Treatment of unexplained chronic cough

Minimizing your symptoms and finding ways to cope with them better is important for your day-to-day wellbeing. Some things you can do are:

• Keep your airways moist: This helps stop you coughing and clearing your throat. Drinking herbal tea or water on a regular basis is one way of ensuring your airways don’t dry out. Another home remedy is inhaling steam from salted water.
• Sweets and chewing gum: Some people find it helpful to chew gum or suck sweets to stop the urge to cough.
• Keeping busy with other things: This can help stop the urge to cough too.
• Avoid triggers: Avoiding things that will trigger your cough (like smoke, cold air or talking for a long time) can also be useful.

Coughing can cause involuntary loss of urine – particularly in women. This can make people very anxious. So it’s a good idea to ask your doctor about ways to try to stop this problem.

Respiratory, language, speech or voice therapy can teach you various strategies and techniques for coping with your symptoms. They cover a range of exercises and components that can be combined to meet your personal needs. Examples include:

• Psychoeducation: The first step is to learn about the condition. The aim is to understand the cough is real and not just “in your head” even if you don’t know what’s causing it.
• Exercises to control breathing and the larynx: You will learn various techniques to identify and control the urge to cough as soon as it starts. You will also be taught special exercises for your breathing and your larynx. They can help you minimize larynx irritation and coordinate your breathing and speech better.
• Vocal hygiene: The therapist gives tips on vocal hygiene and information about things like the role of diet and breathing through your mouth or nose. They will also discuss the hazardous effects that smoking, consuming caffeine and drinking alcohol can have on the mucus membrane lining of the larynx.
• Other physical therapy techniques: These might include connective tissue massage, inhalation or heat therapy.

If your symptoms are severe, it could be worth trying these options. But bear in mind that they’re not offered by all speech or physical therapists. It is also best to check beforehand whether your health insurer will cover the costs.

But there have only been a few, small studies on these techniques so it’s not possible to tell how much they can help. Some of the findings indicate that voice or speech therapy can bring short-term relief for some people.

There aren’t any medications that are specifically approved for treating unexplained chronic cough. But there are a few that can be used if

• there’s no other way of relieving the cough,
• you specifically want to take medication, and
• you’ve carefully considered the pros and cons with your doctor.

Medications containing codeine or noscapine have been approved for treating dry coughs. But there hasn’t been enough research done yet on using them for chronic coughs. Codeine is a weak opioid and it can cause dependency. It can only be prescribed for short periods.

Doctors can also prescribe medication containing gabapentin or a low-dose opioid containing morphine. They block the cough reflex by stopping the signals being transmitted to the brain. But they don’t stop the cause of the chronic cough – and they have multiple side effects.

In Germany, neither of these products is approved for treating unexplained chronic cough. If they’re prescribed for this condition, it’s off-label use. While you’re on them, your doctor will check regularly to see whether the pros still outweigh the cons and whether it makes sense to continue the treatment.

Morphine is an opioid that’s typically used to treat severe pain.

The most common side effects include:

• Mood swings
• Constipation
• Tiredness
• Headaches
• Dizziness
• Vomiting

A serious, but rare, side effect is extremely slow breathing (asphyxia). Experts believe the risk of serious side effects is lower when morphine is used to treat a chronic cough than when it’s used for severe pain because the dosage is lower.

It is particularly important to stick to the dosage recommended by your doctor and to follow any other instructions because a morphine overdose can be fatal.

Morphine is a very strong opioid and it can cause dependency. Over time, it can become less effective.

Gabapentin belongs to a group of drugs that are normally used to treat epilepsy and long-lasting pain.

Common side effects include:

• Vision problems
• Dizziness
• Drowsiness / Sleepiness
• Disorientation
• Dry mouth

In rare cases, gabapentin can cause loss of consciousness, extremely slow and shallow breathing (hypoventilation) and severe allergic reactions.

Gabapentin can lead to dependency too but experts consider the risk lower than with opioids.

If morphine and gabapentin are used to treat a chronic cough, it is considered to be non-approved (“off-label”) use, for which special regulations apply. These drugs can have some serious side effects, which is why they’re only considered if other treatments haven’t brought any relief and the person is suffering badly. Another point to keep in mind is that the cough can come back as soon as you stop taking them.