By definition Chronic Cough is cough which persists beyond the effects of an illness for more than 8 weeks which is not related to the intake of any medicine (like ACE Inhibitors given for Hypertension), smoking, or pulmonary disease.
Cough is one of the commonest symptoms for patients to present to a Hospital or Clinic. in some Centres it is the Most Common presenting symptom in primary care.
WHAT CAUSES COUGH ?
Cough is a protective reflex of the human body which helps to propel mucus, infected material or sometimes the rare foreign body out from the throat and lungs.
It can be voluntary – under our control, or involuntary–which is sudden spontaneous cough.
Cough is an impulse that is conserved across evolutionary development (Canning 2008).
It has traditionally been understood that Chronic Cough in adults could be due to the following:
- Asthma - cough variant asthma
- Post nasal drip
Cough is often accompanied by other symptoms including throat irritation, tickle or itch, voice change, and laryngospasm.
However, current research seems to suggest that in patients of chronic cough seen in Otolaryngology Clinics, Neurogenic Factors could have a significant impact - and these work by lowering the Cough Threshold. That has a significant impact on our understanding of this disorder. Other terms have been coined for this cough, the most common being Irritable Larynx Syndrome (ILS), upper airways cough hypersensitivity syndrome, and reflux cough (Athanasiadis and Allen, 2013).
Once a cough cycle is established, such as in Chronic Cough, the approach to management differs from acute illness treatment. The Cough is likely driven by multiple factors impacting on neural pathways resulting in hypersensitivity and dystussia (Jacqui Allen - Symptom Oriented Otolaryngology Head and Neck Surgery).
Irritable Larynx Syndrome (ILS)
The typical patient describes a dry tickly nonproductive cough often associated with a sensation of itch in the throat (Jacqui Allen). The cough may worsen on lying down, positional change, excessive talking , eating certain foods. It can be severe enough to lead to retching.
Women are more often affected
The treatment of this vexatious condition depends upon the contributory factors and a thorough examination, including laryngeal evaluation by a Flexible Laryngoscope is essential to come to a diagnosis.