Unexplained chronic cough

Unexplained chronic cough tends to be a dry cough (nonproductive). It doesn’t “produce” (remove) any mucus – unlike a productive cough, which brings up mucus from the lungs and, with it, any germs.

Other possible symptoms include:

• Frequent clearing of the throat
• Hoarseness
• The feeling that there is a lump or mucus in your throat
• Headaches

If you have unexplained chronic cough, it means health professionals have been unable to identify any physical causes like respiratory infections, asthma or GERD (gastroesophageal reflux disease). But that doesn’t mean the cough is just in your mind. Experts believe that the cause is an over-sensitive cough reflex, brought on by something like a previous respiratory infection. Then even minor irritants are enough to trigger the cough reflex. For example:

• talking for a long time,
• laughing,
• changes in temperature,
• dry air,
• crumbs of food, or
• smells.

You can also have a chronic cough even without any irritants. And a nonproductive, chronic cough can cause an urge to cough again.

The risk of unexplained chronic cough is high for people whose work requires them to talk or sing a lot.

Most people who have an unexplained chronic cough are over 45 years old. The condition often lasts several years.

It is twice as common in women as in men. Women tend to develop this type of cough after their last period when they enter menopause.

Persistent coughs and recurring coughing fits may cause the following problems:

• Headaches
• Vomiting
• Hoarseness
• Insomnia and tiredness
• Watery eyes
• Involuntary loss of urine and urinary incontinence

In addition, an unexplained chronic cough can takes its toll emotionally, interfere with social activities and impair quality of life.

In rare cases, coughing fits can cause temporary unconsciousness. This happens when the blood flow and oxygen supply to the brain briefly stops during a fit (cough syncope).

Your family doctor can usually do the first round of tests necessary for chronic coughs. Any additional examinations need to be done by a lung specialist (a pulmonologist) or an ENT (ears, nose and throat) specialist.

The diagnosis process consists of various parts:

• Questions about your medical history: The doctor begins by asking about your symptoms (what they are, how long you’ve had them and what triggers them), any illnesses or allergies you have and any medication you take. If you take ACE inhibitors (to reduce blood pressure), for example, they’ll tell you to stop taking them for a while to see whether the symptoms improve.
• Physical examinations: A careful examination of your heart and lungs to diagnose or rule out conditions like asthma or chronic obstructive pulmonary disease.
• Trial treatments to rule out other medical conditions: If, for instance, you have a cough and typical GERD symptoms like heartburn and acid reflux, you might be given proton pump inhibitors (PPIs) to see if they have any effect. If the symptoms improve during this PPI test, it’s very likely the cough is due to GERD.
• Other examinations: You might also have a CT scan or a bronchoscopy to check for rare illnesses.

If it’s still not clear what’s causing your chronic cough after all these examinations, it will be diagnosed as unexplained chronic cough. Experts recommend that people who have this condition should go for regular specialist check-ups.

Treatment aims to provide maximum relief for your symptoms and help you go about your daily life. It makes sense to avoid things that will trigger your cough (like smoke or cold air) and to make sure your airways don’t dry out.

If you have severe symptoms, non-drug treatments, medication or a combination of both can be an option. It may be a good idea to see a lung specialist, speech therapist, psychologist or physical therapist.

The treatments that don't involve the use of medication include speech therapy and physical therapy. Respiratory, language, speech or voice therapy can teach you how to

• change your coughing habits,
• decrease airway irritation,
• suppress or stop your coughing or constant throat-clearing.

Doctors can also prescribe medication containing gabapentin or a low-dose opioid containing morphine. But these products can only be used “off-label” because they’re not approved for treating unexplained chronic cough. They have a number of side effects and can cause dependency. You and your doctor will have to discuss the pros and cons and whether they’re are an option for you.

Other medications like codeine and noscapine have been approved for short-term treatment of dry coughs. But there hasn’t been enough research done yet on using them for chronic coughs.

Unexplained chronic cough can take its toll physically and emotionally. Some people avoid social contact and activities like going to the movies or concerts. They are worried about their coughing annoying other people and they don’t like the unwanted attention the coughing causes. Constantly having to explain why they’re coughing (because others around them are worried about catching something) can be stressful too.

Another aspect is that it’s often not possible to predict when coughing fits will start, how long they’ll last and how they can be stopped. Sometimes the cough just gets worse if you try to suppress it or if you keep thinking about it.

It is important to develop strategies to cope better with the symptoms in day-to-day life and not let them stop you doing things too much. Some people find the following useful:

• Keeping the airways moist by drinking enough water or herbal tea, or inhaling steam (from salted water)
• Stopping the urge to cough by chewing gum, sucking on candies or drinking water
• keeping busy with other things or just ignoring the cough,
• Avoiding potential triggers by doing things like covering their mouth in cold supermarkets
• Talking to other people with the same problem

A lot of people who have unexplained chronic cough get frustrated when all the examinations and test treatments don’t turn up any answers. But it can be helpful to realize that their cough isn’t just in their mind and to understand what might be triggering it.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.