Symptoms & Causes
Common Chronic Cough Symptoms
Persistent or chronic cough disrupts relationships, participation in social situations, professional performance, and recreational activities. In other words, constant cough disrupts life. Chronic cough symptoms may include:
Cough while talking
Tickle in the back of your throat
Cough with exercise
Cough with or after meals
Cough triggered by alcohol, chocolate, breath mints, fatty foods, or caffeine
Why do some people cough and others do not?
There are two types of cough reflex: a primitive/basic cough reflex that prevents us from choking on food and other foreign objects, and a chemosensory cough reflex that responds to infectious/viral, and other topical irritants. Patients with chronic cough are often “hard wired to cough” and have a hypersensitive (excessively sensitive) cough reflex pathway.
The chronic cougher tends to have an increased urge to cough. It can be described as a tickle in the back of the throat. Sometimes it can be a feeling that something is stuck there. Often, there is a feeling of post nasal drip, but rarely any is produced. Some of the triggers of your cough may be silent. A silent trigger is one where cough is the only symptom. In order to be effectively treated these silent triggers must be accurately diagnosed. A hypersensitive or heightened cough reflex requires less stimuli, such as nasal secretions, airborne irritants, acid or gastroesophageal reflux, to trigger a chronic cough.
Chronic Cough Causes
Chronic cough is the result of cough reflex hypersensitivity with triggers from associated conditions such as post nasal drip, acid reflux and asthma. The cough reflex has neurogenic, inflammatory, behavioral and anatomic triggers, and the key to quieting a hypersensitive cough reflex is identifying your unique cough profile and treating it accordingly.
Which illnesses or conditions trigger cough?
- One of the keys to effective treatment is accurately and completely diagnosing your unique cough trigger(s). A trigger is what sets-off your cough. Sometimes the trigger(s) is surprising or silent. Below are the most common chronic cough triggers.
- Upper respiratory viral infections (like the common cold) are potent triggers of cough. The cough reflex can be sensitized for weeks, even months, after a viral respiratory infection
- Post nasal drip may trigger a cough
- Nasal and sinus inflammation from a viral infection, allergies, or sinusitis can activate the cough reflex
- Acid reflux can directly trigger a cough. Acidic and non acidic food refluxing into the esophagus can activate/heighten the cough reflex
- Asthma may trigger a cough
- Lung inflammation, particularly eosinophilic/allergic, can sensitize the cough reflex
What are the steps leading-up to a cough?
- Cough receptors in the upper airway (nose), larynx (voice box), lung, and esophagus are activated by direct irritation such as throat infection, post nasal drip or gastric acid (which has contact with the receptors in the larynx/voice box)
- The receptors send a signal to the cough center in the lower brain area
- The cough center then decides if there is enough stimulus to set off a cough
- The cough center becomes hyperactive by repeated stimulation from the peripheral cough receptors
- The cough center is also influenced by higher brain function which can result in a voluntary and habit cough
- Stimulation of the upper airway, esophagus, and lung can heighten or sensitize the cough reflex without actually triggering off a cough. For example, acid or even food entering the esophagus from the stomach can send signals to the cough center to become more sensitive or irritable. Allergic nasal symptoms also send signals to the cough center and increase sensitivity.