Therapy with angiotensin-converting—enzyme ACE inhibitors. ACE inhibitors such as enalapril Vasotec, generic , lisinopril Prinivil, Zestril, generic , as well as many others, have assumed a prominent role in the treatment of high blood pressure and heart failure. ACE inhibitors are favored by many doctors because they produce good results and have few side effects, with one exception -- a persistent cough. The first symptom is often just a throat tickle, followed by a dry cough that can begin as soon as three weeks or as late as one year after the medication is started.
Once the cough starts, it lingers and lingers. If the cough is mild, patients may choose to continue their medication, or they may cough less if they change to a different ACE inhibitor. But the only way to eliminate a severe cough induced by an ACE inhibitor is to switch to another type of antihypertensive medication.
Fortunately, many are available, including angiotensin-receptor blockers ARBs like losartan Cozaar and valsartan Diovan — drugs that act like ACE inhibitors without causing a cough. Although a chronic cough is usually not serious, warning symptoms call for prompt medical care. The symptoms include:. In nonsmokers, the Big Five account for more than nine of every 10 chronic coughs. But other problems can — and do — cause lingering coughs. Lung infections make people cough. Most cases of pneumonia are acute infections requiring rapid diagnosis and treatment.
However, some lung infections can be more indolent and can cause a persistent cough. Fever is an important clue to infectious causes of persistent coughing. Pertussis whooping cough is a respiratory tract infection that can cause serious problems in children who have not been immunized properly with diphtheria-pertussis-tetanus DPT vaccine. Pertussis began to resurface in adolescents and adults because the original tetanus-diphtheria booster shots did not cover pertussis and the vaccine's effectiveness wears off over time.
Heart disease can masquerade as lung disease if coughing and breathlessness are its main symptoms. It's a common occurrence in patients with heart failure HF. Their cough is most pronounced when they're lying flat, so they often resort to sleeping propped up on pillows. The cough of HF may be dry, or it may produce thin, frothy white sputum. Leg swelling, fatigue, and exercise intolerance are other common symptoms of HF.
Abnormal swallowing can lead to persistent coughing if food triggers the cough reflex by heading down the "windpipe" instead of the "food pipe. Environmental irritants can trigger the cough reflex, not just once but with nearly every breath of air laden with chemicals or particles ranging from sulfur dioxide to nitric oxide to dust and molds.
Even clean air can trigger coughing if it is too dry or too cold. Lung cancer certainly belongs on the list of disorders that cause persistent coughing. Fortunately, though, it's not high on the list, at least in nonsmokers. Mental factors can produce many physical symptoms, including cough. Psychogenic coughing increases at times of stress and disappears during sleep. If you don't think that coughing is a common complaint, just head to the nearest drugstore.
You'll find a bewildering array of syrups, sprays, tablets, and lozenges designed to control coughing. You'll also see a steady stream of customers coughing up lots of money to purchase products that may be ineffective.
Many cough remedies contain expectorants, compounds intended to loosen sputum, making it easier to clear. Guaifenesin is the most popular expectorant. Unfortunately, there is little scientific evidence that expectorants are effective. You'll probably do just as well by using a humidifier and drinking lots of water.
Cough suppressants are also very popular. Nonprescription agents such as dextromethorphan can partially suppress the cough reflex, promoting patient comfort. Prescription cough syrups with codeine tend to be more effective. When used appropriately, cough suppressants can reduce discomfort; remember, though, that because coughing can serve a useful function, it should not always be suppressed. Medicated lozenges and cough drops are among the most widely sold cough remedies.
These products contain various combinations of menthol, camphor, eucalyptus oil, honey, and other ingredients. Like with liquid cough medicines, some also contain topical anesthetics. Despite their popularity, there is no evidence that medicated cough drops are more effective than simple hard candies.
Don't ignore a chronic cough — but don't panic just because your cough lingers for more than three or four weeks. Most often, the puzzle can be solved without elaborate tests, and the problem can be corrected with simple treatments. In fact, you may be able to diagnose and treat yourself, especially if postnasal drip or gastroesophageal reflux is the culprit. Even so, your doctor can also help.
In most cases, it won't take much more than a stethoscope and a treatment trial or two. But if your cough is accompanied by sputum production, bloody sputum, fever, weight loss, night sweats, breathlessness, undue fatigue, or chest pain, you should consult your doctor without delay. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
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A conversation about reducing the harms of social media. Cough in children. When to give kids medicine for coughs and colds. Food and Drug Administration. Kellerman RD, et al. In: Conn's Current Therapy Philadelphia, Pa. Broaddus VC, et al. Chronic cough. Rochester, Minn. Use caution when giving cough and cold products to kids.
Thompson DA. In: Adult telephone protocols. Itasca, Ill. Schmitt BD. In: Pediatric telephone protocols. Pappas DE. The common cold in children: Management and prevention.
Accessed May 20, Green JL, et al. Apparently, the coughing was vigorous enough to herniate her right lung by rupturing an intercostal muscle between two of her lower ribs. Although you are not going to cough up a lung, you can sustain other injuries from frequent and violent coughing , such as:. Sustained coughing can result in blood in your lungs which can be coughed up. It typically appears as small amounts of bright red blood or phlegm and saliva streaked with blood. Along with persistent coughing, this could also be the sign of a chest infection.
Strong pressure is generated every time you have a coughing fit. This pressure can strain muscles and cause pain. It follows that prolonged coughing can result in chronic pain. Fine blood vessels, such as those in your nose, eyes, and anus, can burst under the pressure of violent coughing. The tissues of your throat can become inflamed due to a chronic cough.
Sustained coughing can also lead to throat infections that can spread to other areas of your body. Although a rib fracture caused by chronic coughing is more likely in people with lower bone density, it can happen to people with normal bone density.
The ribs most likely to crack under the pressure of coughing are the fifth through ninth , and they are most likely to crack on the side. When you cough, your ribs are pushed downward and inward. At the same time, your diaphragm is pushed upward.
The combination of these opposing actions can result in a diaphragmatic rupture. Coughing can be traced to numerous causes.
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