Coughing helps to clear foreign substances from your lungs and keep your upper air passages clear. A chronic cough is defined as a cough that lasts more than 8 weeks (or 4 weeks for children) and is one of the most common complaints addressed in family medicine. Typically chronic coughs are symptoms of other disorders, including asthma, allergies, acid reflux or sinus problems. A chronic cough may also be the result of smoking, exposure to secondhand smoke or an infectious disease. If left untreated, a chronic cough can lead to complications such as headaches, dizziness, urinary incontinence, fractured ribs, sore abdominal muscles, excessive sweating, and even conditions such as COPD or emphysema. Healing a chronic cough depends largely on identifying and treating the underlying cause of the cough. If you have a chronic cough, see your doctor: while it's usually not a serious symptom, it can be a sign of serious diseases including lung cancer.
Patients in GOLD groups C and D should be prescribed a long-acting anticholinergic or a combination of an inhaled corticosteroid and long-acting beta 2 agonist. 3 Compared with tiotropium alone, fluticasone/salmeterol (Advair) improved daily symptom scores and decreased mortality (number needed to treat = 40), but increased the incidence of pneumonia (number needed to harm = 25) and did not change the rate of exacerbations. 33 Patients with poorly controlled symptoms should start triple therapy with an inhaled corticosteroid, long-acting anticholinergic, and long-acting beta 2 agonist. The data for triple therapy are inconsistent, with studies showing improvement in lung function and symptom scores but conflicting results regarding reduction in exacerbation rates compared with tiotropium alone. 28 , 34 A summary of initial treatment options and common medications is presented in Table 4 8 and Table 5 , 35 and patient instructions for inhaler use are reviewed in eFigure B .