My friend Mr Okereke(not the real name), lives in Abuja. For the past 4 weeks, he has had this chronic and persistent cough. He is putting up a structure in his village in the South East. Usually he travels by air, but has been afraid to take the risk, lest they quarantine him at the airport, to screen for corona.
Today, I am worried that the old axiom which says “all tuberculosis cough is persistent and chronic, but not all persistent and chronic coughs are tuberculosis “, is becoming muffled. Now it has become “ all chronic and persistent cough is corona until proven otherwise”
Let me paraphrase, accordingly Prof Ludlum John in VeryWell magazine “Is your persistent cough a sign of tuberculosis or lung cancer? The answer is probably no to both, and the only way to find out is to consult your doctor.” especially in this era of corona.
Now let me add a dictum for all of us. “If you have a persistent cough that has lasted for more than 4 weeks please consult your doctor. Corona or no corona.
Nobody likes or wants to visit a doctor, including medical personnel, but our love for our families and the desires to stay healthy should override our phobias.
Wait a minute, have you ever suffered the irritating discomfort of a temporary cough not to talk of persistent one. Then you should understand what this is all about. That, for safety, every illness including cancer that is diagnosed early is half cured.
How do we define a chronic cough?
A chronic cough is defined as a cough that persists for a period of eight weeks or longer.
• The cough may be dry or productive, in other words, you may not cough up mucus – sputum. The cough may also be referred to as “lingering” or “nagging”.
• An acute cough in contrast, refers to a cough that lasts less than 6 weeks, such as those that occur with common cold or coryza.
What are the causes of persistent cough?
1) Allergic rhinitis – hay fever, sinus infections, nasal polyps or other conditions is the most common cause of chronic cough.
2) Asthma – though people, with asthma also have their peculiar symptoms like wheezing, shortness of breath, but cough is always persistent.
3) Acid reflux – Gastro Esophageal Reflux Disease (GERD) – This is the 3rd most common cause of a chronic cough, and is often overlooked. For some people typical symptoms such as heart burn may not be present, and the only symptom may be chronic cough.
4) Bronchitis – It is one of the top 4 causes of chronic cough in adults. It is similar to asthma.
5) Smoking – Unfortunately, it is difficult to distinguish a “smoker’s cough “ from a cough due to other conditions such as other cause of chronic cough.
6) Infection – Example whooping cough may cause persistent cough especially in children.
7) Tuberculosis – Is also a common cause of chronic cough.
8) Some medications – Especially a category of drugs used to treat high blood pressure and heart disease. Roughly 10% to 20% of people treated with ACE-inhibitors develop chronic cough eg vasotec(enalapril) and zestril (lisinopril), but some people are non-reactive and tolerate these drugs.
9) – Lung cancer – For only 2% of chronic cough, lung cancer is the underlying cause.
10) Other cancers and metastases – Other cancers that metastases to the lung like lymphoma, breast cancer, colon cancer, bladder cancer and prostrate cancer can cause chronic cough.
11) Lung diseases – such as emphysema, bronchiectasis and sarcoidosis can cause chronic cough.
12) Fungal infections – such as coccidiomycosis, histoplasmosis these are all fungi, can cause chronic cough.
13) Foreign objects – inhaling foreign dusts like asbestos, coal, carbon etc can cause chronic cough.
14) Heart Failure – can also cause chronic cough.
15) Miscellaneous – There are more causes of persistent cough, but the important point is to note that, there are a number of causes and a careful evaluation is needed if your cough is not going away.
How do we diagnose a chronic cough?
1) Evaluation starts with a careful history, we ask for risk factors.
2) Blood test to look for infections.
3) CT-Scan – To look for evidence of infection and tumour.
4) Allergy tests through esinophilia.
5) Esophageal ph testing – to test for presence of a reflux as a possible cause of persistent cough.
6) Bronchoscopy – to view the lung.
Treatment of chronic lung disease.
1) Treatment depends on the underlying cause.
2) It is important to make a doctor’s appointment, if you have cough that persists, even if you believe there is a reason to explain your cough, such as continued smoking or allergies.
3) Questions your doctor may ask include;
• How long have you been coughing?
• Has the cough been worsening?
• Is the cough steady or does it come and go?
• Is it worse after meals or is it worse at night?
• Is the cough dry, or have you been coughing up phlegm – mucus?
• Have you coughed up blood?
• What other symptoms have you been experiencing? For example, fever, shortness of breath, allergy symptoms, wheezing, or unexplained weight loss?
• What other medical problems do you have?
• Has any one in your family had similar symptoms? Do you have a family history of bronchitis, asthma, emphysema or lung cancer.
• Do you or have you ever smoked?
• Have you been exposed to second hand smoke?
• what medications are you on?
Go to your doctor with these answers. Be medically guided.
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@ _ DRSUN