There is no cure for a cough

What to do if the cough doesn't stop


Heartburn or inflammation of the nasopharynx, as well as some medications, can cause a chronic throat irritation. This is pointed out by the German Society for Pneumology-Pneumology
Respiratory and pulmonary medicine (pulmonology) is a branch of internal medicine that deals with the prevention, detection and specialist treatment of diseases of the lungs, bronchi, mediastinum (middle skin) and pleura (pleura and lung).
and Respiratory Medicine (DGP) in an updated guideline for the diagnosis and treatment of cough in adults.

The cause of a chronic cough does not always lie in the lungs or in the upper respiratory tract. Heartburn or inflammation in the nasopharynx, but also some medications, can trigger the urge to cough. The German Society for Pneumology and Respiratory Medicine (DGP) points this out in an updated guideline on the diagnosis and treatment of acute and chronic cough in adults (see Pneumology 2019; 73 (3); Pp.140-177). In the new edition, the experts pay special attention to possible causes that remain undetected using standard diagnostics. The guideline is intended to be of assistance to pulmonologists investigating the unclear cases of chronic cough.

Acute cough is one of the most common reasons to see a doctor. It usually appears as a symptom of a cold or flu and improves on its own after two weeks. "If there are no serious symptoms such as coughing up blood, shortness of breath or high fever, no further examinations are usually necessary," explains Dr. med. Peter Kardos from the lung practice at the Maingau Clinic in Frankfurt am Main. In some cases, however, the cold cough can last for 3 to 8 weeks, in which case it is a so-called subacute cough, for example in the context of whooping cough.

DGP expert Kardos recommends various medications for normal, cold-related coughs. Pure expectorants only help in the first 2 to 3 days. Some herbal medications have been shown to relieve the duration and intensity of the dry cough that often ensues. Gargle solutions, lozenges, honey and cough drops work by “enveloping” the cough receptors in the throat and thereby protecting them from irritation for a short time. Above all, Kardos advises patience: “Coughing is a useful defense mechanism in our body that pushes everything out that does not belong in the airways. Once the infection underlying the cold has subsided, the cough will also go away. Since it is a viral infection, unfortunately no antibiotics help ”.

If the cough lasts eight weeks or longer, however, the cause should be clarified in further examinations, advises Kardos: "With the help of lung function tests and X-rays, serious diseases such as a tumor or chronic obstructive pulmonary disease (COPD) can be detected or ruled out." Sometimes The cause of the cough is a hypersensitive cough reflex. Then even weak stimuli will trigger a cough in those affected. This can happen when the upper airways become irritated, for example from inflammation of the nose and sinuses. "This should be determined and treated together with the ear, nose and throat specialist," explains Kardos, who was responsible for the DGP guideline.

Heartburn can also trigger a cough: Heartburn is very common, according to Dr. Kardos reports heartburn every second patient when his family doctor asks about it. The rising gastric juice can also cause a chronic cough, but only if the cough reflex is hypersensitive. While heartburn can be treated well with medication, the cough often persists. It is then difficult to treat. "New drugs that inhibit the sensitivity of the cough reflex over a longer period of time are being developed," says the pulmonologist. "However, the clinical tests have not yet been completed."

Source: German Society for Pneumology and Respiratory Medicine (DGP)