Dry Cough

Dr. Nabi Darya Vali (AIIMS)MBBS

December 01, 2018

October 23, 2020

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Dry Cough
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Coughing is a protective reflex that helps clear excess mucus and irritants like dust and smoke from the respiratory tract. It is also a common symptom of diseases such as COVID-19.

Dry or non-productive cough is a cough that does not produce phlegm. It may feel like a tickling sensation or scratchiness in the throat.

Some of the conditions that are most commonly associated with dry cough are:

  • Post-viral (symptoms that linger when you are recovering from a viral infection)
  • Asthma
  • Rhinosinusitis (post-nasal drip, upper airway cough syndrome or “nasal catarrh”)
  • GERD or gastro-oesophageal reflux (a disorder in which the valve separating the food pipe from the stomach does not function properly, and allows stomach acids to enter the food pipe).
  • The use of certain medicines, especially angiotensin-converting enzyme inhibitors or ACE inhibitors used for the treatment of high blood pressure, diabetic nephropathy (nerve problems linked to diabetes) and some heart diseases, can also cause persistent dry cough.

Treatment of dry cough typically depends on the underlying cause. Home remedies for dry cough and medicines for symptomatic relief—especially if the dry cough is worse at night, affects the patient’s sleep or quality of life—can also help. A word of caution around dry cough medicines: research shows that while antitussive (cough suppressant) opiates can reduce persistent dry cough, they can cause drowsiness and may be habit-forming.

Complications of dry cough include sleep disturbance, respiratory muscle cramp, and rarely, fractured ribs and syncopal attacks (fainting suddenly).

Dry cough in addition to other symptoms, like dry cough with shortness of breath or dry cough with fever and chest pain, can signal different health problems. For this reason, while dry cough may seem innocuous enough, it should not be ignored if it persists beyond a few days. Read on to know all about dry cough and when to see a doctor for it.

Symptoms of dry cough

Most of us don’t think about what’s going on in the body when we cough. In truth, coughing is far from simple. It involves the medulla in the brainstem, neurotransmitters (chemicals nerves use to talk to each other and to tissues) like 5-hydroxytryptamine and y-aminobutyric acid, and nerves and muscles of the trachea (windpipe), larynx and intrapulmonary airways, mainly the area where the windpipe splits into the two bronchi or airways that take air to the lungs.

As mentioned before, a cough can be productive (wet) or non-productive (dry). Here are some of the symptoms of dry cough versus wet cough:

  • Dry cough does not produce phlegm, as it stays limited to the upper respiratory tract
  • Dry cough increases cough sensitivity to substances like capsaicin
  • Dry cough is often accompanied by irritation in the throat and chest

In addition to this, dry cough may be accompanied by symptoms such as:

Dry cough causes

There are multiple causes linked with a dry cough, such as:

The less common causes of a dry cough include:

Here’s a more detailed look at some of the main causes:

  1. Dry cough in COVID-19
  2. Upper respiratory tract infections can cause dry cough
  3. Dry, hacking cough in tuberculosis
  4. Dry cough in asthma
  5. Dry cough in GERD or gastroesophageal reflux

Dry cough in COVID-19

COVID-19 is a viral infection caused by the severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 virus. COVID-19 usually starts as an upper respiratory tract infection or URTI. During this stage, the symptoms—in patients who are symptomatic—may include dry or unproductive cough.

The coughing (sometimes dry) may persist for some weeks or months after the infection has cleared, too. (Read more: What is long-COVID?)

Upper respiratory tract infections can cause dry cough

The upper respiratory tract comprises the nose, throat and larynx or voice box. Common examples of upper respiratory tract infections include the common coldpharyngitis, epiglottitis, and laryngotracheitis. These conditions could be caused by a bacterial infectionviral infection or fungal infection. Dry cough is often a symptom of these conditions.

However, dry cough may persist for several months, even years, after the infection clears up (post-infection).

