Dermatologic Manifestations of Pulmonary Disease

7 Common Dry Cough Causes (and Treatment/Remedy Options You Can Try)

A dry cough occurs as a natural reflex when inflammation or irritation affects your airway. It is also called an unproductive cough since it does not produce phlegm or mucus. A dry cough can be classified as acute or chronic, based on its duration.

A dry cough often occurs as a result of an upper respiratory infection and resolves with the course of the disease. However, it can also be a sign of chronic health problems such as acid reflux or asthma. Treatment of a dry cough depends on the cause.

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#1 COVID-19 COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. It causes mild to moderate respiratory illness that typically does not require special treatment. However, older people and those with underlying medical conditions like diabetes, chronic respiratory disease, and cardiovascular disease have the highest risk of developing serious illnesses from COVID-19. The COVID-19 infection inflames your lung tissues, making breathing, getting oxygen, and removing waste more challenging. With COVID-19, a dry cough occurs in about 50% to 70% of people who have the disease. While COVID-19 affects everyone differently, other common symptoms can include: Treatment Most people do not require special treatment for COVID-19. However, your healthcare provider may advise treatment based on your age and other health conditions. COVID-19 treatments include: #2 Asthma Asthma is a chronic lung disease that affects the airways that carry air in and out of your lungs. With asthma, your airways become narrowed when you encounter specific triggers such as smoke, viruses, or allergens like pollen, causing an asthma attack and making it harder to breathe. Asthma can cause a dry cough when the small airway muscles tighten and swell. Other symptoms of asthma include: Chest tightness with pain Cyanosis (a color change in tissue on mucus membranes, fingertips, or nail beds to bluish on lighter skin tones and grayish or whitish on dark skin tones Expanded chest that does not deflate when you exhale Faster or slower than normal breathing Hard or shallow breathing Nighttime waking due to asthma symptoms Ribs or stomach moving in and out rapidly and deeply Shortness of breath Wheezing (a whistling sound when you breathe) Treatment Asthma treatment is complicated because it involves preventing symptoms and symptom relief. Asthma treatments include lifestyle changes and medications, as well as bronchial thermoplasty. Making lifestyle changes to avoid exposure to common asthma triggers that cause the airways to constrict include: Quick-relief medications to help prevent or ease symptoms during an asthma attack include: Inhaled short-acting beta-agonists (SABAs) to open your airways so air can flow through Oral corticosteroids to reduce swelling in your airways Short-acting anticholinergics to help open your airways quickly Long-term medicines include: Another treatment is bronchial thermoplasty. It is a procedure that involves the application of heat to the muscles along the walls of your airways to help prevent airway narrowing. It is done via the insertion of a bronchoscope (a tube with a camera at the end, through your mouth to see inside your airways).  #3 Idiopathic Pulmonary Fibrosis Idiopathic pulmonary fibrosis (IPF) is a severe, progressive, and generally fatal lung disease that causes inflammation and/or scarring of your lungs' alveoli (air sacs) for unknown reasons. The scarring interferes with your ability to breathe because it thickens the lining of your lungs. This causes irreversible loss of the tissue's ability to transport oxygen until the lungs can no longer provide oxygen to your organs and tissues. A dry and nagging cough that worsens over time is a common early symptom of idiopathic pulmonary fibrosis. It can be triggered by factors such as exercise, laughing, crying, or breathing in smoke or other chemicals. Other symptoms of idiopathic pulmonary fibrosis are: Aching muscles and joints Digital clubbing (widening and rounding of the tips of your fingers or toes) Extreme tiredness Gradual unintended weight loss Malaise (generally feeling unwell) Rapid, shallow