Cough lasting more than three weeks is “chronic” and in more than 90 percent of cases result from five common causes:

1.

Smoking (or exposure to second hand smoke)

2. Postnasal drip associated with allergy or sinus infections

3. Asthma

4. Gastroesophageal reflux

5. Medications for high blood pressure and migraine headaches

In up to 25 percent of patients, there may be more than one cause going on at the same time with the most frequent association being Allergy and sinusitis, with Gastro esophageal reflux being overall the most common.

BACKGROUND: Cough is a natural body defense mechanism for clearing secretions and foreign bodies from the lungs and throat. Coughing may be the result of an involuntary reflex response to stimulation of cough receptors in the airways. A variety of local sites are connected to the cough center in the brain, including the nose, ear canal, and the throat. Stimulation of receptors in these sites can result in cough ( for example an odd cause of cough is impacted ear wax).

HOW COMMON: Chronic cough occurs in 14 to 23 percent of adults. In relation to smoking 17 cough is directly related to the number of cigarettes smoked per day. Approximately 25 percent of those who smoke one half pack per day report a chronic cough, while over 50 percent who smoke more than two packs per day have a chronic cough.

I DON’T SMOKE – WHAT ELSE IS THERE ?

Postnasal drip from allergy, asthma ( and all asthma does not wheeze) , Gastroesophageal reflux ( and heartburn is not universal with this), post viral infection or whooping cough ( pertussis) , and medications used to treat high blood pressure and migraines (ACE inhibitors, beta blockers).

Less common causes include congestive heart failure, cancer, emphysema, TB, masses in the chest

Irritation of cough receptors in ear (e.g., impacted cerumen, hair, foreign body), infections, foreign body, or occupational exposures to toxic chemicals. Some physicians feel that some patients have an emotional disorder leading to cough.

In 82 percent of patients, cough has a single cause, and in 18 percent of cases, multiple causes are found. Tailoring treatment to specific causes of chronic cough results in sustained resolution of the cough in 97 percent of patients.

HOW WE WORK THIS UP: We will want a sinus x-ray and perhaps a chest x-ray to rule out infections and masses. We will question you closely about acid reflux of Gastroespohageal reflux. We likely will do a minimal number of allergy skin tests to predict the role of allergy in the process. We will also do a lung function test.

MANAGEMENT OF CHRONIC COUGH

Discontinue Medications Causing Cough Angiotensin-converting enzyme (ACE) inhibitors are useful in the treatment of hypertension, but may cause cough in 5 to 20 percent of patients. Beta blockers are used in high blood pressure, chest pain, hyperthyroidism, migraine and glaucoma. The cough resolves within a month after the drugs are withdrawn.

Treat underlying process including Gastro Esophageal Reflux Disease.