Whether it's a soft, tickly cough or a thunderous, chest-rattling one, the act of coughing is one of those involuntary bodily functions we all experience from time to time. While the act of coughing itself is perfectly normal and even beneficial, it's important to understand that it's not always a benign reaction to minor irritants. Persistent coughing, particularly when accompanied by other symptoms like fever, chest pain, or shortness of breath, can be indicative of various health conditions, some more serious than others. 

These underlying causes can range from the common culprits like colds and allergies to more complex issues like chronic respiratory diseases, infections, or even lung cancer. By knowing what’s triggering your cough, you can find ways for effective management and, when necessary, targeted treatment.

Unmasking the usual suspects: Common respiratory infections

As we’re uncovering the causes of coughing, it's only fitting that we start with some of the most common culprits – respiratory infections.

The common cold

This viral infection, usually caused by rhinoviruses, infiltrates our respiratory system with ease. When these microscopic invaders breach our nasal passages, throat, and upper airways, they trigger an inflammatory response. This inflammation irritates the sensitive mucous membranes lining our airways, leading to that familiar tickle in the throat and a nagging cough.

Influenza (Flu)

The flu, while sharing some symptoms with the common cold, is often more severe. Influenza viruses invade the entire respiratory tract, from your nose to your lungs. The infection leads to a fever, muscle aches, and, of course, a persistent cough. This time, the cough is the result of your body's attempt to rid itself of viral particles and the increased production of mucus triggered by the infection. In addition, flu and COVID-19 also share similar symptoms but with slight distinctions.

Pneumonia

Pneumonia can result from viral, bacterial, or fungal infections, but it's often bacterial pneumonia that triggers the most severe coughing fits. When the tiny air sacs in the lungs become filled with inflammatory material, coughing becomes necessary to clear the lungs of debris and mucus. The cough in pneumonia is often accompanied by sharp chest pain and difficulty breathing, making it a serious cause for concern. 

The allergy and irritant

While respiratory infections are prominent players that causes cough, there's another cast of characters that often go unnoticed until they make their presence felt – allergies and environmental irritants. 

Allergies

Allergies, often triggered by allergens like pollen, dust mites, pet dander, and mould, can set off a cascade of symptoms. When you inhale or come into contact with an allergen, your immune system interprets it as a threat and releases histamines. These histamines cause your airways to become inflamed and your body to produce excess mucus. In response to this inflammation and mucus buildup, a tickly cough becomes a reflex.

Environmental irritants

Beyond allergens, our respiratory systems also face challenges from environmental irritants, which can trigger coughing without the need for an immune response. These irritants include:

• Air pollution
• Cigarette smoke
• Strong odours such as perfumes or cleaning products

Asthma and chronic bronchitis

These conditions are characterised by persistent coughing, often making life a daily struggle for those who bear their burden.

Asthma

Asthma is a chronic respiratory condition that affects millions worldwide. At its core, asthma is characterised by inflammation of the airways. When someone with asthma encounters a trigger, such as allergens, smoke, or cold air, their airways become inflamed and constricted. This inflammation narrows the air passages, making it difficult to breathe and often leading to a chronic cough.

Chronic bronchitis

Chronic bronchitis is a subtype of chronic obstructive pulmonary disease (COPD) characterised by long-term inflammation of the bronchial tubes. This inflammation leads to increased mucus production, a hallmark feature of the condition. The excessive mucus becomes thick and difficult to clear, trapping irritants and microbes. Chesty cough in chronic bronchitis is a response to this mucus buildup.

Gastroesophageal Reflux Disease (GERD)

GERD is a condition where the lower oesophageal sphincter, a muscular ring that separates the oesophagus from the stomach, doesn't function properly. This malfunction allows stomach contents, including corrosive stomach acid, to flow backward into the oesophagus and even reach the throat and airways. 