breathing Shortness of breath that worsens over time Treatment While there is no cure for IPF, treatments can slow down the progression of lung damage and help improve your quality of life. Treatment can include medications, breathing therapies, and surgery. Medications include: Antacids to prevent stomach aid from getting into your lung Antifibrotic agents Esbriet (pirfenidone) and Ofev (nintedanib) to help your lungs work better and prevent acute exacerbation Cough medicationsImmunosuppressant drugs to reduce inflammation if an autoimmune disease is present Steroids that reduce inflammation Breathing therapies include: Surgery includes a lung transplant for treatment of severe symptoms. #4 Gastroesophageal Reflux Disease Gastroesophageal reflux disease (GERD) is a condition in which your stomach acid repeatedly flows back up into your esophagus (the food tube that connects your mouth and stomach). The regurgitated stomach acid is called acid reflux. Problems arise because this highly acidic substance can irritate the lining of your esophagus. While periodic acid reflux is common, it happens repeatedly over time with GERD. GERD can cause a cough when the acid and other digestive enzymes irritate your throat. This change in sensation or irritation can stimulate a cough. In addition to a dry cough, symptoms of GERD can include: Asthma Bloating Burping Chest pain Difficulty swallowing or a sensation of having a lump in your throat) Nausea Regurgitation (the return of stomach contents up through your esophagus and into your mouth) Shortness of breath Sore throat, hoarseness, or laryngitis Sour taste in your mouth Tooth enamel erosion (wearing away) Treatment Treatment for GERD can vary based on the severity of your disease. Common treatments include changes to diet, medications, and surgery. Dietary and lifestyle changes include: Avoid eating before bedtime. Avoid lying down after eating. Avoid trigger foods. Elevate the head of your bed 6 to 8 inches while you sleep. Establish and maintain a healthy weight. Participate in smoking cessation. Over-the-counter (OTC) and prescription medications include: Antacids to neutralize stomach acids including Maalox, Mylanda, Rolaids, TUMS, and others (calcium carbonate) Histamine 2 (H2) blockers to reduce the amount of stomach acid including Pepcit (famotidine), Tagamet HB (cimetidine), Zantac (ranitidine), and Axid (nizatidine) Lyvispah (baclofen) to reduce lower esophageal sphincter relaxation, a condition that allows acid backwash to occur Proton pump inhibitors (PPIs) to reduce the amount of stomach acid including Prilosec (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole) Surgery includes: Endoscopic gastric plication is the application of sutures around your lower esophageal sphincter to tighten it. Laparoscopic fundoplication is considered the gold standard of GERD surgery, it involves a laparoscopic procedure in which your fundus (the top of your stomach) is wrapped around the bottom of your esophagus. Magnetic sphincter augmentation (LINX device) entails the placement of tiny magnetic titanium beads in the area where your stomach and esophagus meet to quickly close the opening to prevent acid reflux after it lets in food and drink. Transoral incisionless fundoplication (TIF) is a procedure performed using an endoscope (a long tube with a camera that is inserted through your mouth into your esophagus) to fold your fundus around your esophagus without an incision. #5 Postnasal Drip Postnasal drip, also known as upper airway cough syndrome, is a feeling of mucus gathering in your throat or at the back of your nose. When you are healthy, you swallow mucus unconsciously many times a day. However, factors such as seasonal allergies, some medications, GERD, and spicy foods can increase the volume of mucus or thicken it. This can lead to coughing as you try to manage the abnormal flow and texture of the mucus. Postnasal drip typically lasts for a few days or weeks, though it can become chronic and persist for months. In addition to a persistent dry cough, symptoms of postnasal drip include: Treatment Treatment for postnasal drip varies based on the cause of the problem, including bacterial infections, chronic sinusitis, seasonal allergies, and GERD. For bacterial infections: Chronic