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Chronic Cough and Sorethroat

Chronic cough and sore throat are defined as symptoms lasting more than 3months. When persistent, it can affect a patient’s quality of life and quality of sleep. Cough and sore throat are symptoms and can arise from different causes and is the reason for many visits to the doctor.

Causes of Chronic Couch and Sore throat

Nasal allergy is a common cause of chronic cough and sore throat.
Postnasal discharge from the nose into the throat results in irritation and inflammation. There are two kinds of allergens; inhalants and food. Typically, food allergens are responsible for phlegm production and throat irritation causing cough and sore throat.

Treatment -Control of symptoms with nasal steroid sprays, oral antihistamines is safe, cheap and effective. Sublingual immunotherapy (SLIT) provides a long-term solution for allergy control. This involves desensitizing the patient to a specific allergen. Food allergens can be identified through skin tests and offending foods eliminated from the diet.

Chronic Sinus Infection
Sinusitis can result in the pooling of mucus in the nasal cavity and tracking of discharge into the throat causing irritation, inflammation, and itch which causes cough and sore throat.Treatment – Chronic sinusitis is generally not responsive to standard courses of antibiotics although a prolonged course lasting 4 to 6 weeks sometimes works. Sinus surgery is generally recommended as definitive treatment.

Gastro-esophageal reflux disease (GERD)
Reflux of acidic stomach contents upwards to the throat frequently results in irritation. GERD is a very common cause of chronic cough and sore throat. This is frequently seen in the elderly. overweight and patients with hiatus hernia.

Treatment -Patients with long-standing GERD should have a gastroscopy if one has not been already done. Helicobacter infection, Barrett’s esophagus, gastric ulcers can be confirmed and treated if present. Avoidance of certain foods such as spices, nourish. Spirits (alcohol), stimulants (caffeine), sizzling (fried) may help.

Lung inflection/ Disease
Common lung infections such as mycoplasma pneumonia and tuberculosis which is endemic in Singapore) can cause a chronic cough. Lung infections generally produce phlegm which is sometimes blood-stained.

Treatment – an assessment by a Respiratory Physician is recommended and treatment is dependent on the organism involved.

Asthma is a disease of airways, resulting in difficulty breathing or wheezing often characterized by abnormal breathing tests. Soma asthma sufferers have chronic cough as their only symptom. They may even have normal lung function tests. This is often referred to as cough-variant asthma. Asthma symptoms can be aggravated by cold air, exposure to air pollutants or pollen, smoke. or perfumes.

Treatment – effective treatments with steroids and bronchodilators are available.

Many smokers have a ‘smoker’s cough’. This is thought to be due to irritants in the smoke that results in an inflammatory reaction. Smoke also damages cilia which clear phlegm and dirt within the trachea and lung. Lid up of phlegm also incites cough.

Recurrent Tonsillitis/Adenoiditis
Tonsils and adenoids are rudimentary lymphoid aggregations found at the back of the nose and throat. When diseased, they can cause recurrent episodes of sore throat and sometimes cough. Unlike the other causes of chronic cough and sore throat recurrent tonsillitis and adenoiditis is associated with fever. lethargy and loss of time from school and work.

Treatment– each episode is treated with a course of antibiotics. However, if the episodes are recurrent and frequent. surgery to remove the tonsils and adenoids offers a long-term solution.

The list of drugs and medications because the cough is a long one. ACE inhibitors used in treatment for hypertension is a notable example. Patients should always check with their doctors or pharmacists if they are not sure.

Treatment – removing the offending medication should resolve the problem.

Others -Postinflammatory/ Habitual Cough
In some instances. especially after a bout of infection. The throat is ‘sensitized’ and itchy and patients continue to cough even though the infection or offending cause has resolved. This post­inflammatory cough or habitual cough can be quite debilitating. Interestingly, the cough subsides during sleep, only to start again when the patient awakes.

Treatment – Medications used to reduce throat itch, inflammation and allergy can be useful.

Chronic cough and sore throat are common problems that bring patients to their doctors. It can be debilitating and affects work and school. Worse, it can affect sleep and lead to depression and stress. However, treatment is available and effective.

A word of caution – cough mixtures is are potentially addictive, especially when they contain codeine. These medications must be used sparingly. Treatment should always be aimed at the root cause of the cough and sore throat.