DEAR DOCTOR K:
I had a chest cold. I feel better, but I’m still coughing a lot. This has been going on for more than three weeks. Why am I still coughing?
Most likely, you had bronchitis, an inflammation of the lining of the bronchial tubes. Bronchitis is usually caused by an infection — viral or bacterial. The bronchial tubes are air passages connecting the lungs to the windpipe. Bronchitis usually starts with an upper respiratory illness that spreads from the nose and throat down into the airways. (I’ve put an illustration showing how bronchitis affects the airways on my website, below.)
Your immune system often is able to wipe out the infection in about five to 10 days. However, for several different reasons, symptoms may persist — as they have with you.
Though your body usually fights off the initial respiratory infection promptly, your bronchial tubes can remain inflamed and sensitive for several weeks, causing you to continue coughing. The inflammation also can create spasm or irritability of the bronchial tubes: They intermittently tighten up suddenly, causing coughing. This can produce other symptoms as well:
- a tight feeling in your chest
- shortness of breath when you exert yourself
- mild fatigue
To treat your irritable bronchial tubes, your doctor may prescribe an inhaler of what is called a bronchodilator medicine. Albuterol is one commonly prescribed. Bronchodilators are used by people with asthma to ease breathing during an asthma attack.
If this does not control the cough, you may also need a corticosteroid inhaler. Corticosteroids can help to reduce inflammation of the airways. In rare cases, you might need to take an oral corticosteroid, such as prednisone, for several days.
Another cause of a persistent cough after bronchitis is sinus inflammation, leading to post-nasal drip. Junk from inflamed sinuses drops down into the back of the throat. The throat has sensitive areas that when stimulated cause a person to cough. Post-nasal drip can stimulate them. An over-the-counter saline spray can help to remove mucus and irritants from your nose. It will also help to moisturize your nasal passages.
A persistent cough also can be caused by thick mucus in the bronchial tubes. Try drinking plenty of fluids to make the mucus thin, watery and easy to cough up. Warm, moist air also can loosen mucus. Try using a vaporizer or humidifier; standing in or near a hot shower; or drinking hot tea or soup.
In some cases, a person continues to cough for weeks after bronchitis because of a stubborn infection. Most cases of bronchitis are caused by viruses. But bronchitis can also be caused by bacteria, which might not yet be eliminated by your immune system. If your doctor suspects a bacterial infection, he or she may prescribe an antibiotic.
There’s usually a fixable reason for a persistent cough after bronchitis. If the home remedies I’ve recommended don’t work, talk to your doctor.