When stomach acid makes its way into the throat and airways, the acid irritates the sensitive mucous membranes lining the throat and air passages, leading to inflammation. This inflammation triggers the body's natural defence mechanism – coughing. In the case of GERD-induced coughing, the cough is chronic and persistent. The nagging cough is often described as a dry, hacking cough that seems unrelated to a respiratory infection. 

One particularly vexing aspect of GERD-induced coughing is its propensity to strike during the night. Nocturnal coughing can disrupt sleep patterns, leaving individuals fatigued and frustrated.

Postnasal drip: The dripping dilemma

Postnasal drip occurs when this excess mucus doesn't stay where it's supposed to – in your nose. Instead, it travels backward, down the back of your throat, creating an uncomfortable sensation. This sensation often triggers coughing, as your body attempts to clear the irritant and excess mucus from the throat.

What causes postnasal drip?

• Allergic reactions
• Sinus infections
• Nasal conditions (chronic rhinitis or even structural issues within the nasal passages)

Medications and side effects

While drugs are often prescribed to alleviate various health concerns, it's crucial to be aware that certain medications can induce coughing as a side effect. While not all medications cause coughing, some are notorious for it. One class of drugs that stands out in this regard is ACE inhibitors.

Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed for conditions like high blood pressure and heart failure. They work by relaxing blood vessels, making it easier for blood to flow and lowering blood pressure. While these drugs can be highly effective, they can also induce a persistent dry cough in some individuals. The exact mechanism behind ACE inhibitor-induced coughing is not entirely understood. It is believed to involve the accumulation of bradykinin, a substance that can irritate the airways and trigger coughing.

The smoking culprit

Active smoking

Active smokers inhale a toxic cocktail of chemicals and irritants with every puff. These substances not only harm the lungs but can also inflame and irritate the delicate airways, leading to chronic coughing. Smoking-induced cough is often referred to as a "smoker's cough" and can be characterised by its persistence and a productive cough that produces mucus.

Secondhand smoke

Even if you're not the one lighting up, exposure to secondhand smoke is no less harmful. Inhaling the smoke exhaled by others introduces similar irritants into your airways, increasing the risk of developing a chronic cough.

Underlying lung conditions

Underlying lung conditions such as interstitial lung disease (ILD), pulmonary fibrosis, and lung cancer often stealthily induce persistent coughing, serving as crucial early warning signs. 

In ILD, scar tissue in the interstitium, the lung's supporting tissue, impairs lung function, leading to a dry, uncomfortable cough. Pulmonary fibrosis, a subtype of ILD, causes oxygen exchange issues, prompting a chronic cough as the body compensates for reduced oxygen intake. Lung cancer, on the other hand, is known for a persistent cough, which can vary from dry to producing blood-tinged sputum due to irritation from tumours or lesions.

Psychological and habitual coughing

Beyond physical triggers, chronic coughing can also be influenced by the workings of the mind and learned behaviours. 

Stress

Yes, there is such thing as stress cough. When we're under stress, our bodies can react in various ways, including triggering a persistent cough. Stress-induced coughing is often dry and unproductive. The exact mechanism isn't fully understood, but it's believed to involve the nervous system and heightened sensitivity of the airways.

Anxiety

Anxiety and its physical symptoms can manifest in many ways, and chronic coughing can be one of them. Anxiety-induced coughing may result from increased muscle tension or a heightened state of alertness.

Habitual coughing

Sometimes, coughing can become a habit. It might start as a response to a minor irritation but then persist even after the initial trigger is gone. Habitual coughing can be particularly challenging to break because it becomes ingrained in one's behaviour.

Conclusion

From common respiratory infections to allergies, environmental irritants, and even underlying lung conditions, the causes of coughing are diverse and sometimes unexpected. Timely diagnosis and intervention can help you work ways for proper management of the condition. There are many ways to manage coughing, from medications prescribed by healthcare providers to more natural methods like using chest balms, particularly for children, or employing breathing devices to clear mucus from the lungs naturally.

The methods may vary depending on individual condition and needs but understanding the causes is the first step for you to seek the help you need.

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Health & Wellbeing Respiratory Health