I Have a Persistent Cough – Is it an Allergy?

A persistent, seasonal cough might indicate cough-variant asthma. Here’s what you need to know.

Chronic coughing is among the most common reasons people seek medical attention. When coughing is particularly intense and prolonged, it can have numerous negative consequences.

Intense coughing, known as a “nagging” cough, can irritate the lungs, resulting in more coughing. This loop can lead to the following complications:

• Sleep Deprivation: Constant coughing throughout the night can make falling and staying asleep difficult, leading to daytime fatigue.
• Lightheadedness and Fainting: Vigorous coughing can cause dizziness or fainting spells. The pressure put on the blood vessels in the head can lower blood flow to the brain, resulting in lightheadedness or even loss of consciousness. This symptom can be dangerous if a person is not in a safe environment or performing tasks that require concentration.
• Headaches: Constant strain and pressure on the neck and head can contribute to the development of migraines or other types of headaches.

A wide range of potentially serious conditions can cause persistent coughing. Understanding the underlying mechanisms, types of coughing, and symptoms associated with cough-variant asthma can help you effectively identify and manage this condition.

What Causes Coughing?

Coughs are reflexive, forcible expulsions of air from the lungs through the throat and mouth. Coughing is a natural defense mechanism that helps clear irritants, such as mucus, from the respiratory system and defends against potential infections or foreign substances.

Types of Coughs

Coughs can be classified in several ways: Duration (how long they’re experienced), sensation, and underlying cause.

• Duration
  • Acute Cough: A short-term cough caused by an infection, illness, or other temporary condition. This cough lasts no longer than three weeks.
  • Subacute Cough: A cough that persists between three and eight weeks post-infection or illness.
  • Chronic Cough: A cough is considered chronic when it lasts longer than eight weeks. A refractory chronic cough lasts longer than eight weeks despite medical intervention.

• Sensation
  • Productive Cough (Wet Cough): A cough that expels phlegm or mucus.
  • Non-productive Cough (Dry Cough): A cough that does not bring up phlegm or mucus. A tickling sensation in the throat typically precedes a dry cough. It is often caused by an infection or immune response that leads to inflammation in the upper airways.

• Common Causes
  • Infection: Colds, Flu, acute viral bronchitis, and pneumonia are types of infections that commonly cause a cough response.
  • Irritants: Tobacco smoke, vaping, dust, and environmental pollutants can trigger persistent coughing.
  • Medications: Drug-induced cough is a chronic condition sometimes triggered by a response to angiotensin-converting enzyme (ACE) inhibitors, which are prescribed to manage high blood pressure.
  • Chronic Obstructive Pulmonary Disease (COPD): COPD is a progressive lung disease characterized by the obstruction of airflow in the lungs. The obstruction leads to symptoms such as shortness of breath, wheezing, and persistent productive (wet) coughing.
  • Upper Airway Cough Syndrome (UACS): Sometimes known as postnasal drip syndrome, UACS is among the leading causes of persistent cough. It is thought to be triggered by upper and lower airway sensory nerve hypersensitivity.
  • Gastroesophageal Reflux Disease (GERD): Continual irritation from stomach acid flowing into the esophagus can cause persistent coughing.
  • Asthma: Coughing related to asthma tends to be seasonal, though chemicals or common allergens can also trigger it. Coughing is the primary – sometimes only – symptom of cough-variant asthma.

What Is Cough-Variant Asthma?

Cough-variant asthma (CVA) is a form of asthma characterized by a persistent dry cough as the main symptom, rather than wheezing or shortness of breath. Unlike typical asthma, the cough in CVA can occur without other symptoms.

Asthma causes inflammation and swelling in the airways of the lungs. Inflammation causes breathing tubes to constrict, making the lungs more reactive to environmental irritants like cigarette smoke, dust, and pollen. The lungs then attempt to expel the irritants by initiating a coughing response.

Symptoms of Cough-Variant Asthma

CVA is often misdiagnosed due to its atypical symptoms. The main symptom is a persistent dry cough lasting several weeks or even months. The cough may worsen in the morning or after exposure to certain triggers, such as allergens or respiratory infections.

Causes of Cough-Variant Asthma

The exact cause of CVA is not fully understood, but it is believed to be related to inflammation and irritation of the airways. In CVA, the airways become hypersensitive, leading to bronchoconstriction (narrowing of the airways). This disorder may cause a cough that persists even in the absence of other asthma symptoms.

Could I Have Cough-Variant Asthma?

If you answer “yes” to the following questions, please consider scheduling an appointment with an allergist to screen for cough-variant asthma:

• Have you experienced a dry cough for more than 8 weeks?
• Does your coughing get worse when you’re exposed to dust, strong fragrances, pet dander, dry weather, or cold air?
• Do you take beta blockers?
• Do you routinely wake from sleep due to coughing?
• Do you have dry coughing fits after exercise?

How Can Allergists Treat Coughing?

Forceful or erratic coughing that flares up multiple times per week should receive a medical diagnosis. If your coughing is triggered by exposure to irritants like pet dander, pollen, and dust, or if it is seasonal, CVA could be the cause. An allergist can provide treatments that dramatically reduce your coughing frequency and intensity.

Treatments for coughing include a bronchodilator and corticosteroid inhaler, which reduce inflammation and mitigate symptoms when used regularly.

Non-prescription medications and treatments are usually ineffective for Cough-Variant Asthma (CVA).

If you struggle with a persistent cough that doesn’t accompany any other symptoms, please contact our helpful team at Allergy Partners to schedule a full evaluation today.