Why Am I Still Coughing?

By Linda Shiue

It's cold and flu season, and there is coughing all around.  Cough is a common symptom of colds and flu, as I described earlier this week, but how long is too long to keep coughing?

Most colds and flu last three to seven days, but it is normal for a cough to last for up to two weeks.  Sneezing and congestion may last this long, too.

The American College of Chest Physicians, the specialty organization of lung specialists, has issued guidelines that define three categories of cough based upon duration:

•                Acute cough, lasting less than three weeks

•                Subacute cough, lasting between three and eight weeks

•                Chronic cough, lasting more than eight weeks

So if you are still coughing after two weeks, what is the reason?

It may simply be postnasal drip, that sticky mucus which clings to the back of your throat and causes a dry tickle.  While the mucus is produced in your sinuses and nasal passages, you don't have to feel congested in order to have postnasal drip.  This can follow a cold or can be due to allergies.

Your cough could also be from pertussis, or whooping cough, which in adults usually causes a chronic cough rather than the characteristic "whoop" that can be heard in children.  Pertussis was thought to have been eradicated, but because of waning immunity and kids not getting vaccinated, it's back.  This can be treated with antibiotics.  You can lower your chances of getting this if you ask your doctor for the tetanus booster which is combined with pertussis vaccine.  It's safe to get this combination vaccine as soon as two years from your last tetanus booster.

It could also be asthma.  Specifically, what is known as cough-variant asthma.  While the biological mechanism is the same as in the asthma you may be more familiar with, with wheezing and shortness of breath, cough-variant asthma is exactly as it sounds- a chronic dry cough.

MANY MORE ADULTS HAVE ASTHMA THAN REALIZE IT!

•                Number of noninstitutionalized adults who currently have asthma: 16.4 million

•                Percent of noninstitutionalized adults who currently have asthma: 7.3%

HOW DO YOU FIND OUT IF YOU HAVE ASTHMA?

Your doctor will ask you several questions about your history and symptoms to help determine if asthma is a possibility.  An exam may be done which will include looking at your nasal passages, listening to your lungs and your heart.  You may be asked to do a test called a "peak flow" measurement in the office, which involves blowing into a hand-held instrument which measures the volume of air you can blow out of your longs.  Special tests may be ordered, possibly including spirometry (measurement of your lung function using a computerized machine) and a chest xray.  Depending on your risk factors, your doctor might also simply treat you with standard asthma medication to see if that helps you get better.

HOW IS ASTHMA TREATED?

Inhaled medications including bronchodilators such as albuterol, which are medications which open up your airways, and steroids to treat inflammation in your lungs may be used.  If asthma is the culprit, you may get improvement within a few weeks.

WHAT ELSE COULD IT BE?

Besides viruses, there are other infections: tuberculosis, bacterial pneumonia.

And also non-infectious causes: allergies, lung irritation from smoke or fumes, acid reflux, cancer.

RED FLAGS TO WATCH FOR

This guide is geared towards adults.  Please see your doctor if your cough lasts longer than two weeks and/or it is accompanied by these warning signs:

-bloody sputum

-fever more than 101.5 F

-chest pain

-shortness of breath or difficulty breathing

-wheezing

-fatigue or extreme tiredness

-loss of appetite

-unintentional weight loss