sinusitis may require surgery to open blocked sinuses. Seasonal allergies may be treated with the following: Antihistamines Avoiding triggers Cromolyn and steroid nasal spray Decongestants Immunotherapy (desensitization) Oral steroids If GERD is the cause, traditional treatments for this condition will be used. Measures to allow the mucus to pass more easily include: Avoid diuretics (medications that reduce fluid from your body by increasing urination). Drink more water. Eliminate caffeine. Mucus-thinning agents such as Mucinex, Robitussin (guaifenesin). Saline nasal sprays such as Ocean or Ayr to reduce secretion thickness. #6 Upper Respiratory Infections Upper respiratory infections (URIs) are contagious infections that affect your upper respiratory tract (including your nasal passages, sinuses, and throat). The most common upper respiratory infections are viral infections, such as the rhinovirus, which causes the common cold. Viruses such as adenovirus and bacteria such as chlamydia can cause upper respiratory infections. A dry cough is a common URI symptom because these conditions affect your nasal passages and throat. Other symptoms of upper respiratory infections can vary by specific disease. These symptoms can include: Bad breath Body aches Conjunctivitis (itchy and watery eyes) Diarrhea Fever Headache Nasal congestion and difficulty breathing through the nose Nausea Runny nose Shortness of breath Sinus pain Sneezing Sore or scratchy throat and pain when swallowing Vomiting Treatment Treatment for an upper respiratory infection can vary based on the cause of the infection. Dry cough remedies can include medications and lifestyle changes. Medications include: Lifestyle changes include: Increased fluids Rest Supplemental oxygen #7 Lung Cancer Lung cancer is cancer that starts when cells in your lung mutate (develop abnormally) and grow out of control. It usually occurs from breathing dangerous chemicals, but can also develop without a known cause. As the abnormal cells grow, they join to form a tumor, which destroys surrounding healthy lung tissue. Lung cancer can cause a cough when it originates in your large central airways. A tumor can narrow the airway and cause coughing. While a dry cough can be an early sign of lung cancer, the disease affects everyone differently. In most people, symptoms do not occur until the disease advances. In addition to a dry cough, other possible symptoms of lung cancer include: Chest pain that worsens with coughing, deep breathing, or laughing Constant fatigue Coughing up blood or rust-colored spit or phlegm Loss of appetite Repeated episodes of bronchitis or pneumonia Shortness of breath Swollen or enlarged lymph nodes (glands) inside your chest in the area between your lungs Unexplained weight loss Wheezing Treatment Treatment for lung cancer varies based on its type and stage. Depending on additional factors such as your age and other health conditions, treatment for lung cancer can include one or more of the following therapies: Other Potential Causes There are many other potential causes of a dry cough. These include: Smoking or Inhaling Cigarette Smoke Smoking or breathing in smoke can sometimes cause a smoker's cough fast your body tries to clear the irritants caused by smoking. Angiotensin Converting Enzyme (ACE) Inhibitors About 10% of people who take ACE inhibitors develop a dry cough. These drugs, such as Vasotec (enalapril) and Zestril (lisinopril), are commonly used to treat high blood pressure. Bronchiectasis Bronchiectasis is an obstructive lung disease that occurs from inflammation and infection. It causes permanent widening of your airways. Bronchiectasis occurs from inflammation and infection. Cystic Fibrosis Cystic fibrosis is a progressive, and life-threatening condition. It damages the lungs and digestive tract. Sarcoidosis Sarcoidosis develops when groups of cells in your immune system form called granulomas. These small, red, and inflamed lumps can cause permanent scarring in your lungs and lymph nodes in your chest. Pneumonia Pneumonia or other lung infections are contagious conditions caused by bacteria or viruses in your lower respiratory tract. They spread when an infected person coughs or sneezes. Laryngopharyngeal Reflux Laryngopharyngeal reflux is a