My husband refuses to get his chronic cough checked
QMy husband has had a cough for about six months now. He also clears his throat a lot. He is 50 and has recently started smoking again after being off them for five years. I really want him to go and get his cough checked out but he refuses, saying it will clear up when he gives up smoking again, which he intends to do soon. What do you think? A There are a number of things that come to mind here. Your husband is a smoker and so he is at risk of certain smoking-related conditions that can cause cough. Chronic bronchitis is a daily productive cough typically worse in the mornings after waking up that is principally caused by smoking. You may have heard of the term COPD, which stands for chronic obstructive pulmonary disease, and chronic bronchitis along with emphysema comes under the umbrella of COPD. Typically, it takes many years of smoking to develop chronic bronchitis.
A test that I would recommend for your husband is a chest X-ray (CXR). While there are more sensitive tests to help determine what is going on in the chest, a CXR remains a good initial screening tool.
If your husband has COPD there are certain features that can be seen on CXR to help make the diagnosis. More importantly, we can identify other more obvious abnormalities such as pneumonia or a lung tumour.
Lung cancer is the diagnosis that every smoker dreads. It can often be silent with little or no symptoms early on which means that by the time people present their symptoms the cancer is often advanced. Cough is one of those symptoms that can occur and the reason why I suggest he attends his GP who can arrange a CXR.
It’s not all doom and gloom, though. There are a number of causes of chronic cough (a cough lasting more than eight weeks) that are not so sinister. If the CXR is normal, we will often consider a diagnosis of asthma but typically we expect to see additional symptoms such as wheeze, chest tightness and breathlessness, often with typical triggers such as animal dander, house dust mite or pollen. Two other very common causes are sinus inflammation with a postnasal drip, also termed upper airway cough syndrome. This is very common and can lead to the throat clearing that you alluded to. The initial treatment is a simple steroid nasal spray. The other cause is gastro oesophageal reflux disease which can lead to irritation at the back of the throat. This can be helped with simple measures to reduce reflux such as reducing spicy foods, caffeine and alcohol. Lastly, has your husband perhaps been commenced on blood pressure medication recently?
ACE inhibitor medications used to treat high blood pressure can cause a dry barking cough in a small number of people. I would strongly recommend your husband quit smoking and there is no time like the present.
If you have any queries, email askthedoctor@ independent.ie. Dr Jennifer Grant is a GP with Beacon HealthCheck