From postnasal drip to infection: Tips for a lingering cough

There are few things more annoying than a persistent cough, one that lasts for days or weeks and just won’t go away.

Of course, in “COVID times,” there’s the added feeling that you’re looked at as a pariah — even during allergy season.

Also, a cough that just won’t go away might make you worry about whether there’s something else wrong.

Here’s what we know about chronic coughing, what it means, and when you should be concerned and how to get relief…

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Coughing basics

Coughing is a complaint that leads to an estimated 30 million office visits every year.

The causes can vary, but typically coughing is most often attributed to respiratory infection or allergies. It is also how the body expels foreign matter like fumes or dust from the respiratory system.

There are three main types of cough:

• An acute cough is what you experience while you’re sick with a viral or bacterial infection.
• A sub-acute cough is one that lingers for three or more weeks following an upper respiratory illness
• A chronic cough is one that continues for longer than twelve weeks. Chronic coughing is usually caused by asthma and post-nasal drip, perhaps due to allergies

Postnasal drip is the most common cause of chronic or persistent coughs. When a virus, allergies, dust, chemicals or inflammation irriate the nasal membranes, they produce mucus that drips down the throat. That leads to irritation that makes you cough.

A post-infectious cough is a lingering cough following an upper respiratory infection. It may last for weeks or months, progressing into a chronic cough.

Causes of cough to rule out

Even though it’s a stomach condition, acid reflux, especially GERD, can be a surprising cause of a lingering cough.

Stomach acid is potent stuff. Without even having to back up into your throat, the fumes alone from stomach acid are strong enough to irritate your lungs.

Blood pressure drugs can cause a chronic dry cough, particularly ACE inhibitors. Your doctor may be able to change your medication if it is the reason for your cough.

Lung cancer can cause a chronic cough depending on the location of the tumors. Anyone who’s ever smoked should have this cause ruled out.

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Treatment choices: conventional and not so much

You’d think that the medical profession would have a long list of treatments that work like a charm. That, unfortunately, is not the case.

In 2006, the American College of Chest Physicians published guidelines to help doctors diagnose and treat coughs. This 17-year-old document still represents the best medicine has to offer.

Based on the limited data available from those guidelines, most doctors prescribe either inhalers, steroids, narcotics, or over-the-counter medications for persistent coughs that do not resolve on their own.

Results vary from person to person. And for children, studies have shown that over-the-counter cough suppressants and antihistamines are no more effective than a placebo.

So, what about all the natural cough “cures” you’ve heard about? You may be surprised that there’s some science behind their positive effects…

• Many people swear by honey to treat coughs. One trial showed that, over a three-day period, honey was more effective than a placebo at soothing a cough. Need more evidence? An Oxford University review analyzed data from 14 clinical trials and found that honey was 36 percent better than over-the-counter cough and sinus medicines at reducing coughing, and  44 percent better at reducing the severity of a cough.
• Not crazy for honey? Try sucking on a piece of chocolate.
• Try a steaming cup of ginger tea. Its anti-inflammatory compounds can relax membranes in the airways, which could reduce coughing.
• And we can’t forget the superfood enzyme that researchers have found thins mucus and phlegm to make a cough more productive so you can get that stuff out of your lungs.

The main reason these natural remedies work is that they soothe, coat and relieve inflammation in irritated airways where cough receptors are housed.

Many of these cough receptors are around the vocal cords, which is why you may cough more when you try to speak. But during healing, new cough receptors are regenerated. Many of the natural cough solutions work best if you can rest your airways, especially the vocal cords.

Sources:

Getting Rid of a Chronic Cough Is Tougher Than You Think — Science Alert

Over‐the‐counter (OTC) medications for acute cough in children and adults in community settings — Cochrane Library

That nagging cough — Harvard Medical School

Honey for acute cough in children — Cochrane Library