During an infection (or allergy) you may also develop a runny nose. A runny nose is a sign that the body’s producing more mucus. Some of this excessive, thin (runny) mucus can drip down to the back of the throat instead of going out the nose. This is known as post-nasal drip, which can irritate the throat and trigger the cough reflex.

While minor infections and dry cough are quite common and generally easy to resolve, experts say that chronic cough—especially in children—could lead to inflammation in the epithelial (outermost) layer of the bronchi which acts as a barrier between the airways and everything outside them. This inflammation also makes it easier for irritants to enter the airways. This inflammation also increases the sensitivity of the cough receptors in the body, which is part of the reason why people with dry cough are often hypersensitive to inhaled capsaicin or the chemical that makes chillies spicy. (Read more: Home remedies for cough in babies)

Dry, hacking cough in tuberculosis

We think of wet cough and blood-stained sputum when we think of tuberculosis. The fact is that the infection—when it affects the lungs (pulmonary tuberculosis)— may start out as a dry cough that persists for three weeks or more. Later, the cough would become productive (with phlegm) and possibly bloody.

Dry cough in asthma

Asthma in children is often accompanied by dry cough (cough-variant asthma) which tends to be worse at night. Some grown-ups may also have asthma with cough, but it is rarer in adults. Dry cough along with wheezing and shortness of breath can also be a sign of worsening asthma in adults living with this chronic condition.

Read more: Upper airway obstruction

Dry cough in GERD or gastroesophageal reflux

Acid reflux is one of the top 5 causes of persistent dry cough in the world. Research has shown that if stomach acids continually reflux or go up into the oesophagus, it can cause inflammation in the food pipe which in turn can lower the threshold at which we cough.

In some cases, the amount of stomach acid that reaches the throat is so small that it doesn’t produce any other signs of GERD. However, as this type of acid reflux has a more direct impact on the cough receptors in the larynx and trachea, it could cause even more throat irritation.

Research has also shown that GERD patients tend to have lower tracheal pH (or more acidic conditions in the trachea or windpipe) during a reflux episode which irritates the trachea and triggers the cough reflex.

Dry cough diagnosis

To determine the cause of your dry cough, your physician will take your detailed medical history and ask about any other symptoms you may be having. Next, he or she will give you a physical examination, including examining your nasal passages and throat. Depending on your medical history, age and the physical examination, the physician may advise tests such as:

Dry cough treatment

Since coughing is a protective reflex (it helps remove irritants and extra mucus from the upper respiratory tract), doctors usually don’t want to stop it altogether. In October 2020, a group of scientists in Australia discovered that different parts of the brain are involved in protective or good cough and cough as a sign of illness or bad cough. Further research is on to see how treatments for chronic cough could target bad cough without affecting good cough.

For now, the treatment of a dry cough depends on its cause:

  • If the cause is an allergy or allergy-linked post-nasal drip, then the treatment would include antihistamines and home remedies for allergic rhinitis. Steroid nasal drops, antibiotics or a nasal decongestant may also be prescribed to some patients depending on the severity of the condition. Nasal sprays and inhalers for dry cough due to allergic rhinitis or post-nasal drip include:
    • Saline or corticosteroid nasal spray
    • Corticosteroid inhaler (medicine is breathed in through the mouth)
  • If the cough is caused by a viral infection that is self-limiting, it will likely resolve on its own within a week or two—see a doctor if the cough persists even after the infection has cleared.
  • If the cause is GERD or acid reflux, you will need longer-term treatment with some combination of proton-pump inhibitors or H-2 receptor blockers (to reduce the production of stomach acids) and antacids. Some people may also need to undergo a small surgical procedure called fundoplication wherein a surgeon tightens the muscular valve (sphincter) between the stomach and oesophagus to prevent reflux. Lifestyle modifications in diet and sleeping posture will also have to be made for GERD-linked dry cough. Self-care measures for GERD include avoiding eating just before bedtime and raising the head of your bed.
  • In asthma, inhaled steroid therapy (nebulizer), bronchodilators, mucomyst and, in some cases, antibiotics may be advised by the doctor.
  • If you take ACE inhibitors or beta blockers which trigger dry cough, as your doctor for an alternative medication.

