Have you ever experienced it? Coughing so often that it becomes annoying, taking medicine but still not getting better. Sometimes coughing lasts for several weeks. Many people with these symptoms may think it is just a normal cough, but in fact, a cough that lasts a long time may be a symptom called “chronic cough,” which is a sign of many diseases. Dr. Winai Boveja, a pulmonologist at the Pulmonary Medicine Clinic, Phyathai 3 Hospital, will talk about this.
What causes coughing?
Coughing is the body’s response when there is a foreign substance causing irritation in the respiratory tract, such as germs, phlegm, or smoke. The body tries to expel it by coughing. Usually, continuous coughing lasts no more than 3-4 weeks and then subsides. In some cases, coughing is not caused by foreign substances that can be expelled by coughing, such as something pressing on the lung tissue or bronchus causing coughing, like a mass or lung cancer. The body tries to expel it but cannot, which causes chronic cough that does not go away.
What is “chronic cough”?
Chronic cough is a cough that lasts continuously for at least 8 weeks. Chronic cough can have various causes, including infections or non-infectious conditions such as allergies, bronchitis, asthma. In some cases, chronic cough may be caused by other diseases unrelated to the respiratory tract, such as acid reflux or heart failure. Therefore, finding the cause of chronic cough may not be answered in the first medical visit. Planning diagnosis and follow-up treatment requires understanding and cooperation from the patient.
When should you see a doctor for a cough?
- Cough lasting more than 8 weeks
- Cough symptoms getting worse progressively
- Cough accompanied by other symptoms such as blood in sputum, weight loss, loss of appetite, shortness of breath, fatigue, chest pain
- Cough with blood in sputum
- Cough after exposure to tuberculosis patients or close contact with tuberculosis patients
- Having underlying diseases such as diabetes, kidney disease, heart disease; if coughing occurs, you should see a doctor immediately
Don’t ignore chronic cough!! It may be a symptom of these diseases
- Pulmonary tuberculosis Although there may be no symptoms in the early stage, when the disease progresses, there will be chronic cough, fatigue, loss of appetite, weight loss. Some cases may cough up blood, chest pain, and shortness of breath.
- Lung cancer When the disease worsens, there is chronic cough. Some cases may cough up fresh blood. Some may have chest pain, fatigue, loss of appetite, weight loss, or fever.
- Emphysema Often found in people with a long history of heavy smoking. Patients usually have chronic cough with phlegm and get short of breath easily, with noisy breathing.
- Asthma Usually presents with coughing, especially at night or in cold weather. The severity depends on the degree of small airway narrowing. Symptoms range from difficulty breathing, frequent coughing, noisy breathing, shortness of breath. Symptoms often worsen with respiratory infections.
- Allergic rhinitis Usually causes itchy nose, itchy throat, cough, sneezing. Some cases have clear nasal discharge. Symptoms occur when exposed to allergens such as dust mites, pollen, animal hair, cold air, etc.
- Acid reflux Causes dry cough, especially after meals or when lying down. There may or may not be heartburn or sour belching.
- Sinusitis Usually preceded by a cold or allergic rhinitis. Some cases improve initially but worsen later. Often coughs at night due to postnasal drip.
- Airway hyperresponsiveness Occurs after respiratory infections, where cold symptoms have resolved but cough persists, especially at night or in cold air or wind.
“Chronic cough” can be treated…
Treatment of chronic cough involves treating the underlying cause as well as managing the symptoms. Besides taking history and basic physical examination for diagnosis, some cases may require further tests as appropriate, such as nasal and throat examination, sinus X-ray to check for sinus syndrome, chest X-ray to look for lung abnormalities, sputum examination, lung function tests to assess for asthma, chest CT scan if abnormalities are found on chest X-ray, and bronchoscopy (fiber optic bronchoscopy) to confirm diagnosis.
Bronchoscopy for accurate detection of abnormalities
Currently, bronchoscopy techniques and equipment have been developed to help doctors make accurate and safe diagnoses for patients. Bronchoscopy is a safe procedure with few serious complications.
Indications for bronchoscopy
The doctor divides patients into two groups for easier understanding in real life.
The first group is asymptomatic but with abnormal chest X-ray findings such as
- Nodule
- Mass, single or multiple
- Ground glass opacity
- Consolidation
It should be emphasized that in asymptomatic cases, doctors rely on history taking, risk assessment, smoking history, family history, occupational history, exposure to lung disease patients, and physical examination to estimate the likelihood of disease and plan diagnosis and follow-up. Not all patients in this group require bronchoscopy; evaluation is done case by case based on appropriateness and indications.
The second group includes patients with symptoms or a history of lung and respiratory diseases but cannot be diagnosed by initial examination or whose symptoms do not improve with treatment, such as the following conditions:
- Chronic cough with chest X-ray showing bronchial narrowing
- Chronic cough
- Coughing up blood
- Cough with noisy breathing (stridor or wheeze)
- Repeated pneumonia or lung infections
- Severe lung infections unresponsive to antibiotics
- Pneumonia in immunocompromised patients or those on immunosuppressive drugs
- Staging of lung cancer
- Assessing metastasis to the lungs
- Suspected lung mass such as lung cancer, tuberculosis, or lung inflammation
- Suspected bronchial mass, bronchial stenosis, or tracheomalacia
Bronchoscopy procedure and patient care during the procedure
During bronchoscopy, the patient will receive local anesthetic spray in the nose and throat, causing numbness and difficulty swallowing. Blood pressure, pulse, and oxygen saturation will be monitored continuously for safety. The procedure is mostly done lying down, with oxygen supplied through a nasal cannula, covered with a drape and eye protection to prevent contamination. In some cases, intravenous sedation may be given before bronchoscopy.
The doctor inserts the bronchoscope through one nostril or the mouth, passing through the throat and vocal cords into the bronchus. The patient may feel some discomfort during the procedure. Local anesthetic is sprayed through the scope into the bronchus periodically, which may cause coughing or slight choking. The patient can breathe normally. Sedation is given intravenously to help relaxation. Oxygen is supplied throughout the procedure to ensure adequate oxygen levels.
Risks and possible complications
Some patients may experience bleeding after biopsy, pneumothorax, low blood oxygen, arrhythmia, etc. However, complications from bronchoscopy are usually mild and resolve on their own, such as sore throat or blood-tinged cough. After bronchoscopy, patients will be observed. If no abnormalities are found, patients can go home without hospitalization and will be scheduled for follow-up to discuss results.
How to prepare before undergoing “bronchoscopy”
- Stop eating and drinking after midnight before the procedure or at least 6 hours prior
- Clean your mouth and teeth thoroughly
- Inform the doctor about any medications you are taking, as some medications need to be stopped before bronchoscopy
- Bring a relative with you on the day of the procedure
In the past, diagnosing the cause of a lung mass often required surgery to remove the mass, which could provide diagnosis and treatment in one operation. However, surgery is a major procedure requiring general anesthesia and long recovery, causing unnecessary loss of lung tissue. Therefore, knowing the cause of a lung mass through bronchoscopy causes the least pain and difficulty for patients and allows the fastest recovery, making it very beneficial.
Currently, bronchoscopy techniques and equipment have been developed to help provide accurate and safe diagnoses for patients.
