As many as one in five of us have a persistent cough, which usually doesn't have a serious cause but can be exhausting - especially if it stops us sleeping. When I was a student learning to examine patients, my consultant always reminded me that to examine a patient's abdomen properly, you had to check them out 'from nipples to knees'. Likewise, a cough can be caused by irritation of the airways anywhere from your throat to the bottom of your lungs. Some are obvious, but you might be surprised at the culprits your GP will point the finger at.
Doctors describe a persistent, or 'chronic' cough as one lasting more than eight weeks. Three to eight weeks is 'sub-acute' and less than three weeks is 'acute'. The time your cough lasts is important because chronic coughs usually have different causes (and treatments) to others. Coughs lasting less than three weeks are usually caused by viruses, and self-help remedies from your pharmacist will help you through them. See your doctor if your cough persists for more than three weeks or you get other symptoms like shortness of breath, chest pain or coughing up blood. Likewise, if you have a long-term chest condition like asthma or COPD, you need to contact your doctor if the cough has made these symptoms worse.
Smoke gets in your eyes (and your lungs)
If you smoke or have smoked, chronic cough could be due to a chronic lung condition called COPD (sometimes called emphysema or chronic bronchitis). If you're over 35, have ever smoked and have chronic cough, bring up sputum regularly, get bronchitis in winter, get wheezy or out of breath, COPD may be to blame. It can be diagnosed easily by a test called spirometry, which involves blowing into a special machine. Asthma usually comes on in childhood but can start later in life. Both can be treated with inhalers, but stopping smoking is still essential. If you don't smoke but work in a smoky atmosphere or with chemicals or fumes, they can irritate your upper airways, causing persistent tickly cough.
What goes down must come up!
Colds, allergies and chronic sinusitis can cause a drip down the back of your throat which irritates your upper airways, especially when you lie down. Do you suffer from permanently blocked nose and a nasty taste in the back of your throat?
Treatments for sinusitis vary depending on how long you've had it, how severe your symptoms are and whether you have polyps in your sinuses. Allergies like hay fever and persistent rhinitis (constantly blocked nose caused by allergy to house dust, meaning symptoms are often worse in winter and when you're indoors) can be treated with nasal sprays and antihistamine tablets.
What comes up can cause a cough!
When I talk to my patients about 'reflux', they normally think of heartburn - that burning pain behind your breastbone that's worse when you lie flat. It can also give rise to an acid taste in your mouth, and this acid can irritate the throat. It's one of the most common causes of chronic cough. Solutions include anti-acid medicine, losing weight, avoiding eating late at night and not wearing tight belts or trousers. Propping the head of the bed up a bit (with a brick under the top legs) can also help.
The heart of the matter
If your heart isn't pumping blood round your system as efficiently as it should, it can lead to a 'logjam' of fluid which builds up in your lungs. This is called heart failure - although it's not strictly a 'failure' of the heart. Other pointers to heart failure include shortness of breath on exercise or lying flat; swollen ankles and waking up in the night gasping for breath. The outcome for heart failure patients has improved dramatically in recent years with the advent of new medical treatments.
Could your medicine be to blame?
A groups of drugs used very commonly to treat high blood pressure can cause dry, irritating cough in up to one in 10 men and one in five women. They're called the ACE inhibitors and have names ending in'-pril' (enalapril, lisinopril, etc). Symptoms can start when you've taken them without problem for months or even years. Speak to your GP if you think they may be to blame - there are alternatives that don't cause cough
Could it be cancer?
Of course everyone's worst fear when they get anything wrong with them is the Big C. However, do bear in mind that there are many causes of chronic cough which are much more likely than this. If you get chest pain, coughing up blood or bloodstained sputum, weight loss or tiredness along with your cough, do get it checked out.
With thanks to 'My Weekly' magazine where this article was originally published.