type of reflux (the return of stomach acid from your stomach into your throat) that triggers postnasal drip, the sensation of a lump in your throat, and a dry cough. Environmental Allergies Environmental allergies are types of allergies cause your body to overreact to harmless substances in the environment. They can include pollen, mold, pet dander, or grass. Certain Medications A dry cough can occur as a side effect of the following types of medications: How to Get Rid of a Dry Cough at Home There are many ways to get rid of a dry cough at home. Choosing the best treatment depends on the cause of your symptoms. Since a dry cough can occur as a symptom of another condition, it is important to treat and manage underlying health problems. At-home remedies encompass lifestyle modifications and medications. Lifestyle Modifications These include: Avoid known allergens such as smoke and hay fever to reduce the risk of a dry cough caused by an allergic reaction. Avoid secondhand airborne irritants and cigarette smoke in your home and workplace. Consult your healthcare provider about changing your prescription if you take a medication known to cause a dry cough. Drink plenty of liquids such as water, soup broths, or herbal teas to moisturize a dry throat. Operate an air-conditioner rather than fans or open windows to cool the inside air. Take hot showers or use a humidifier to create moisture in the air. Try aromatherapy by using essential oils such as holy basil, eucalyptus, thyme, or peppermint in an oil diffuser. Use dust mite covers to encase pillows and mattresses inside dust mite covers. Use extra pillows or a wedge to elevate your head while sleeping. Nonprescription (Over-the-Counter) Treatments These treatments include: Breathe in steam from a humidifier or leaning a safe distance above a bowl of boiling water and drape a towel over your head to inhale the moisture. Consume holy basil as a tea or added to steam as an extract to treat a dry cough. Gargle with a mixture of one-half teaspoon of salt dissolved in 8 ounces of warm water. Make thyme tea by steeping 3 to 4 teaspoons of dried thyme leaves or powder in boiling water for five to 10 minutes. Thyme contains thymol, an antispasmodic to relax throat muscles. Steep freshly grated ginger root in hot water to make ginger tea or add ginger to other herbal tea blends to take advantage of ginger's anti-inflammatory properties and compounds called gingerols that can relieve coughing. Suck on hard candy or cough drops with ingredients like peppermint, honey, or eucalyptus oil to treat the sensation of a tickle in the back of your throat. Take a natural capsaicin (chili) supplement to reduce the effects of dry coughs triggered by environmental irritants. Take cough suppressants, such as Delsym (dextromethorphan), Mucinex DM (guaifenesin and dextromethorphan), and Tessalon (benzonatate) Take 1 to 2 teaspoons of raw, unpasteurized honey alone or in warm water or herbal tea to soothe irritation. Prescription Cough Suppressants Prescription cough suppressants include the following: When to Contact a Healthcare Provider With so many potential causes, it can be difficult to know whether your dry cough is a minor inconvenience or a symptom of a serious medical condition. To ensure you're not ignoring warning signs of a potential health problem, consider the following guidelines for when to seek medical attention for a dry cough. Contact a healthcare provider for a dry cough that occurs with any of the following characteristics: Call 911 or go to an emergency room if you have a dry cough with any of the following features: Summary In most cases, a dry cough is not a cause for concern. It typically occurs as a common cold or flu symptom that wanes as the condition resolves. While home treatments can relieve symptoms, they do not cure coughs. Curing a cough requires resolving or treating the underlying cause. Knowing the source of your cough can help you manage symptoms and avoid triggers in cases of problems like allergies and reflux. When a dry cough occurs as a sign of an underlying condition, it must be identified and treated to resolve the cough. Contact your healthcare provider if you have a dry cough that persists longer than three weeks or fails to improve with home treatment.

