Warning Signs For Chronic Coughs And Tuberculosis (TB) - Dr Ravikeerthy M

Cough is the protective reflex that occurs when cough receptors are stimulated/irritated by Infections, Pollen, Foreign body, inhalation of gas and or secretions. Cough is a symptom, but the excess and continuous cough can lead to other symptoms like breathlessness, chest pain, headache, fainting attacks and urinary incontinence. Cough can be acute or Chronic.

Common causes of acute cough are Infections ranging from the common cold to Pneumonia (involving both upper respiratory and lower respiratory tracts), Bronchiolitis in young children, aspiration of food/saliva/sputum or foreign body, acute exacerbation of Asthma and Pulmonary embolism which is relatively rare but a serious condition. If the cough persists for six weeks or longer we call it a chronic cough.

Chronic cough can be troublesome and has an impact on quality of life. There are many causes for chronic cough Infections of the respiratory system especially Tuberculosis in the Indian subcontinent, Chronic bronchitis, bronchiectasis, sarcoidosis, allergies including Asthma, Plearal diseases, congenital conditions like cystic fibrosis, Lung carcinoma, Laryngitis and Gastroesophageal reflux disease (GERD). Gastroesophageal reflux disease and allergies are the common causes of chronic cough among noninfectious causes and Tuberculosis is the common infectious cause.

GERD is a condition in which gastric acid enters into the oesophagus either because of a weak gastroesophageal sphincter, Hiatus hernia obesity more so abdominal obesity. It is also a lifestyle disease, especially in people who consume Alcohol, and smoke, in those who consume excess coffee, chocolates and spicy foods and in people with a sedentary lifestyle.

Common clinical presentation in GERD is a burning sensation in the chest or heartburn, regurgitation of food and cough especially on lying down or supine position. Treatment of GERD includes weight reduction, regular exercise, and avoiding Alcohol /Tobacco/ smoking/ coffee/Tea/aerated drinks/spicy oily foods.

Maintaining an upright posture after food and a slow walk after food intake also reduces GERD, reducing cough. People may need antacids like proton pump inhibitors to reduce the symptoms. Cough suppressants alone may not be effective in reducing the symptom of GERD.

Among the infections that cause chronic cough, Tuberculosis remains the major cause all over the world especially in the Indian subcontinent and in Africa. Tuberculosis is caused by Mycobacterium Tuberculosis which is a treatable condition. Failure to recognize the condition at an early stage may lead to multiple complications including death and spread to others.

Some of the warning signs of Tuberculosis are a chronic cough with or without expectoration and associated weight loss, loss of appetite, blood in sputum, breathlessness, Fever and fatigue.

Chronic Obstructive Airway disease is the other common condition which causes chronic cough. This condition includes Chronic Bronchitis and Emphysema. More common in men than in women and in chronic smokers. Allergies including asthma may also present with chronic cough. They tend to have associated wheezing in these conditions. Bronchiectasis and cystic fibrosis are other conditions that chronic cough.

Lung cancer or Bronchogenic carcinoma is another cause of chronic cough. More common in smokers and in Men. They can also have associated symptoms like breathlessness, weight loss and hemoptysis(Coughing of Blood).

Rarely cardiac diseases like heart failure may present with cough.

When to see a doctor for chronic cough-

1. The cough persists for more than three weeks
2. Associated with fever, weight loss
3. Associated with hemoptysis
4. Associated with wheezing/Breathlessness
5. Associated with chest pain palpitations/chest pain/leg oedema/facial puffiness
6. Associated with fainting attacks or urinary incontinence

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