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:

• Shortness of breath
• Fever and chills
• Sore throat
• Night sweats
• Unexplained weight loss
• A decrease in exercise tolerance (you get tired more easily than before)
• Wheezing or whistling sound while breathing
• Heartburn
• Difficulty in swallowing
  
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There are multiple causes linked with a dry cough, such as:

• Viral infections like COVID-19, the common cold and the flu (influenza)
• Post-viral or post-infective cough (read more: Post-COVID care tips)
• Inflammatory diseases like laryngitis, tonsillitis and sinusitis
• Bacterial infections like whooping cough and tuberculosis which can result in severe hacking—or an outburst of coughing that could result in breathing difficulties.
• Chronic respiratory illnesses like asthma and emphysema 
• Interstitial lung diseases: A set of 100 chronic lung diseases in which there are inflammation and/or scarring of the lungs (pulmonary fibrosis). Examples include bronchiolitis, alveolitis and pulmonary vasculitis (read more: what are lung infections?)
• Smoking
• Allergic rhinitis (hay fever) or allergic reaction to pet dander, pollen, dust or inhaled foreign body
• Side effects of medicines like angiotensin-converting-enzyme (ACE) inhibitors which are most commonly prescribed for hypertension
• Gastro-oesophageal reflux or GERD
• Post-nasal drip or upper airway cough syndrome, in which mucus secretions from the nose go into the throat and cause coughing
• Dry cough is also associated with snoring and obstructive sleep apnea

The less common causes of a dry cough include:

• Heart failure
• Lung cancer, particularly the early stages of pleural mesothelioma
• Blood clot in the lungs (pulmonary embolism)
• Cancer therapy, including chemotherapy

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

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:

• Allergy test
• Chest X-ray
• Sinus X-ray
• Sinus CT scan
• Ambulatory pH monitoring and gastroscopy for GERD
• Throat swab (a sample is collected from the back of your throat, and the specimen is tested for infections)
• Lung function test
• RT-PCR test for infections like COVID-19
• Blood test
• Mantoux tuberculin skin test

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