What you need to know about Chronic cough and allergic rhinitis

25 October 2019 12:00 pm - 1     - {{hitsCtrl.values.hits}}

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Chronic cough and allergic rhinitis are two types of respiratory diseases often encountered by people. To shed more light on these areas, the Daily Mirror Health Capsule interviewed Consultant Paediatric Respiratory Physician at the Lady Ridgeway Hospital for Children, Dr.Ganganath Gunathilaka.
 
Due to the sensitivity of the throat, the simple act of drinking water could, if disrupted, cause one to cough.Nobody worries about an occasional cough because it is commonplace. However, there is reason to be concerned if the cough persists for over two weeks. Coughing, especially a lingering cough can produce fatigue, interrupt sleep and impair concentration and work performance.Dr.Gunathilaka identified these as an acute cough that goes on for a few weeks, a habitual cough, or it can be a condition with an underlying disease. “In my view, there are three components to a cough. A pathological component, psychological component and a social component,” the Doctor said. A habitual cough can be stimulated psychologically. Thereby, it’s important to identify a habitual cough to avoid unnecessary treatment.
 
 
Causes
The Doctor observed that there is a broad spectrum of causes for a chronic cough. He identified asthma, bronchiectasis, postnasal drip and gastroesophageal reflux disease (GERD) as the main causes.
 Other conditions such as tuberculosis, outbreaks of influenza, chronic respiratory infections,allergic rhinitis, sinusitisand pneumonia are also causes.Some of the less common causes include, environmental irritants, lung infections and psychological disorders. Smoking is a leading cause and smokers would eventually develop a chronic ‘smoker’s cough’.
 
Bronchial asthma is a significant cause of the chronic cough. Breathlessness and wheezing are the common symptoms of asthma. But instead of a wheeze some people may just cough.“You can get a cough in the night and in the morning when you have bronchial asthma. When someone has bronchial asthma, exposure to allergens and cold or dusty aircan also cause a chronic cough.” Dr.Gunathilaka stated that a postnasal drip occurs, when the membranes of the nose respond to irritants and produce more mucus. This mucus, which is watery and runny, can drip down the throat causing irritation of the nerves which leads to a cough.Bronchiectasis causes a dilatation of the airway and the production of excess mucus, which results in a chronic cough. GERD, is caused when acid from the stomach makes its way to the oesophagus instead of going down to the intestines. This acid irritates the nerves on the oesophagus triggering the cough reflex.
 
 
When to worry
Although it’s usually not serious, a chronic cough should not be ignored. There are certain warning symptoms that call for prompt 
medical care. 
 
  • Coughing up blood
  • High or prolonged fever
  • Shortness of breath
  • Wheezing
  • Night sweats
  • Chest pain
 
Treatment
Dr.Gunathilaka revealed that treatment for a chronic cough would depend on the underlying or actual cause.He emphasized the importance of seeking medical advice for a prolonged cough of over two weeks. 
 
 
Allergic Rhinitis
Allergic rhinitis, also known as hay fever, is caused by the sensitivity of the nose and upper respiratory system to certain allergens. When a person breathes in something to which they are allergic to, the inside of their nose would become swollen and inflamed. Dr.Gunathilaka identified an aero allergen as an airborne substance that can trigger an allergic reaction when inhaled. He observed that certain people may react to a particular substance and develop allergies. While symptoms presented by adults and children are similar, the causes tend to be different. 
 
The Doctor revealed that possible aero allergens include, house dust mites (reaction to their faeces), cockroaches, animal dander, fungus allergies and pollen (especially during harvest season).
 
It is possible for the sinuses to get infected when they are blocked. “Mucus is a rich substance in which bacteria can grow easily. When this happens, an infection will follow,” said Dr.Gunathilaka, adding that a person’s voice and hearing can also be affected due to an infection. Constantly rubbing of the eyes, causes damage to the cornea resulting in impaired vision. 
 
Additionally, allergic rhinitis can disrupt the daily life of a person who suffers from this condition. “The personal and daily life of a person is disrupted. It is difficult for students to study when experiencing symptoms of allergic rhinitis. Even the confidence of a person is affected,” said the Doctor.
 
 
Why do only certain people?
Only certain people will have an abnormal reaction in their bodies to certain allergens. “For some people, their body would destroy it, while in others they can have a reaction inside their bodies,” said the Doctor. There are multiple factors that can cause this. Most people who develop allergic rhinitis, have a genetic predisposition to developing allergies. Together with this factor, environmental pollution and allergens and neonatal issues at birth could further cause a person to develop this condition.
 
Dr.Gunathilaka said that due to the prevalence and use of vaccinations and antibiotics, the body although equipped, is not trained to fight against these conditions and diseases. “The modernisation of the environment can cause people to have allergic reactions in certain conditions.” 
 
 
Symptoms
Symptoms can be purely seasonal, episodic or year round depending on the allergen and the exposure to it. “There are variations according to the time of day. One can experience them in the morning and it can completely subside during the day only to resurface in the night,” said the Doctor. The symptoms experienced varies from person to person.
Dr.Gunathilaka identified the following symptoms or reactions of allergic rhinitis.
 
  • Itchy eyes
  • Red eyes
  • Blocked nose
  • An itchy nose and throat
  • Sore throat
  • Sneezing
  • Eyes tearing
  • Allergic salute
 
If the person has a severe reaction to an allergen, the symptoms can be experienced throughout the day. “If the reaction is severe, then treatment is necessary. If it is mild, treatment is not essential as more harm can be caused due to the treatment,”said the Doctor, adding that it is a clinical decision to treat a person suffering from the condition.
 
 
Treatment
Allergic rhinitis can either be symptomatically managed or specially treated. Antihistaminic medication is prescribed for symptomatic management, while nasal sprays and appropriate drugs are prescribed under specialised treatment. “The use of nasal sprays doesn’t cause the user to become addicted to using it,” emphasised the Doctor, adding that many people fear using it due to this reason. 
 
As allergens are the starting point of allergic rhinitis, avoiding those triggers would be an effective treatment. However, not all allergens can be avoided. But, steps can be taken to minimize the chances of encountering or reacting to them. “For example, it is impossible to completely avoid dust mites. Keeping the house clean and exposing bedding and pillows to sunlight will help reduce the dust mites,” said the Doctor. 
 
It is important to identify the allergen that causes the reaction. This can be detected through an allergen test. Once it has been identified, then it can be treated accordingly. Dr.Gunathilaka, emphasised that this is a condition that needs to be controlled and should not go untreated. Once under control a person can live a normal life.
Pics by Damith Wickramasinghe
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  Comments - 1

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  • Mr Royce Arasaratnam Monday, 28 October 2019 03:19 PM

    Well presented article. DNA makes us who we are! Thus no cure but good control is the way forward. MR Royce Arasaratnam FRCS ( orl ) Retd. Consultant Otolaryngologist UK


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