by the nervous system.

Coughing helps to manage bronchial secretions, remove any foreign bodies from the upper airways and keep them clean.

Following a physical stimulus, or a possible irritant, the respiratory muscles ‘contract’, generating a violent and rapid spasm.

This is a protective reflex, but in some situations it can be a symptom of an underlying, possibly more serious disease.

We define a chronic cough as one that lasts more than 8 weeks; if it lasts less than that, we speak of an acute cough.

If the cough persists over time, contacting a pulmonary specialist is essential, so that he or she can identify the causes for better therapeutic management and to reduce complications.

Cough: what are the causes?

It is not always easy to identify a direct cause of a cough, as it is a common nonspecific symptom of several diseases and there are often several processes involved in causing it.

It is common for patients to report an acute or chronic cough as their main symptom, which often also has a major impact on their daily life.

If we are dealing with an acute cough, it is essential to define how and when the symptomatology started, because this allows us to exclude a possible inhalation of a foreign body, or an underlying infectious process.

In cases of chronic cough, it is essential to study the patient, investigating first the most common causes and then the rarer ones.

Among the most common and numerous causes of cough, we indicate, among those with a pulmonary origin

respiratory tract infections
of a viral nature, such as influenza and COVID-19
of a bacterial nature
bronchial asthma
chronic bronchitis such as Chronic Obstructive Pulmonary Disease – COPD;
bronchiectasis.

Common causes not directly related to the lungs include:

disorders of the upper airways (nose and throat)
gastroesophageal reflux
heart disease;
problems of an allergic nature.

Coughing can also be a side effect of drug therapy, such as certain antihypertensives (ACE inhibitors).

When a patient presents with a cough, the first approach is to rule out infectious or common pathologies, through appropriate investigations.

In a second step, if these have given a negative result or the patient has not responded to treatment in the most appropriate manner, rarer pathologies are investigated, such as pulmonary interstitial diseases, accumulation diseases, autoimmune diseases, anatomical lung alterations or neoplasms.

In even rarer situations, where the cough is not explained by organic or inflammatory changes of any kind, the conclusion is idiopathic cough, i.e. without a clear explanation or somatic.

What are the complications of coughing?

A cough can also cause physical and psychological complications, ranging from mild to severe, depending on the duration of the symptom.

Many of these are associated with the increased pressure (abdominal, thoracic and cranial) caused by coughing itself.

Mild complications may be:

pain (often in the chest muscles);
changes in mood and sleep (such as depression, fatigue and insomnia);
headaches;
gastroesophageal reflux;
vomiting.

More serious complications include:

rib fractures;
pneumothorax;
syncope;
cardiac arrhythmias;
urinary incontinence;
abdominal wall hernias.

Cough: the pneumological examination and tests for diagnosis

First of all, the patient and the specialist will have an in-depth interview, during which the pulmonologist will collect the necessary data for a physiological, pathological and pharmacological anamnesis, which will then be supplemented with a clinical examination, and the performance of an X-ray (X-ray) of the chest, which aims to look for signs that can guide the diagnosis.

The spirometric examination will provide the pulmonologist with various pieces of information on the state of health of the lung and can then guide the diagnostic pathway.

The interview will also define the times when the cough stimulus manifests itself most frequently, perhaps in the morning, after meals or in the evening when one is in bed, and the type of cough, whether dry, of the wheezing or irritative type, or ‘fat’.

The information obtained up to this point will allow the diagnostic procedure to be directed towards pulmonary or extra-pulmonary causes.

When we talk about pulmonary causes, second-level functional or radiological investigations such as a global spirometry, alveolar-capillary CO (DLCO) diffusion, i.e. a bronchodilation test to rule out possible bronchial asthma, or a chest CT scan to rule out the possible presence of pulmonary alterations such as pulmonary fibrosis, neoplasms or bacterial, mycobacterial, viral or fungal infections.

If this proves negative, other second- and third-level examinations such as bronchial provocation test, fibrobronchoscopy, polysomnography and echocardiogram are carried out.

In the case of extra-pulmonary causes, an evaluation of the upper airways (to exclude pathologies such as allergic rhinitis or chronic rhinosinusitis) and the gastro-oesophageal tract is performed to rule out gastro-oesophageal reflux disease.

The cardiovascular system should also be assessed, especially if there are also signs of decompensation. If an allergy is suspected, an allergy assessment with allergometric tests is indicated.

How to soothe a cough?

The remedy of a cough is closely linked to identifying what causes it.

The discomfort that often accompanies it can be reduced by taking mucolytics if it is a fat, productive cough, or sedatives in the case of a dry, hacking cough.

It should be noted, however, that these drugs treat the discomfort, but do not resolve the cause of the cough, and often the coughing urge remains.

Once the cause has been identified, a customised medical therapy can be performed that can resolve the cough or at least reduce its impact on quality of life.

Acute Bronchitis: What Are The Symptoms, How Long Does The Cough Last And How To Treat It

Bronchiolitis: Symptoms, Diagnosis, Treatment

Chest Pain In Children: How To Assess It, What Causes It

Bronchoscopy: Ambu Set New Standards For Single-Use Endoscope

Child Health: An Interview With Beatrice Grassi, Creator Of Medichild

Oesophagitis: Symptoms, Diagnosis And Treatment

Asthma, The Disease That Takes Your Breath Away

Pertussis: How To Recognise Whooping Cough And Identify The Best Treatment