Coughing is a normal natural reflex by our airways in an attempt to expel mucus, foreign body, irritants and germs. However coughing for an extended period of time can be troublesome and usually is due to a disorder which needs to be identified in order to resolve it.
A person is deemed to have prolonged or chronic coughing if that cough persists for longer than 3-4 weeks duration. The possible causes include: infection (pulmonary tuberculosis should be considered in certain population groups), hypersensitivity, environmental triggers, acid reflux, post nasal dripping, heart failure, autoimmune conditions or something more sinister like a tumor along the airways.
Therefore, it is important to consult an Internal Medicine (IM) Physician or a Respiratory Physician in order to properly assess and seek out the cause. The IM Physician will perform a detailed history taking to identify the nature and characteristics of the cough as well as potential triggers within and outside the patient’s body. The IM physician may also enquire about details of the patient’s home and work environment as well as personal habits e.g. cigarette/ vape smoking etc. A past medical history and a family history is also important as certain conditions like Bronchial Asthma can run in families or have onset earlier in life with frequent recurrences. The IM physician may also perform a comprehensive physical examination from head to toe to help identify the exact diagnosis. Simple bedside tests like a spirometry pre and post nebulization may also be done to determine if bronchial asthma/ hypersensitivity conditions are present.
Supporting tests like blood tests, chest X-rays and ECGs are often required to assist in narrowing down the possible diagnoses. Further detailed examinations like CT scan of the lungs may be required if outcomes from the initial workup are still unclear. In certain cases, referral to other units may be required for more advanced assessments e.g. referral to a respiratory physician for bronchoscopy to examine the airways from within, referral to a gastroenterologist for endoscopic examination of the stomach and esophagus, referral to a cardiologist for a ECHO scan of the heart and referral to a ENT surgeon for nasolaryngoscopy to assess the nose and upper throat areas.
Treatment of the prolonged cough will depend on the underlying cause. Certain conditions will resolve in a short period of time e.g. Acute Bronchitis or even Pneumonia; whereas certain conditions may take longer duration to control with effective treatment e.g. Bronchial Asthma or even Chronic Obstructive Pulmonary Airways Disease. Certain more serious conditions, like a lung tumor will need further specialist treatment from a cardiothoracic surgeon and/or oncologist. The key to successful treatment is always early detection and early diagnosis. Therefore it is always essential to visit your IM physician early once symptoms are not resolving with treatment from primary care clinics or from medications bought over the counter or if symptoms keep recurring despite already taken medications.
