Why can’t I stop coughing? Causes/Possible Diseases and Countermeasures

Why can’t I stop coughing?

Coughing is a natural reaction that occurs to protect the body.

When foreign objects such as dust, food, saliva, etc. enter the respiratory tract, which is the passageway of air, when phlegm accumulates, or when irritating gas is inhaled, coughing occurs in an attempt to expel these substances from the body.

Coughing is a bioprotective reflex that occurs involuntarily, making it difficult to stop yourself.

Type of cough

Cough is divided into two types, “wet cough” and “dry cough”, depending on the presence or absence of phlegm.

productive cough

A productive cough is a wet cough with phlegm. It is a cough that makes sounds such as “goho goho”, “gehogeho”, and “zero zero”, and is a physiological cough to expel phlegm.

Diseases that cause wet cough include bacterial pneumonia/bronchitis, pulmonary tuberculosis, viral pneumonia/bronchitis, asthma, COPD (chronic obstructive pulmonary disease: chronic bronchitis/emphysema), lung cancer and other lung-caused diseases. Of course, there are cases where there are causes other than the lungs, such as sinusitis, postnasal drip due to allergic rhinitis, and chronic heart failure.

dry cough

A dry cough is a dry cough that does not produce phlegm. Cough is characterized by dry sounds such as “konkon”, “kenken”, and “kohokoho”, and the cough itself becomes painful, so cough is the target of treatment.

Cough asthma, atopic cough, interstitial pneumonia, mycoplasma pneumonia, reflux esophagitis, and psychogenic (stress, etc.). In addition, there is a case of coughing as a side effect of antihypertensive drugs, so it is necessary to pay attention to the contents of the medicine.

A cough that lasts longer than 2-3 weeks may not be just a cold

Cough is classified into three categories based on how long the symptoms last.

• Acute cough (within 3 weeks after coughing)
• Protracted cough (cough lasting 3 to 8 weeks)
• Chronic cough (mansei gaiso): a cough that lasts for more than 8 weeks

When you have a long-lasting cough, you tend to think lightly that you may have a long-lasting cold, but as a guideline, if the cough lasts for more than 2-3 weeks, it may not be a cold.

Many common cold syndromes are caused by viruses. Since the virus that causes cold syndrome cannot survive in the respiratory tract for more than two weeks, it is common for the illness to heal naturally if the patient is at rest due to the action of the immune system. However, even if the virus is inactivated, inflammation in the respiratory tract may remain and only the cough may prolong. This is called post-infectious cough.

Bacterial colds can be more severe than viral colds, but they can be treated with antibiotics.

• Cough that does not go away for more than 2 weeks
• Severe cough that keeps you from sleeping

If you have any of the above symptoms, you should see a doctor as soon as possible, as it may not be a cold but another disease.

Cough symptom self-check

Here is a self-checklist for cough symptoms. Let’s check if there is anything that applies.

• Wheezing and wheezing sounds when breathing
• The weather can make the cough worse
• Coughing and sputum production at night, such as when sleeping or late at night
• Coughing in the morning, waking up with a cough
• Coughing when breathing cold air (coughing when walking out of the house in winter, getting off the train, coughing in the frozen section of the supermarket, etc.)
• Coughing when eating spicy food
• Coughing when breathing air from an air conditioner
• Coughing when inhaling steam
• coughing while talking
• Trying to go out at the same pace as people of the same age is painful
• When it doesn’t come out, it doesn’t come out at all, but once it comes out it won’t stop easily
• Smoking index over 400 (smoking index: number of cigarettes smoked per day x number of years of smoking)

If any of the above apply, your cough may be caused by some other illness rather than a cold. Don’t put up with it and see a respiratory specialist before it gets worse.

Causes of persistent cough

Here are some reasons why you may not be able to stop coughing.

bacteria and viruses

Pneumonia and bronchitis caused by viral infections such as rhinovirus, respiratory syncytial virus, influenza virus, and coronavirus, and bacteria such as Streptococcus pneumoniae, Mycoplasma, and Bordetella pertussis, can cause uncontrollable coughing.

In addition, after the infection with bacteria or viruses subsides, the cough may persist for a long time, and this is called post-infectious cough. Basically, you will see the progress with antitussives.

Allergic substance

Allergens can cause allergic coughs and coughs from allergic rhinitis, which can be uncontrollable.

Substances that cause allergies, such as mites, dust, and pet hair, vary from person to person, but an allergy test at a hospital can determine the cause. Treatment consists of oral antiallergic drugs and inhaled steroids.

Harmful substances such as cigarettes and dust

Long-term inhalation of substances that are harmful to the human body, such as cigarettes, dust, and chemicals, can cause chronic airway inflammation and alveolar inflammation in the respiratory system, which can lead to uncontrollable coughing.

Even so, if you are unable to quit smoking or if you do not receive appropriate medical intervention, your respiratory function will gradually begin to decline, and you will develop COPD (chronic obstructive pulmonary disease).

