Frequently Asked Questions

+ What is chronic cough?

Coughing is a normal and important reflex which prevents you from choking and allows you to clear your lungs or throat. Coughing can become a problem when it is persistent even when you are not ill or have not been exposed to an obvious irritant such as cigarette smoke. Cough that lasts greater than 8 weeks is referred to as chronic cough.

Having chronic cough can affect your quality of life and may lead to other conditions such as: incontinence, chest or rib pains, or feeling like you are going to feint. Some people might find that this makes them feel depressed, embarrassed, frustrated or socially isolated. Many people who have chronic cough find that they are very sensitive to perfumes, bleaches and cold air which cause the sensation of tickling/irritation in the throat and an urge to cough. This is because the nerves in the throat and upper airways have become supersensitive. Women have a greater sensitivity than men and two in three people who have chronic cough are women. The main age group affected are people in their fifties and sixties although it can occur at any time in life even in childhood.

+ Why do I have chronic cough?

Coughing is an important and normal reflex if you aspirate a solid, liquid or harmful vapours. Most people with a chronic cough have a very sensitive cough reflex such that they cough at very low levels of sensory stimuli or cough many more time than healthy people who do not have chronic cough. Once you start coughing, you might find it difficult to stop coughing.

Current research suggests that chronic cough is to due an alteration in the function of the vagus nerve responsible for sensing stimulus in the airways, nose and esophagus and the brain which processes these signals. So the problem could be a sensitivity of the vagus nerve and/or neurons in the brain which process the information coming up from the vagus nerve.

You may be told you have cough hypersensitivity syndrome. This is the umbrella term often used to describe this altered function of the vagus nerve and the brain.

There are conditions which might trigger this cough hypersensitivity and we may investigate if you have those conditions.

+ What investigations are available for my chronic cough?

These are some of the common tests that we might do to look for underlying triggers of cough.

• Spirometry
• Chest x-ray
• Blood test
• Methacholine Challenge
• Naso-endoscopy
• 24-h pH monitoring
• Barium swallow
• High-resolution oesophageal manometry

+ How can my physician and I manage my chronic cough?

At your first assessment your doctor should cover the following:

• A full medical history
• Physical examination
• Smoking history

These are conducted to make sure that there is no infection, no foreign body that has been breathed in and that you are not using any medication that may cause cough such as an ACE inhibitor.

They will also:

• Assess how your cough impacts you- this may be done with a questionnaire or by simply asking you to rate the severity of your cough out of 10.
• Test your breathing using a spirometry test (this may be different during the COVID-19 pandemic).
• Conduct a chest radiograph.

+ What medications are available for my chronic cough?

Chronic cough can be a difficult condition to treat. Even after thorough testing, we may not identify a trigger or cause. If we are able to detect any evidence of lung disease, nasal disease or reflux disease then we will try this treatment first. If there is no relief, then we may consider prescribing medications to suppress the cough with medication that inhibit areas in the brain which may have become more sensitive and making you cough. These medication include: pregabalin, gabapentin, tricyclics and opiates- such as low dose morphine. These are also often used as pain killers. We may also refer you for speech and language therapy.

+ How do I get referred to a cough clinic?

Referral must come from your physician to one of the cough clinics that have been listed. Refer to this page for more details.