Ex­pert Voice:

What’s caus­ing that lin­ger­ing cough?

Expat Living (Singapore) - - Contents -

Got a per­sis­tent cough you just can’t seem to get rid of? It may be more than a rem­nant of that cold you fought off a few weeks ago. If the cough has lasted more than eight weeks or longer in adults, and four weeks in chil­dren, it’s con­sid­ered “chronic”.

What causes chronic cough?

Ac­cord­ing to res­pi­ra­tory physi­cian DR JIM TEO YEOW KWAN, there are a num­ber of causes, and the treat­ment op­tions vary ac­cord­ingly.


“A cough can linger long af­ter other symp­toms of pneu­mo­nia, flu, cold or other in­fec­tions of the up­per res­pi­ra­tory tract have gone away,” he says. “A com­mon but un­der-recognised cause of chronic cough in adults is per­tus­sis, also known as whoop­ing cough.”

If fever per­sists and pu­ru­lent phlegm per­sists for more than five days, it’s likely a bac­te­rial in­fec­tion that’s caus­ing your chronic cough, and an­tibi­otics may be pre­scribed.

Chronic bron­chi­tis

Chronic cough can also be a sign of chronic bron­chi­tis, a long-term res­pi­ra­tory tract in­fec­tion that most com­monly af­fects cur­rent or former smok­ers.

“This long-stand­ing in­flam­ma­tion of the ma­jor air­ways can cause a cough that brings up coloured spu­tum,” says Dr Jim Teo. “Chronic bron­chi­tis is usu­ally part of the spec­trum of smok­ing-re­lated lung dis­ease called chronic ob­struc­tive pul­monary dis­ease ( COPD), which in­cludes em­phy­sema as well. Chronic bron­chi­tis and em­phy­sema of­ten co­ex­ist in cur­rent or former smok­ers with COPD.”

Post­nasal drip

“When your nose or si­nuses pro­duce ex­tra mu­cus, it can drip down the back of your throat and trig­ger your cough re­flex. This con­di­tion is also called up­per air­way cough syn­drome (UACS).”

Luck­ily, an­ti­his­tamines and de­con­ges­tants are among the dif­fer­ent types of drugs that can be used to treat al­ler­gies and post­nasal drip.


“An asthma-re­lated cough may come and go with the sea­sons, ap­pear af­ter an up­per res­pi­ra­tory tract in­fec­tion or be­come worse when you’re ex­posed to cold or cer­tain chem­i­cals or fra­grances,” says Dr Jim Teo. “And, in one type of asthma, cough­ing is the main symp­tom.”

The most ef­fec­tive treatments for asthma-re­lated cough are in­haled asthma drugs, which re­duce in­flam­ma­tion and open up the air­ways.


“Gas­troe­sophageal re­flux dis­ease (GERD) is a com­mon con­di­tion where stom­ach acid flows back into the oe­soph­a­gus, cre­at­ing con­stant ir­ri­ta­tion that can lead to chronic cough­ing,” ex­plains Dr Jim Teo. “This cough­ing, in turn, wors­ens GERD, cre­at­ing a vi­cious cy­cle.” He adds that when life­style changes don’t take care of the acid re­flux, a pa­tient may be treated with acid block­ers, med­i­ca­tions that block acid pro­duc­tion.

Blood pres­sure drugs

Ac­cord­ing to Dr Jim Teo, an­giotensin­con­vert­ing en­zyme ( ACE) in­hibitors, which are com­monly pre­scribed for high blood pres­sure and heart fail­ure, are known to cause chronic cough in some peo­ple.

When to see a doc­tor

See your doc­tor if your cough has lasted for weeks, you’re cough­ing up blood or if your cough is as­so­ci­ated with fever, short­ness of breath and chest pain. It’s also im­por­tant to see a doc­tor if your cough is caus­ing you se­ri­ous prob­lems such as keep­ing you from sleep­ing or in­ter­fer­ing with your work or ev­ery­day ac­tiv­i­ties.

Cough sup­pres­sants may be pre­scribed, par­tic­u­larly if the rea­son for your cough can’t be de­ter­mined right away. How­ever, Dr Jim Teo says there’s no ev­i­dence that over-the-counter cough medicines are ef­fec­tive in treat­ing chronic cough.

The Res­pi­ra­tory Prac­tice has five lo­ca­tions: Gle­nea­gles Med­i­cal Cen­tre, Mount El­iz­a­beth Med­i­cal Cen­tre, Park­way East Med­i­cal Cen­tre (Joo Chiat), Far­rer Park Med­i­cal Cen­tre and Mount Alver­nia Med­i­cal Cen­tre D. res­pi­ra­to­ryprac­tice.com

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