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Coughing Up Dry

By: Marc Evans Abat, MD, FPCP, FPCGMCoughing Up Dry

A dry cough is basically coughing without any phlegm production.  There are many causes of a dry cough.  Basically, anything that irritates the airways, from the entrance (the mouth, throat, and nose), down to the lungs, may lead to a dry cough.  These are some common causes:

  • Any infection at the start (whether viral or bacterial) can initially cause dry coughing.  It may stay that way all throughout, or be converted later into a productive cough with phlegm.
  • Exposure to noxious fumes (smoke, gases, and fumes).  Cigarette smoke is a common cause of a dry cough (it later leads to productive coughing due to the progression of airway damage).
  • Allergic cough can be triggered by exposure to known or unknown triggers like dust.
  • Post-inflammatory cough is a dry cough that happens after an infection has resolved, but the residual inflammation is still present.
  • Acid reflux into the throat in some individuals can cause irritation and hence a chronic dry coughing that is sometimes worse during the night or when sleeping.
  • It can be a symptom of asthma, wherein the attack does not manifest with wheezing and severe airway narrowing, but more of a prolonged dry cough that is easily triggered even with minor effort or speaking.  The coughing can be triggered by any of the aforementioned reasons.  Temperature changes, particularly dry, cold temperatures can also trigger an asthma-related dry cough.
  • It can be a manifestation of other diseases like heart failure or even cancer anywhere along the respiratory tract.  The cough results from either airway irritation, congestion of the airways or lungs or impairment in air flow.
  • Some medications can cause dry persistent coughing.  Among persons with hypertension, the use of medications called ACE inhibitors (e.g. enalapril, captopril, ramipril) leads to an increase of certain chemicals that stimulates coughing.  The mechanism is not mediated through an allergy pathway.
  • In many older individuals, frequent dry coughing may already be a sign of a possible swallowing disorder.  The coughing is related to unwanted entry of foreign particles into the airway (e.g. saliva, food or water).  The coughing is a protective reaction in this situation. 
  • Obstructive sleep apnea can be a cause of dry cough.  This happens when the flow of air is blocked during sleep when the tongue or throat muscles relax excessively. The more forceful movement of air through the throat causes irritation.  This is often observed in those who snore.


How do we relieve a dry cough?

  • Ensure adequate fluid intake.  This will help maintain moisture in the throat and airways.  The amount will vary depending on the person but generally is about 1.5-2 liters a day (give or take a glass or two).
  • Bacterial infections should be treated judiciously by your personal doctor.  Viral infections should be treated supportively.
  • Remedies that soothe the irritation of the throat should be taken.  These come either as lozenges, syrups or throat sprays.  These either help reduce the inflammation or provide temporary comfort sensation (e.g. in the case of menthol-containing remedies).
  • Some medications can help convert the hard dry cough to a softer productive cough (expectorants) or suppress a cough (antitussives).
  • Medications should also be taken to relieve the underlying cause (e.g. acid medications for reflux, bronchodilators for asthma, and antihistamines for allergies).
  • Offending agents should be removed, avoided and modified (avoiding dust and smoke exposure, avoiding cold air exposure, smoking cessation, changing cough-inducing medications)
  • If the dry cough persists despite all the remedies, please consult your doctor for a more thorough check-up.

These tips should hopefully keep you up to speed regarding dry cough!

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