In addition to coughing, shortness of breath and phlegm are noticeable, and in severe cases, home oxygen therapy may be required. If you are a smoker and have a cough or shortness of breath that lasts for more than 2 to 3 weeks, it is important to consult a respiratory medicine doctor and receive an appropriate examination.

Alcohol (alcohol-induced asthma)

If you start coughing and won’t stop when you’re drinking, it may be because your airways are inflamed due to the irritation of the alcohol.

When alcohol is ingested, it is broken down into a substance called acetaldehyde in the liver, but acetaldehyde is harmful to the human body and can cause asthma attacks.

Acetaldehyde also increases histamine production. Histamine also causes asthma attacks by narrowing the airways.

others

In addition, hay fever , taking antihypertensive drugs, cold stimuli, capsaicin, food allergies, eosinophilia (people with a constitution in which one of the white blood cells is a large number), chronic sinusitis, reflux esophagitis, cough asthma can also cause coughing.

People with hay fever often have asthma, which is closely related to coughing. Coughing may also be a side effect of medications that lower blood pressure. A side effect of the drug is a dry cough.

Illness that doesn’t stop coughing

From here, we will introduce diseases related to cough symptoms.

Conceivable illness with a cough that subsides within 2 weeks

In viral upper respiratory tract infections (cold and influenza virus infections), acute bronchitis, pneumonia, etc., infection with viruses and bacteria can cause inflammation in the respiratory tract, causing coughing or an uncontrollable cough. , many of these subside within 2 weeks.

In addition to coughing, symptoms such as:

• Upper respiratory inflammation (cold): cough, fever, sore throat, runny nose, sneezing
• Influenza: cough, high fever, diarrhea, sore throat, general joint pain
• Acute bronchitis: cough, fever, phlegm, general malaise

Possible diseases with cough lasting more than 2 weeks

A cough that lasts longer than 2 weeks may indicate another illness rather than the common cold.

cough asthma

Asthma is an increasing cause of prolonged cough in recent years.

The reality is that the diagnosis of asthma is often difficult even for respiratory specialists. It is impossible to diagnose cough and asthma for the first time at a hospital of internal medicine that you visit for the first time based only on the progress, interview, and physical examination. A diagnosis of cough asthma cannot be made without proper examination and treatment.

The reason why it is important to make a correct diagnosis is because it is known that if cough asthma is left untreated, one in three people will progress to bronchial asthma. Adult-onset bronchial asthma is almost never completely cured. It is important to recognize that bronchial asthma is a progressive disease that will become severe without appropriate therapeutic intervention.

It is most important to correctly diagnose cough asthma, and to prevent the transition to asthma by providing appropriate treatment for an appropriate period of time.

Bronchial asthma

It is important to consider bronchial asthma by dividing it into a type that is caused by allergic substances, a type that is caused by eosinophil cells in white blood cells, a type that is both types, and a type that is neither. is.

Patients with mild to moderate symptoms are basically controlled with inhaled steroid therapy. Don’t forget that it’s a progressive disease that will get worse if you don’t use the base inhaler properly. Do not stop taking asthma medications without consulting your doctor, even if your cough symptoms have resolved with treatment. It will lead to aggravation.

There are still many patients who believe that oral administration is more important than inhalers. The important thing is daily inhaled steroids! Whether you have symptoms or not, you have asthma.

I often use an analogy, but let’s say that a patient with blood pressure of 180/90 takes antihypertensive drugs and the next morning his blood pressure becomes normal. Do you think your high blood pressure is cured? So is asthma. I will say it again. Asthma is asthma whether you have symptoms or not. Once diagnosed with asthma, inhaled corticosteroids should be used whether or not symptoms are present.

In addition, unlike oral or intravenous steroid administration (systemic administration), inhaled steroids have very few side effects on the whole body, and are characterized by an extremely high level of safety.

People fear inhaled steroids because they are steroids. If you are afraid of steroids, it is rather important to use inhaled steroids every day, which have few side effects and are extremely safe.

COPD (chronic obstructive pulmonary disease)

A prolonged cough may also indicate COPD (chronic obstructive pulmonary disease).

COPD is also called tobacco disease, and continuous inhalation of harmful substances causes inflammation, which narrows the bronchi and destroys the alveoli, making it difficult to take in air. It is also the 10th leading cause of death in Japan, and is a disease with a high risk of death.

Recently, it is also known as a cause of frailty (weakness), and it is known that if smoking cessation and its treatment are not started from the early stage, it will cause general muscle weakness and increase the risk of becoming bedridden.

People who smoke a longer number of cigarettes per day or who have a longer history of smoking tend to have more severe COPD, and the risk of developing COPD increases if one pack of cigarettes a day continues for about 20 years.

COPD includes “emphysema”, in which inflammation occurs in the bronchi and alveoli due to the influence of tobacco, resulting in tissue destruction, and “chronic bronchitis,” in which coughing and sputum persist.

