A chronic cough is a continuous cough that lasts longer than 4 weeks. If you have a chronic cough, it's important to see a specialist who can exclude serious underlying illnesses such as cancer, vocal fold paralysis or tuberculosis, and provide effective treatment.
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An acute cough is an extremely common symptom, which we have all experienced at some point. It often resolves on its own, and most people don’t feel the need to seek medical attention or treatment.
A chronic cough is a continuous cough that lasts longer than 4 weeks. This is a cause for concern and should be assessed by a specialist.
Worrying symptoms associated with a chronic cough include:
Most causes of a chronic cough will be benign and multifactorial in origin.
Exacerbating or causal factors include:
As part of gathering your medical history, you may be asked to fill out validated questionnaires related to voice and chronic cough. This will help the specialists at our ENT Clinic assess the severity of your symptoms and provide them with a baseline against which to compare improvement from therapeutic interventions.
An examination of the larynx via nasal endoscopy is very important to exclude growths on the vocal folds (VFs) that may be triggering the cough. It will also demonstrate stigmata of other conditions like laryngopharyngeal reflux. Examination of vocal fold motion whilst breathing may, in some case,s demonstrate dys-coordinated vocal fold opening with respiration (normally the vocal folds move apart when you breathe in or out) called paradoxical vocal fold motion. Other, more subtle motion defects can only be visualised after performing video stroboscopy, which we perform routinely when assessing the larynx.
You may also require allergy testing and certain specific blood tests depending on the potential cause(s).
A high-resolution CT scan of the neck and chest may be requested to aid diagnosis. Occasionally, this may demonstrate a narrowing in the airway just below the vocal folds, which may warrant further investigations and specific surgical management.
A CT scan of the paranasal sinuses will help diagnose chronic rhinosinusitis.
If there is concern about aspiration, then a video swallow assessment may be useful. This is a dynamic X-ray study which looks at how a swallowed radio-dense dye passes through and around the larynx and upper swallowing apparatus.
As conditions pertinent to gastroenterology and respiratory medicine may contribute to or indeed cause the cough, you may be referred to a gastroenterologist or respiratory physician for further investigations and management. These may include an ambulatory pH study, a gastric endoscopy, and lung function testing.
Reassuringly, a combination of good vocal hygiene strategies and targeted medical treatment will relieve a cough in up to 80% of patients.
Benign causes are many, but your clinician may suggest a combination of one or more of the following groups of medication: antibiotic, antifungal, topical and/ or systemic steroids, anti-allergy and anti-reflux medicines.
A small percentage of patients will have cough refractory to the above treatment with no obvious underlying cause despite exhaustive investigations. Often, innocuous triggers such as a cold atmosphere or talking for a long time may trigger bouts of coughing. There may be some tenderness on neck palpation, and this is usually due to compensatory tension in the muscles surrounding the larynx. Such patients have usually developed a hypersensitive larynx that is exacerbated and made ironically worse by repeated coughing.
Speech and language therapy is very useful and has a number of aims. Speech and language therapists (SLTs) are experts in teaching you strategies to obtain voluntary control of the cough and to try and respond in a manner other than coughing; they will also guide physiotherapeutic manoeuvres aimed at reducing the tension in the laryngeal muscles. These strategies will help break the cycle of hypersensitivity-cough-hypersensitivity-cough. Good hydration and lifestyle modification to improve vocal hygiene should counter the effects of ongoing irritants like gastro-oesophageal reflux.
There is also some evidence that certain neuromodulator medications can dampen down the sensitivity of the larynx and help improve a chronic cough, especially when used in conjunction with speech and language therapy.
At Welbeck, our respiratory specialists are experts in their field and are dedicated to providing world-class care to every patient.
With access to colleagues across other specialities, our consultants are also able to refer within the Welbeck ecosystem if needed to ensure you receive the best possible treatment as quickly as possible, all under one roof.
All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.
Your health is important to us, so we strive to offer same-day appointments whenever possible.
Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.
The following self-care tips may help you ease or reduce the symptoms of your chronic cough:
stay hydrated - Drinking plenty of fluids throughout the day can help thin mucus and soothe your throat
avoid irritants - Identifying and avoiding potential triggers like smoke, dust, caffeine, and aerosols can reduce coughing episodes
steam inhalation - Inhaling steam in a warm shower or from a bowl of hot water can help loosen mucus and soothe the airways
over-the-counter medications - Expectorants can help to thin, loosen and clear mucus from the airways, while cough suppressants may help reduce coughing
quit smoking - If you smoke, stopping is crucial to reducing your cough. However, your cough may get worse for a period while your lungs return to clearing mucous effectively.
A chronic cough can impact your quality of life. Depending on the severity of your cough, it can result in a number of physical and mental health symptoms, including:
A chronic cough can be a sign of an underlying lung condition such as asthma, acid reflux, smoking-related lung disease, and even lung cancer. You should seek input from your GP or a respiratory doctor should you have a cough lasting longer than 6 to 8 weeks, as there may be causes which can be treated. A chronic cough can’t always be prevented, but you can do things to reduce your risk, including:
stopping, or not starting, smoking
avoiding exposure to irritants like air pollution, dust, and strong chemicals
drinking 1.5 to 2 litres of fluid daily to help thin mucus, making it easier to clear from your airways
managing any underlying conditions such as asthma, allergies, nasal symptoms, and acid reflux
practising at-home self-care methods such as steam inhalation, sucking on cough drops and using humidifiers to keep airways moist
We recommend making an appointment with a Welbeck specialist if you have a cough and any of the following symptoms:
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Available consultations
Causes
smoking, allergies, infections
Tests
CT scan
Treatment
antibiotic, antifungal, topical and/ or systemic...
Why choose Welbeck?
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All our private ENT specialists at OneWelbeck in London are leaders in their sub-specialties, providing the highest quality treatment to ensure you receive the best available care. Click on the profiles below to see which of our consultants specialise in Chronic Cough.