Chronic cough

Story

Connected to · 3

regulates · 3

Hypertension
The enzyme that ACE inhibitor blood pressure drugs block also normally breaks down bradykinin and substance P; when these build up in the airway they turn the cough reflex up, and about 15% of people on these drugs develop a dry cough, sometimes months after starting. Stopping the drug is the only reliably effective fix, usually easing within 1 to 4 weeks; angiotensin receptor blockers do not affect the cough reflex.
Smoking
Smoking is the major removable cause of chronic cough. Nicotine in smoke suppresses the cough reflex, so in the first month after quitting the cough may temporarily get worse; the guideline tells doctors to warn patients in advance that this does not mean quitting went wrong.
GERD
Refluxed stomach contents (not only acid but also gas and non-acid fluid) may irritate vagal nerve endings in the throat and airway and turn the cough reflex up, and an esophagus that moves poorly is common in chronic cough. But this route is often overrated: in a multicenter survey in China, reflux-related cough made up only 4.6%, and without acid reflux, acid-suppressing drugs do no better than placebo.

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Stop 1/7

Why a cough won't stop

THE SHORT ANSWER

Cough is a protective reflex that can be turned up. In adults it is chronic only after 8 weeks; then the question is what turned the reflex up.

WHAT IT MEANS FOR YOU

Coughing up blood or labored breathing: see a doctor soon. A lot of blood, no breath or chest pain: go to the emergency department now.

EVIDENCEGUIDE 2 · COHORT 1

READ THE ORIGINAL

Coughing is a protective reflex. Endings of the vagus nerve sit in the lining of the throat and windpipe; when something irritates them, they signal the brainstem, which orders a forceful breath out that blasts out foreign material and mucus. The reflex is there to protect you: people with a weak cough reflex are the ones who keep inhaling things into their lungs.

The trouble is that it can be turned up. By duration, a cough under 3 weeks is acute and usually a cold; 3 to 8 weeks is often the tail end of a cold; only beyond 8 weeks in adults (4 weeks in children) is it called chronic cough. In most people with chronic cough, a little cold air, perfume or smoke sets off a bout. It is not that something stays in the airway; the alarm threshold has dropped.

So when a cough has gone on for a long time, the question is what turned the reflex up, not how to keep pushing the cough down.

Coughing up blood or labored breathing: see a doctor soon. If you cough up a lot of blood, can't get your breath or have chest pain, go to the emergency department now.

Educational content, not medical advice — consult a clinician.

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Chronic cough

Story

Connected to · 3

regulates · 3

Hypertension
The enzyme that ACE inhibitor blood pressure drugs block also normally breaks down bradykinin and substance P; when these build up in the airway they turn the cough reflex up, and about 15% of people on these drugs develop a dry cough, sometimes months after starting. Stopping the drug is the only reliably effective fix, usually easing within 1 to 4 weeks; angiotensin receptor blockers do not affect the cough reflex.
Smoking
Smoking is the major removable cause of chronic cough. Nicotine in smoke suppresses the cough reflex, so in the first month after quitting the cough may temporarily get worse; the guideline tells doctors to warn patients in advance that this does not mean quitting went wrong.
GERD
Refluxed stomach contents (not only acid but also gas and non-acid fluid) may irritate vagal nerve endings in the throat and airway and turn the cough reflex up, and an esophagus that moves poorly is common in chronic cough. But this route is often overrated: in a multicenter survey in China, reflux-related cough made up only 4.6%, and without acid reflux, acid-suppressing drugs do no better than placebo.

Read full story

Stop 1/7

Why a cough won't stop

THE SHORT ANSWER

Cough is a protective reflex that can be turned up. In adults it is chronic only after 8 weeks; then the question is what turned the reflex up.

WHAT IT MEANS FOR YOU

Coughing up blood or labored breathing: see a doctor soon. A lot of blood, no breath or chest pain: go to the emergency department now.

EVIDENCEGUIDE 2 · COHORT 1

READ THE ORIGINAL

Coughing is a protective reflex. Endings of the vagus nerve sit in the lining of the throat and windpipe; when something irritates them, they signal the brainstem, which orders a forceful breath out that blasts out foreign material and mucus. The reflex is there to protect you: people with a weak cough reflex are the ones who keep inhaling things into their lungs.

The trouble is that it can be turned up. By duration, a cough under 3 weeks is acute and usually a cold; 3 to 8 weeks is often the tail end of a cold; only beyond 8 weeks in adults (4 weeks in children) is it called chronic cough. In most people with chronic cough, a little cold air, perfume or smoke sets off a bout. It is not that something stays in the airway; the alarm threshold has dropped.

So when a cough has gone on for a long time, the question is what turned the reflex up, not how to keep pushing the cough down.

Coughing up blood or labored breathing: see a doctor soon. If you cough up a lot of blood, can't get your breath or have chest pain, go to the emergency department now.

Educational content, not medical advice — consult a clinician.