Chronic Cough

There are many reasons why you or your child may have a cough that’s just not going away. Let’s explore some of the possible causes for a cough and see if you need to visit Dr. Sima Stein for an evaluation.

1. Postnasal Drip / Upper Airway Cough Syndrome (UACS)

Postnasal drip is when nasal secretions from the nose drip down to the back of the throat. The secretions contain enzymes and inflammatory cells that irritate the throat and cause a cough. This is usually caused by allergies, sinusitis, or the common cold. Some symptoms may be frequent throat clearing, runny or stuffy nose, or sneezing. Symptoms may be exacerbated when lying down as gravity naturally allows the secretions to drip towards
the back of the throat. Diagnosis can be confirmed by a doctor with a history and physical exam. Treatment involves use of antihistamines/decongestants and saline rinses.

2. Asthma (Cough-Variant or Typical)

Asthma is another condition that can cause chronic coughing. It is usually triggered by viral infections or known allergy triggers. Other risk factors include having a personal history of allergies or eczema. An asthmatic cough may sound dry or wheezy and it can be worse after exercise or at nighttime. Someone may feel a tightness in their chest or short of breath. Asthma is diagnosed by doing a special breathing test called a Spirometry to measure the lung function. When the diagnosis is unclear, there is another special test called the Methacholine
Challenge Test, where Methacholine is given to induce constriction. A bronchodilator is used during this test to reverse the effects of methacholine.
Treatment often involves inhaled corticosteroids or bronchodilators.

https://www.chrichmond.org/services/pulmonary-medicine/specialty-programs-and-clinics/you-can-control-asthma-now/what-is-asth
ma/

3. Seasonal Allergies

Allergies occur when your body’s immune system overreacts to a normally harmless substance, which is called an “allergen.” It often follows a seasonal pattern. For example, if you are allergic to a certain tree in the neighborhood, your allergies may be worse during spring and fall when there is excess pollen in the air. Some symptoms of allergies include sneezing, itchy eyes, tearing, clear nasal discharge, and even a cough (commonly caused by postnasal drip).
Diagnosis is often made by history - symptoms start when going outdoors and improve after removing the triggers. Diagnosis of specific allergens can also be confirmed with allergy testing. Treatment includes antihistamines (Zyrtec, Claritan, Allegra), nasal sprays, and of course, avoiding allergy triggers.

https://www.pedilung.com/pediatric-lung-diseases-disorders/post-nasal-drip-in-children/

4. Whooping Cough (Pertussis - Bordetella pertussis)

Whooping cough is caused by Bordetella pertussis, which is a highly contagious bacteria that spreads via respiratory droplets. This condition has three stages:
1. Catarrhal: seems like the common cold (runny nose, sneezing, low fever)
2. Paroxysmal: Angry coughing fits, followed by a “whoop” gasp of air (whoop is more common in children). Sometimes patients will have “post-tussive emesis” which is vomiting from coughing so hard.
3. Convalescent: Prolonged cough that lingers for on average 2 weeks, even after the illness fades. Diagnosis can be made with a nasopharyngeal swab culture or PCR, or by a blood test (antibody). Treatment involves antibiotics (Azithromycin, Clarithromycin, Erythromycin). Most importantly, this can be prevented with the DTap/Tdap vaccine! Consider protecting yourself and your baby and let your doctor know if you have any questions.
5. GERD (Gastroesophageal Reflux Disease) GERD, or gastroesophageal reflux disease, occurs when the lower esophageal sphincter (LES)
temporarily relaxes, allowing stomach contents to flow backwards and up the esophagus. The LES is like a valve or mini door that normally keeps stomach contents in. The backwards flow can cause stomach content and acid acid to rise up towards the esophagus and lead to coughing. GERD may be worse when lying down, cause chest pain or a sour taste in the mouth, or cause
vocal changes and chronic cough. Your baby may make coughing or “gurgling” noises, especially after eating. For babies, GERD symptoms can be improved with upright feedings and regular burping after each meal. The goal is to keep your baby upright for 15-30 minutes to allow all of the milk to reach the stomach. Most of the time, symptoms can improve without medications for infants.
If you think your infant is experiencing GERD, come to Dr. Stein’s office for an evaluation.