How To Investigate The Causes Of Chronic Cough In Adult Africans

 

By Foluke Akinwalere. Freelance Health Writer and DLHA volunteer. With medical review and editorial support by the DLHA Team

 

African man with cough seeing a doctor

 

Highlights

 

• The burden of chronic cough reported from African countries is limited compared to what is reported from high income countries of Europe, Asia and North America.

 

• The most common causes of chronic cough in adult African are respiratory infections, environmental factors, or underlying medical conditions.

 

• The unique diagnostic challenges faced when investigating chronic cough in adult Africans include limited healthcare resources, overlap of symptoms and cultural beliefs and practices.

 

• The outcome of the investigation of chronic cough should inform its management. This should be comprehensive and take into account the specific underlying causes, individual patient factors, and the region's healthcare resources.

 

Introduction

 

Chronic cough is a common symptom, often indicating an underlying health issue. It can have a multitude of causes, and a systematic investigation by a healthcare professional is crucial to identify and address the underlying condition. 

 

In the context of adult Africans, investigating the causes of chronic cough can be a unique challenge due to the diverse factors at play. 

 

This article discusses the steps that are taken to investigate the cause(s) of chronic cough in African adults and sheds light on key considerations and realistic approaches.

 

 

What is Chronic Cough?

 

A chronic cough is a persistent cough that lasts for an extended period of eight weeks or longer. Chronic cough is not a standalone condition but a symptom of an underlying medical condition; a signal that something else is amiss.

 

Some of its characteristics features include:
 

• Frequency: It occurs on a regular or daily basis.

• Duration: Lasts for an extended period, typically more than eight weeks.

• Productive or Non-productive: Chronic cough may be dry or produce mucus or phlegm.

• Triggers: It may be triggered or worsened by various factors, such as cold air, irritants, or specific activities.

• Nocturnal: Coughing may be more frequent at night.

 

Associated symptoms include: 

• Wheezing

• Chest discomfort

• Shortness of breath

• Difficulty swallowing

• Coughing up blood or noticing blood in phlegm

• Developing a fever

• Having persistent night sweat

• Weight loss

 

 

How common is chronic cough in Africa?

 

A study showed that chronic cough was found to be significantly more common in Europe and America compared with Africa and Asia.¹ More population-based research is needed from African countries to confirm this claim. 

 

The common causes of chronic cough in the Western world are upper airway cough syndrome (UAWCS), asthma, and GERD.

 

But in Sub-Saharan Africa, chronic cough exhibits different patterns compared to other regions because geographical variations in risk factors like tobacco smoking, HIV/AIDS, malnutrition, pollution, and poverty make it challenging to apply global trends to this region.²

 

Therefore, it is crucial to understand the causes and clinical characteristics of chronic cough in adult Africans for more effective and economical diagnosis and treatment.

 

 

Common Causes of Chronic Cough in Adult Africans

 

Chronic cough in adult Africans can have various causes, some of which are unique to the region, while others are common globally.

 

1. Infectious Diseases: Infectious diseases such as tuberculosis, pneumonia, chronic bronchitis, postnasal drip, respiratory tract infections, and HIV/AIDS are significant contributors to chronic cough in adult Africans. Tuberculosis, in particular, is a major concern and often presents with a persistent cough as one of its primary symptoms.

 

2. Environmental Factors:  Exposure to indoor air pollutants, including smoke from cooking with solid fuels, can contribute to chronic cough. Poor ventilation and living conditions may worsen respiratory symptoms.

 

3. Gastroesophageal Reflux Disease (GERD):  GERD is increasingly recognized as a cause of chronic cough. Acid reflux can irritate the airways and lead to persistent coughing.

 

4. Occupational Hazards:  Certain occupations, such as mining and agriculture, may expose individuals to dust and chemicals, leading to chronic respiratory conditions and cough.

 

5. Tobacco and Secondhand Smoke:   Smoking and exposure to secondhand smoke are known risk factors for chronic cough. These behaviours are prevalent in some African communities.

 

6. Allergic Rhinitis:  Allergies, including allergic rhinitis, can trigger chronic cough in susceptible individuals. Allergens such as pollen and dust mites may be more common in certain regions.

 

7. Chronic Obstructive Pulmonary Disease (COPD):  The primary cause of COPD is exposure to tobacco smoke (either active smoking or secondhand smoke).³   It is a progressive lung disease that can manifest with chronic cough and breathlessness. 

 

8. Asthma:  Asthma can manifest with chronic cough as a primary symptom, and it often goes undiagnosed.

 

Other causes are:

• Environmental Allergens:    such as dust, pollen, and mold.

• Post-Infectious Cough:   common cold after a viral respiratory infection

• Psychogenic Cough:   Stress, anxiety, and psychological factors

• Undiagnosed Conditions: rare lung diseases or structural abnormalities.

• Medications:  particularly angiotensin-converting enzyme (ACE) inhibitors.

 

 

Challenges of Investigating Chronic Cough in Africa

 

The challenges of investigating chronic cough in Africa can be complex and multifaceted. Here are some key challenges:

 

1. Limited Access to Healthcare: Healthcare systems in Africa suffer from neglect and underfunding, leading to severe challenges across the six WHO pillars of healthcare delivery.⁴ In many parts of Africa, access to healthcare services is limited, particularly in rural areas. This can result in delayed diagnosis and treatment for individuals with chronic cough.

 

2. Overlap of Symptoms with Infectious Diseases:  Chronic cough shares symptoms with infectious diseases like tuberculosis (TB) and other respiratory infections, which are prevalent in many African regions. This overlap can lead to misdiagnosis or delayed diagnosis of the underlying cause.