'Slapped Cheek' Virus Spreads Across The U.S.

Yet another respiratory virus is on the rise in the United States: human parvovirus B19, which is highly contagious and spreads primarily among children via respiratory droplets.

After 14 European countries announced that cases were unusually high so far this year, the U.S. Centers for Disease Control and Prevention (CDC) issued a warning earlier this month that test positivity for parvovirus B19 is climbing here as well.

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"The increase may be even greater than the CDC has estimated since there is no routine surveillance for parvovirus B19 infections in the U.S.," says Stanley Deresinski, MD, a clinical professor of medicine in the division of infectious disease at Stanford Medicine in California. "It has been suggested that the increase may be due to an 'immunity gap' due to the relative lack of human contact during the COVID-19 pandemic, resulting in a large cohort of individuals lacking immunity since they were not infected during that time."

While the CDC has not been tracking case numbers, recent blood tests from commercial laboratories have suggested that infections are rising. The proportion of people with IgM antibodies (produced in response to parvovirus) has increased among all ages from just over 3 percent during 2022–2024 to 10 percent in June 2024.

Infection is most common among elementary school–age children, and the latest CDC numbers show a spike in children ages 5 to 9. The proportion of these children with IgM antibodies more than doubled from 15 percent during 2022–2024 to 40 percent in June 2024.

Parvovirus B19 is also called "fifth disease" because, historically, it was fifth on a list of common childhood illnesses characterized by a rash.

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Although Usually Mild, Symptoms of Parvovirus May Be Flu-Like Typically, parvovirus infection causes no symptoms at all, or symptoms that are mild and go away on their own.

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"In those who develop symptoms, there are often two phases to the illness," says Dr. Deresinski. In the first phase, he says, fever and muscle aches begin approximately seven days after exposure and last about five days. This is the period during which the infection is most transmissible.

Infected individuals may also experience headache, cough, and sore throat.

In the second phase, when the body's immune system develops antibodies to the virus, a "slapped cheek" rash may appear on the face in children, while adults may experience joint pains. Parvovirus B19 can also cause a general rash on the chest, back, buttocks, arms, or legs.

Who Is Most at Risk of Infection? Children ages 4 to 10 are most likely to get the disease, according to Nationwide Children's Hospital, and outbreaks often occur when kids are back in school.

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"One child with parvovirus infection is likely to infect a large proportion of classmates," says Deresinski.

In fact, by age 20, about half of all Americans have had the illness. Yet Deresinski notes that many people are not familiar with the disease, and may be more aware of canine parvovirus, which is highly contagious in dogs but different from the human version.

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Some People Are at High Risk From Parvovirus

While mainly transmitted through respiratory droplets, the virus can be passed during pregnancy from mother to her fetus. In its August advisory, the CDC refers to reports from clinicians who observed "more than the expected number" of cases of parvovirus B19 infections among pregnant people, including cases resulting in severe fetal anemia (dangerous drop in blood count) requiring fetal transfusions or pregnancy loss.

The virus can be spread through blood transfusions as well. In people with sickle cell anemia, who may get blood transfusions to treat their illness, parvovirus infection can worsen anemia, leading to aplastic crisis (when the bone marrow suddenly stops making red blood cells) that may require hospitalization.

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The CDC also cautions that those who are immunocompromised (due to leukemia or other cancers, organ transplant, or HIV infection, for example) can experience severe anemia.

What Is Standard Treatment for Parvovirus?

Because parvovirus B19 is usually mild and goes away on its own, treatment usually involves addressing the symptoms such as fever, itching from rash, or joint pain.

Patients may take acetaminophen to relieve headache and fever and nonsteroidal anti-inflammatory drugs like ibuprofen for joint pain and swelling.

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Also, drinking plenty of fluids and getting rest can ease symptoms.

Protecting Against Parvovirus B19

There is no vaccine or treatment that can prevent parvovirus B19 infection, but the CDC offers these recommendations for limiting the spread of any respiratory viruses:

Cover your mouth and nose with a tissue when you cough or sneeze. If you don't have a tissue, cough or sneeze into your elbow, not your hands.

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Learn and use proper handwashing technique. Frequent handwashing is especially important in childcare settings and healthcare facilities.

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Clean frequently touched surfaces, such as countertops, handrails, and doorknobs, regularly.

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Those who do have parvovirus symptoms are urged to stay home and keep away from others. Once the telltale rash appears, however, the infected person is no longer contagious.

NIH Reports 'Low-Intensity' Blood Stem Cell Transplants For Sickle Cell Appear Safe For Lung Health

NIH study finds lung function remained stable or improved in adults after transplant. 