Non-tuberculous mycobacterial disease

It is said to be common among middle-aged and older women, and among those who have a hobby of gardening. Symptoms of non-tuberculous mycobacterial disease are rarely observed from the early stage, and it progresses slowly over a period of 10 years. becomes.

Treatment involves taking 2 to 3 antibiotics daily for at least a year. However, there is almost no cure, and the aim is to suppress the progression and severity of the disease.

Interstitial pneumonia

Interstitial pneumonia is inflammation and damage to the walls of the alveoli (the lungs are made up of small grape-like sacs called alveoli), and the walls thicken and harden (fibrosis). It is a disease that makes it difficult to take in.

There are various causes of interstitial pneumonia, but when the cause is unknown, it is called idiopathic interstitial pneumonia. Among them, the type called idiopathic pulmonary fibrosis is the most common and accounts for about 90% of idiopathic interstitial pneumonia.

The prognosis of pulmonary fibrosis is very short, only 5 to 6 years, so it is important to find it early and treat it well at a specialized medical institution.

lung cancer

Lung cancer is also a cause of cough. In the early stages of lung cancer, there are almost no subjective symptoms.

Lung cancer can occur in non-smokers as well as heavy smokers, so it’s important to get an imaging test if you have a persistent cough.

It is difficult even for experienced doctors to detect lung cancer or tracheal cancer that has developed in the back of the heart with plain chest radiographs (so-called X-rays), so if the initial treatment does not work, it is necessary to undergo a CT examination. there is.

Novel coronavirus infection (COVID-19)

The new coronavirus infection (COVID-19) also has a cough symptom.

According to ” IDWR 2020 No. 16 <Notable Infectious Disease> Novel Coronavirus Infectious Disease (COVID-19) ” published by the National Institute of Infectious Diseases , about half of the patients infected with the new coronavirus in Japan Nearly 46.1% have cough symptoms.

If you are infected with the new coronavirus, you will experience cold-like symptoms such as a mild cough, sore throat, and fever for about a week. However, after the fever subsides, the coughing worsens, and many people can’t stop coughing.

It seems that there are cases where the cough does not stop for several weeks even after the medical treatment period ends, and in the case of long-term people, it continues for several months. Many people will improve in a few days if they are properly tested and treated properly, so don’t ignore the prolonged cough after being infected with the corona virus and see a doctor as soon as possible.

reflux esophagitis

It may seem unrelated at first glance, but this is surprisingly common.

If you have heartburn symptoms and a persistent cough, this is likely the cause. It’s important to tell your cough symptoms in detail when you visit an internal medicine doctor, but be sure to tell them that heartburn is tough.

chronic sinusitis

Sinusitis is classified into neutrophilic sinusitis and eosinophilic sinusitis. Neutrophilic sinusitis is said to be caused by backflow of pus and nasal secretion into the pharynx, causing irritation and coughing.

On the other hand, the type called eosinophilic sinusitis is often complicated with asthma, and it is necessary to be careful because it cannot be appropriately controlled without the use of inhaled steroids, which are anti-asthma drugs.

Eosinophilic sinusitis is often accompanied by nasal polyps (polyps in the nose), and in such cases non-steroidal antipyretic analgesics such as loxoprofen and voltaren cannot be used.

In that case, acetaminophen is used as an alternative drug, but in the case of adults, taking more than 400 mg at a time may induce asthma attacks, etc., and acetaminophen is not absolutely safe, so be careful. Is required.

Coping and prevention methods when coughing does not stop

From here, in order to prevent coughing, the principle is to treat the cause, but along with that, we will introduce cough prevention that you can do yourself.

First of all, use the medicine exactly as prescribed

In particular, it is not recommended to discontinue the drug for bronchial asthma, COPD, cough asthma, reflux esophagitis, sinusitis, etc. without a doctor’s instruction.

Gargle, mask, frequently drink water and lick candy

It is a good idea to gargle and wear a mask to prevent viruses and bacteria that cause coughing from entering. For people with low saliva and dry mouth, it is good to wear a mask to control the humidity, and when it is dry, drink water frequently and lick candy.

control the humidity in the room

A dry environment will activate the virus. In addition, the respiratory tract becomes dry, making it easier for viruses and bacteria to infect.

Humidity can be controlled by using a humidifier, so it’s a good idea to use a humidifier during the dry winter season. However, excessive negligence can lead to mold growth in the room, so aim for 50-60%.

Don’t leave a prolonged cough and go to the hospital early!

If you have a persistent cough that doesn’t go away, you may have another illness instead of a cold. As a guideline, if the cough persists for more than 2 to 3 weeks, see a respiratory specialist.

You should also see a doctor as soon as possible if you cannot sleep due to coughing, cannot lie down due to coughing, or have difficulty breathing even if it has not been two or three weeks.