Cough for more than 3 weeks? Do not ignore it

The commonest causes we actually find

• Cough-variant asthma. Asthma that produces no audible wheeze at all — only a dry, persistent cough that is worse at night, in cold air, while laughing, or after exertion. It is frequently mislabelled as "allergic throat" for years.
• Post-nasal drip from allergic rhinitis or sinusitis. Mucus trickling down the back of the throat produces constant throat clearing and a cough that is worst on waking.
• Gastro-oesophageal reflux (GERD). Acid reaching the lower throat irritates the cough reflex. Classic clues are cough after meals, when lying down, or with hoarseness — and note that many patients have no heartburn whatsoever.
• Tuberculosis. Still a leading cause of chronic cough in Telangana. Any cough over two to three weeks warrants consideration of TB, especially with weight loss, evening fever or night sweats.
• Post-infectious cough. Airway nerve hypersensitivity that can linger six to eight weeks after a viral illness. It resolves, but it needs to be distinguished from the causes above.
• ACE inhibitor drugs. Blood pressure medicines ending in "-pril" (ramipril, enalapril, lisinopril) cause a dry nagging cough in up to 15% of users, sometimes starting months after the tablet was begun. It stops on switching the drug — but never stop a BP medicine without consulting your doctor.
• Smoking and chronic bronchitis, bronchiectasis, interstitial lung disease, heart failure, and lung cancer.

Red flags that need urgent assessment

Please do not wait or continue over-the-counter syrups if any of the following are present.

• Blood in the sputum, even a single episode or a small streak.
• Unintentional weight loss, loss of appetite, or drenching night sweats.
• Fever lasting more than a week, particularly evening fever.
• Increasing breathlessness, or chest pain.
• A change in the character of a long-standing smoker’s cough.
• Hoarseness of voice persisting beyond three weeks.
• Age over 40 with a smoking history and a new cough.

What a proper evaluation involves

A chronic cough is a diagnostic problem, not a prescription problem. A methodical work-up finds the cause in the large majority of cases.

• A careful history: timing, triggers, sputum, smoking, occupation, current medicines, reflux and allergy symptoms, and any TB contact.
• Chest X-ray — the essential first test for any cough over three weeks.
• Sputum examination including a rapid molecular test (CBNAAT/GeneXpert) where TB is a consideration. It is far more sensitive than smear microscopy alone.
• Spirometry with a reversibility test, and where needed a bronchoprovocation test, to detect cough-variant asthma.
• Allergy assessment and ENT or sinus evaluation for post-nasal drip.
• CT chest and bronchoscopy where the X-ray is abnormal, the cough is unexplained, or blood-stained sputum is present. Bronchoscopy allows direct inspection of the airways and targeted sampling.

Why cough syrup is the wrong answer

Suppressing a cough without knowing its cause does two things: it delays diagnosis, and in productive conditions such as bronchiectasis or a chest infection it actively prevents the clearing of mucus. Codeine-containing syrups also sedate and are habit-forming. The right approach is to identify the mechanism and treat that — an inhaler for cough-variant asthma, acid suppression and dietary change for reflux, a nasal steroid for post-nasal drip, or full anti-TB therapy for tuberculosis.

What you can do while waiting for your appointment

• Stop smoking and avoid all second-hand smoke, incense and mosquito coils.
• Raise the head of the bed, avoid late heavy meals, and cut down spicy and fried food if reflux is suspected.
• Steam inhalation and saline nasal rinses for post-nasal drip.
• Note down when the cough is worst — night, after meals, on exertion, or in cold air. That single observation often points straight to the diagnosis.
• Bring every X-ray, prescription and old report to your appointment, including the tablet strips of your BP medicines.

Frequently asked questions

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