August 28, 2024 – So-called low-intensity blood stem cell transplants, which use milder conditioning agents than standard stem cell transplants, do not appear to damage the lungs and may help improve lung function in some patients with sickle cell disease (SCD), according to a three-year study of adults who underwent the procedure at the National Institutes of Health (NIH).

Damage to lung tissue and worsened lung function is a major complication and leading cause of death in people with sickle cell disease, a debilitating blood disorder. The new study, published today in the Annals of the American Thoracic Society, helps answer whether less intensive types of transplants, which tend to be better tolerated by many adults, by themselves either cause or promote further harm to the lungs.

"By using a low-intensity blood stem cell transplant for sickle cell disease, we may be able to stop the cycle of lung injury and prevent continued damage," said study lead Parker Ruhl, M.D., an associate research physician and pulmonologist at NIH. "Without the ongoing injury, it's possible that healing of lung tissue might occur, and this finding should help reassure adults living with sickle cell disease who are considering whether to have a low-intensity stem cell transplant procedure that their lung health will not be compromised by the transplant."

Until recently, bone marrow and blood stem cell transplants were the only cure for sickle cell disease, but relatively few adults have undergone the treatments due to health risks associated with high doses of chemotherapy required to prepare for transplants. In addition, the process requires a genetically well-matched donor, usually a sibling who does not have SCD. These procedures involve giving patients blood stem cells obtained from a donor to grow normal red blood cells to replace the "sickled" cells. The sickled cells block blood flow throughout the body, causing a host of problems, including episodes of acute pain, infections, stroke, and acute chest syndrome, in which lungs are deprived of oxygen.

Researchers say at least one-third of the sickle cell stem cell transplants performed are low-intensity. While they are slightly less effective than the standard transplants, adults who often have more pre-existing organ damage than children tend to do better with them and also experience a lower risk for complications such as graft-versus-host disease. The current study examined if these transplants offered other benefits for adults with already vulnerable lungs.

For the research, Ruhl and her team studied 97 patients with sickle cell disease who underwent a low-intensity, or non-myeloablative, blood stem cell transplant between 2004-2019 at the NIH's Clinical Center in Bethesda, Maryland. Participants were then followed for up to three years.

The researchers conducted a variety of pulmonary function tests, including forced expiratory volume in one second (FEV-1), which measures the amount of air exhaled in the first second after forced exhalation. Another was a lung diffusion test, or diffusing capacity of the lungs for carbon monoxide (DLCO), which measures how much oxygen moves from the lungs to the blood when exhaling. They also conducted a six-minute walk distance test, which measured how far a patient could walk and their oxygen levels during a set time.

After three years, overall lung function among the patients remained stable. FEV-1 levels remained relatively unchanged post-transplant compared to pre-transplant, indicating that lung function did not worsen over time. Notably, DLCO levels and six-minute walk distance improved significantly following transplant.

Ruhl said that larger studies with longer follow-up periods and the inclusion of transplant data from other clinical centers, including those from patients who received a standard transplant, are still needed to put the current findings in context. In the meantime, she and her team will continue to follow the NIH patients and report on longer term outcomes at the five- and 10-year mark.

In December 2023, the U.S. Food and Drug Administration approved two genetic therapies that use patients' own blood stem cells to treat SCD. Researchers hope that the techniques used in this study will also be used to evaluate lung function for other new genetic therapies.

This study was supported in part by the Divisions of Intramural Research at NIH's National Institute of Allergy and Infectious Diseases (project AI001150) and NIH's National Heart, Lung, and Blood Institute (projects HL006211-08 and HL006007-06 and grant 1U01HL156620-01).

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit www.Nhlbi.Nih.Gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.Nih.Gov.

NIH…Turning Discovery Into Health®

Study: Ruhl AP, Shalhoub R, Jeffries N, et al. Pulmonary Function After Non-Myeloablative Hematopoietic Cell Transplant for Sickle Cell Disease. [2024] Annals of the American Thoracic Society. DOI: 10.1513/AnnalsATS.202309-771OC

Source: NIH

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