From the Guidelines
An irritative cough is a persistent cough triggered by irritation or inflammation in the airways rather than by an infection or excess mucus, and its management should start with a thorough medical history and physical examination to determine the underlying cause, as recommended by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1.
Causes and Triggers
The causes of an irritative cough can be varied, including:
- Acid reflux
- Post-nasal drip
- Asthma
- Environmental irritants like smoke or pollution
- Certain medications such as ACE inhibitors These causes should be considered and addressed in the management of the cough, as suggested by the ACCP guidelines 1.
Management and Treatment
The treatment of an irritative cough should be directed at the underlying cause, and may include avoiding triggers, using a humidifier, drinking plenty of fluids, and taking over-the-counter cough suppressants containing dextromethorphan for temporary relief 1. Some specific treatments for common causes of irritative cough include:
- Antacids or H2 blockers like famotidine (20mg twice daily) for acid reflux-related coughs
- Antihistamines such as loratadine (10mg daily) or nasal steroid sprays like fluticasone (1-2 sprays per nostril daily) for allergic causes It is essential to note that if the cough persists beyond 2-3 weeks, becomes severe, or is accompanied by other symptoms like fever or shortness of breath, medical evaluation is necessary as it could indicate a more serious condition requiring specific treatment, as emphasized by the ACCP guidelines 1.
From the Research
Definition of Irritative Cough
- An irritative cough is a type of cough that is caused by the stimulation of nerve endings in the respiratory tract by irritants such as chemicals, particles, or gases 2.
- This type of cough is a protective mechanism that helps to clear the airways of harmful substances and prevent damage to the lungs.
Causes of Irritative Cough
- Occupational and environmental irritants, such as those found in the workplace or in polluted air, can cause irritative cough 2.
- Chemicals, particles, and gases can all stimulate the nerve endings in the respiratory tract and trigger a cough.
- Irritants can cause a reversible inflammatory change in the living tissue of the respiratory tract, leading to cough 2.
Characteristics of Irritative Cough
- Irritative cough can be acute or chronic, depending on the duration and severity of the exposure to the irritant 2.
- The cough can be dry or productive, and may be accompanied by other symptoms such as wheezing, shortness of breath, or chest tightness.
- The cough reflex can be triggered by the activation of transient receptor potential (TRP) cation channels, such as TRPV1 and TRPA1, which become activated or hyperactivated in response to chemicals or lung injury 2.
Treatment of Irritative Cough
- Treatment of irritative cough typically involves avoiding exposure to the irritant and using medications to suppress the cough 3, 4.
- Antitussives, such as dextromethorphan, may be used to treat irritative cough, although their efficacy has been questioned in some studies 3, 4.
- Further research is needed to fully understand the mechanisms of irritative cough and to develop effective treatments.