 

3. Cultural Beliefs and Practices: Cultural beliefs and practices can influence healthcare-seeking behaviour. Some individuals may prefer traditional remedies or delay seeking medical care, which can hinder early diagnosis and treatment.

 

4. Limited Availability of Diagnostic Tools:  Access to diagnostic tools, such as advanced imaging and specialised tests, can be limited in some areas.

 

Additional challenges include:
 

• Underdiagnosis of Non-Communicable Diseases:  Non infectious causes of  COPD and asthma may be underdiagnosed due to a focus on infectious diseases.

 

• Lack of Trained Healthcare Professionals:  There is  a shortage of healthcare professionals, particularly in rural and underserved areas in most African countries adding to access issues.

 

• Language and Cultural Barriers:  Effective communication with patients is essential for an accurate diagnosis to understand and gather pertinent medical history.

 

• Limited Availability of Specialized Care:  Scarcity of specialised healthcare services in certain regions.

 

• Coexisting Conditions:  Patients in Africa may have multiple coexisting health conditions, making it difficult to pinpoint the primary cause of chronic cough.

 

• Stigma and Discrimination of certain conditions:  This is particularly applicable to TB or HIV. These often cause access issues for patients.

 

 

Approaches to investigating chronic cough in adult Africans

 

In investigating chronic cough in adult Africans, your doctor or other healthcare providers use a range of tools and approaches to pinpoint the cause(s), thereby aiding diagnosis and effective treatment.

 

Medical History and Physical Examination

Your doctor will take a complete patient history from you. Questions will be asked about:

• the duration of your cough?
• what you do to cause it to flare up?
• what you do to reduce the severity of the cough?
• whether you cough up mucus or not?
• if you cough up mucus, what colour?
• whether the mucus is blood stained or not?
• whether or not you have been exposed to any environmental pollutants?
• whether you have fever or not?
• your occupation?
• your past medical history?
• your family and smoking history?
• what medicine, herbs or home remedies you take?
• whether or not you have been admitted into hospital before?
• whether you have lost weight of recent or not?
• Etc.

These questions and more will provide your doctor with valuable insights about your cough.

 

Next your doctor will examine your body organs with special attention to your chest. This helps to identify some general or cause-specific signs in your chest such as, wheezing or other abnormal breath sounds. These signs may guide your doctor towards a clinical diagnosis of your condition. 

 

Laboratory tests and other evaluations

For additional information that will help your doctor in confirming your diagnosis, some specialised tests or evaluations may be requested as considered necessary. These include: 

 

Chest X-ray

 A chest X-ray can provide initial information about lung health and identify structural abnormalities or signs of infection.

 

Pulmonary Function Tests (PFTs)

 Spirometry and other PFTs can assess lung function and help diagnose conditions such as asthma and chronic obstructive pulmonary disease (COPD).

 

Sputum Analysis

Collecting and analysing a mixture of saliva and mucus samples can help identify the presence of infectious agents, such as Mycobacterium tuberculosis, which causes tuberculosis.

 

CT Scans

Computed tomography (CT) scans may be necessary, where available and affordable to visualise lung tissue in greater detail and detect structural abnormalities or diseases like lung cancer.

 

Bronchoscopy

In cases where the cause of chronic cough remains unclear, a bronchoscopy can be performed to directly visualise the airways, collect samples for analysis, and identify abnormalities or tumours.

 

Allergy Testing

Skin or blood tests for allergen-specific IgE antibodies can be conducted to diagnose allergic causes of chronic cough, such as allergic rhinitis.

 

Gastroesophageal Reflux Evaluation

pH monitoring and endoscopy may be used to assess whether gastroesophageal reflux disease (GERD) is contributing to the cough.

 

Occupational and Environmental Evaluations

Assessment of occupational and environmental exposures is vital in identifying work-related lung diseases or exposure to pollutants that could be causing a chronic cough.

 

Tuberculosis Culture and Drug Sensitivity Testing

 When tuberculosis is suspected, culture and drug sensitivity testing can help determine the specific strain of bacteria and its vulnerability to antibiotics.

 

Psychosocial Evaluation

In cases where psychological factors are suspected to contribute to chronic cough, a psychosocial evaluation by a mental health professional can be beneficial.

 

 

Conclusion

 

Chronic cough in adult Africans is a complex issue influenced by various factors. An accurate diagnosis is crucial for effective management and improved patient outcomes. There is a need for healthcare professionals to be sensitive to the unique challenges and circumstances facing African patients with chronic cough, so as to ensure that they receive the best possible care for their ailment.


 

References:

 

1. Song WJ, Chang YS, Faruqi S, Kim JY, Kang MG, Kim S, Jo EJ, Kim MH, Plevkova J, Park HW, Cho SH, and Morice AH. The global epidemiology of chronic cough in adults: a systematic review and meta-analysis. European Respiratory Journal 2015 45: 1479-1481; DOI: 10.1183/09031936.00218714

 

2. Desalu OO, Ojuawo OB, Aladesanmi AO, Adeoti AO, Opeyemi CM, Oloyede T, Afolayan OJ, Fawibe AE  Etiology and Clinical Patterns of Chronic Cough in the Chest Clinic of a Tertiary Hospital in Nigeria. Int J Gen Med, 15:5285-5296, 27 May 2022

 

3. WHO Regional Office for Africa Chronic Respiratory Diseases [Internet, n.d.]. Accessed October 16, 2023

 

4. Obinna O, Oleribe OO, Momoh J, Uzochukwu BSC, Mbofana F, Adebiyi A, Barbera T, Williams R, and Taylor-Robinson SD.  Identifying Key Challenges Facing Healthcare Systems In Africa and Potential Solutions Int J Gen Med 2019;12;395-403.

 

 

Related: What Africans need to know about cough

 

 

 

Published: October 20, 2023

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