What is the most common cause of a chronic cough in an individual who smokes a pack of cigarettes a day?

Cough is a sudden explosive force of air through the glottis (vocal folds). It is an essential mechanism for clearing secretions and harmful materials from the trachea and bronchi. Although an individual may cough voluntarily, coughing is predominantly the result of an involuntary reflex stimulated by cough receptors in the airway. Chronic cough (CC), defined as a persistent cough of greater than 3 weeks duration, is no longer protective and is usually the result of aberrant stimulation of the cough receptors. Affected individuals have a diminished quality of life secondary to ensuing hoarseness, chest pain and muscle ache. Life’s daily activities become subject to frequent, disabling interruptions.

The most frequent causes of chronic cough are listed in Table I. The most common etiology is smoking. The more cigarettes an individual smokes, the more likely he/she is to suffer from CC. Up to 25% of persons who smoke 1 pack per day and almost 50% of those who smoke 2 packs per day will endure CC. Medications, asthma, post-viral reactive airway disease and reflux are other common inciting factors. In our experience, CC is frequently caused by multiple factors.

We have developed a multisystem approach to the patient with CC. Individuals presenting to the Voice and Swallowing Center have usually been referred by their primary care physician after unsuccessful first-line therapy. We therefore utilize multisystem tertiary care diagnostics to arrive at a diagnosis expediently and relieve the cough. Our outpatient armamentarium includes but is not limited those diagnostics listed in Table II.

At the UC Davis Center for Voice and Swallowing Disorders we have a chronic cough clinic devoted to the care of individuals who suffer from this debilitating ailment. The clinic also serves as a clinical research facility dedicated to improving the care of individuals with CC.

Chronic obstructive pulmonary disease (COPD) refers to a group of diseases that cause airflow blockage and breathing-related problems. COPD includes emphysema and chronic bronchitis.1

With COPD, less air flows through the airways—the tubes that carry air in and out of your lungs—because of one or more of the following:2

• The airways and tiny air sacs in the lungs lose their ability to stretch and shrink back.
• The walls between many of the air sacs are destroyed.
• The walls of the airways become thick and inflamed (irritated and swollen).
• The airways make more mucus than usual, which can clog them and block airflow.

In the early stages of COPD, there may be no symptoms, or you may only have mild symptoms. As COPD worsens, the symptoms may become more severe. Symptoms of COPD include:2

• A cough that lingers for a long time and doesn’t go away completely, or a cough that produces a lot of mucus
• Shortness of breath, especially with physical activity
• Wheezing (a whistling sound when you breathe)
• Tightness in the chest

Not everyone with these symptoms has COPD. A doctor can determine if you have COPD or another condition that has similar symptoms.

How severe your COPD symptoms are depends on how much lung damage you have. If you continue smoking, the damage will occur faster than if you stop smoking.2

Smoking cigarettes will kill you, but before you die, you could experience some pretty terrible diseases and health conditions from smoking. Here are some of the most gruesome diseases caused by smoking*:

1. Lung Cancer

More people die from lung cancer than any other type of cancer. Cigarette smoking is the number one risk factor for lung cancer; it's responsible for close to 90% of lung cancer cases. Your chance of still being alive five years after being diagnosed is about 1 in 5.

2. COPD (chronic obstructive pulmonary disease)

COPD is an obstructive lung disease that makes it hard to breathe. It causes serious long-term disability and early death. COPD starts by making it hard to be active, such as playing with a grandchild, then usually gets worse, until climbing a short set of stairs or even walking to get the mail is exhausting or impossible. It can leave people stuck in their homes, unable to do the things they want or see friends. About 85% to 90% of all COPD is caused by cigarette smoking. COPD is the fourth leading cause of death in the United States.

3. Heart Disease

Smoking harms nearly every organ in your body, including your heart. Smoking can cause blockages and narrowing in your arteries, which means less blood and oxygen flow to your heart. When cigarette consumption in the U.S. decreased, so did the rates of heart disease. Yet, heart disease remains the number one cause of death in the U.S.

4. Stroke

Because smoking affects your arteries, it can trigger stroke. A stroke happens when the blood supply to your brain is temporarily blocked. Brain cells are deprived of oxygen and start to die. A stroke can cause paralysis, slurred speech, altered brain function and death. Stroke is the fifth leading cause of death in the United States and a leading cause of adult disability.

5. Asthma

Asthma is a chronic lung disease that makes it harder to move air in and out of your lungs—otherwise known as "breathing." Because cigarette smoke irritates air passages, it can trigger sudden and severe asthma attacks. Asthma is a serious health condition that affects close to 25 million Americans. Smoking only makes it worse.

6. Reproductive Effects in Women

Smoking can cause ectopic pregnancy in women, which is when a fertilized egg implants somewhere other than the uterus. The egg can't survive and, if left untreated, can be life-threatening for the mother. Smoking also causes reduced fertility, meaning it makes it more difficult to get pregnant.

7. Premature, Low Birth-Weight Babies

The effects of smoking not only impact mom's health, but also that of the baby. Smoking while pregnant can cause babies to be born prematurely and/or with a low birth-weight. Babies born too early or too small have increased risk of health complications and even death.

8. Diabetes

You're more likely to get type 2 diabetes if you smoke. People who smoke cigarettes are 30% to 40% more likely to develop type 2 diabetes than people who don't smoke. Additionally, smoking increases the risk of complications once diagnosed with diabetes, such as heart and kidney disease, poor blood flow to legs and feet (which leads to infections and possible amputation), blindness and nerve damage.

9. Blindness, Cataracts and Age-Related Macular Degeneration

Smoking can make you go blind. It damages your eyes and can result in vision loss. Age-related macular degeneration is caused by smoking. It is the leading cause of blindness in adults ages 65 and older.

10. Over 10 Other Types of Cancer, Including Colon, Cervix, Liver, Stomach and Pancreatic Cancer

Basically, all the cancers. For both cancer patients and survivors, those who smoke are more likely to develop a second primary cancer. And now we know that smoking causes at least a dozen cancers, including liver and colorectal, and reduces the survival rates for prostate cancer patients.

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