How do we treat chronic cough?

 In a lot of people chronic coughing is related to conditions such as asthma, acid reflux and problems with the nose and sinuses. If these conditions are treated the chronic cough often settles down. 

 

  • Asthma is usually treated with inhalers and sometimes a short

course of steroid tablets.

  • Reflux is usually treated with tablets to reduce stomach acid.

  • Problems with the nose and sinuses (e.g. rhinitis) are usually

treated with nasal sprays and sometimes decongestants and

antibiotics.

  • We may also discuss switching certain medications to help improve

your cough (e.g. alternative blood pressure medications).

 

 

A refractory chronic cough is when the cough does not improve

with treatment of the above conditions and unexplained chronic

cough is when these or other conditions cannot be found. We think

the main problem in refractory and unexplained chronic

cough is that the nerves controlling cough become very sensitive. 

 

As cough hypersensitivity is caused by over-reactive nerves,

treatment aims to target these nerves and reduce their

responsiveness. We try and achieve this with pharmacological and/or non-pharmacological treatment.

 

Approximately 50% of our patients tolerate pharmacological treatment and see a benefit to their overall coughing. However, a proportion of patients may not be suitable for these drugs, or may experience side effects such as nausea, “brain fog” or constipation. 

 

More recently, non-pharmacological treatment by speech therapists (SLTs), has shown positive improvements in chronic cough by “retraining” the larynx. This primarily includes patient education, with a focus on reducing upper airway sensitivity and muscle tension and providing cough control exercises. Some of our patients prefer to trial SLT before medications, whilst others may opt for a combination of the two.

 

For patients who are refractory (i.e have no response) to any of the treatments we currently provide, we may invite you to participate in research. This helps us to develop more specific and targeted treatments for cough hypersensitivity – see our Research section for more information.

How do we treat refractory and unexplained chronic cough?