Other measures to relieve a dry cough include:

  • Self-care measures like drinking warm water with honey and holy basil (tulsi) leaves. Honey coats and soothes the throat and helps to relieve the irritation that triggers a dry cough. Tulsi is effective against bacteria such as S. aureus and soothes sore throats.
  • Drinking plenty of liquids (warm broths, tea, etc.) can also soothe the throat (read more: How to make bone broth)
  • Gargling with salt water helps a cold and sore throat with dry cough
  • Stay hydrated
  • Cough suppressants—available as lozenges—may contain an antibacterial or liquid or linctus cough mixture which suppress the urge to cough. Examples include:
    • Pholcodine
    • Dextromethorphan
    • Codeine
    • Dihydrocodeine
    • Pentoxyverine
  • Cold and flu combination medicines usually contain the following:
    • An antihistamine
    • A decongestant (to relieve a blocked or stuffy nose)
    • Paracetamol
  1. Dry cough treatment in COVID-19

Dry cough treatment in COVID-19

For mild COVID-19, simple home remedies for COVID-19, lots of rest and drinking fluids throughout the day could help. For more severe COVID-19, treatment of the infection with antivirals and supportive therapies like fluid therapy for COVID-19 and oxygen therapy for COVID-19 will take care of the dry cough also. For Post-COVID cough, try steam inhalation and home remedies for dry cough, and if possible, place a humidifier in your room. Talk to your doctor if the cough gets worse.

For patients who were intubated for COVID-19 treatment, throat pain and irritation (including dry cough) could persist. Talk to your doctor if the throat irritation does not get better in a few days.



References

  1. American lung association. Cough Symptoms, Causes and Risk Factors. Chicago, Illinois, United States
  2. NHS Inform. Cough. National health information service, Scotland. [internet].
  3. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Cough
  4. Health Link. Dry Coughs. British Columbia. [internet].
  5. Healthdirect Australia. Cough. Australian government: Department of Health
  6. Zbigniew Zylicz and Małgorzata Krajnik. What has dry cough in common with pruritus? Treatment of dry cough with paroxetine. Journal of Pain and Symptom Management, February 2004; 27(2): 180-184.
  7. Chung K.F. and Lalloo U.G. Diagnosis and management of chronic persistent dry cough. Postgraduate Medical Journal, 1996; 72(852): 594-598.
  8. Karlberg B.E. Cough and inhibition of the renin-angiotensin system. Journal of Hypertension. Supplement: Official Journal of the International Society of Hypertension, 1 Apr 1993, 11(3):S49-52 PMID: 8315520.
  9. L. Padma. Current drugs for the treatment of dry cough. Journal of the Association of Indian Physicians, May 2013; 61
  10. Ing A.J., Ngu M.C. and Breslin A.B. Chronic persistent cough and gastro-oesophageal reflux. Thorax, 1991; 46(7): 479-483.
  11. Mahashur A. Chronic dry cough: Diagnostic and management approaches. Lung India, January-February 2015; 32(1): 44–49. PMID: 25624596.
  12. Chung K.F. and Pavord I.D. Prevalence, pathogenesis, and causes of chronic cough. The Lancet, 19–25 April 2008; 371(9621): 1364-1374.
  13. TB Online [Internet]. Pulmonary TB.
  14. The Physiological Society, via EurekAlert [Internet]. New release: The good cough and the bad cough, 7 October 2020.
  15. Farrell M.J., Bautista T.G., Liang E., Azzollini D., Egan G.F. and Mazzone S.B. Evidence for multiple bulbar and higher brain circuits processing sensory inputs from the respiratory system in humans. The Journal of Physiology, 7 October 2020. Epub ahead of print. PMID: 33029786.

Doctors for Dry Cough

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Medicines for Dry Cough

Medicines listed below are available for Dry Cough. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

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